Practice of Sleep Medicine: Sleep Disorders in Children and Adults

Contents
About the Authors
1: Physiological Basics of Healthy and  Disturbed Sleep
1.1 History of Sleep Medicine
1.2 Classification of Sleep Disorders
1.3 Phenomenology of Sleep
1.4 Physiological Alterations During Sleep
1.4.1 Cardiovascular System During Sleep
1.4.2 Thermoregulation
1.4.3 Hormone System and Sleep
1.5 Circadian Rhythm
1.6 Sleep Regulation
1.7 Functions of Sleep
1.8 Dreaming
1.8.1 Definitions
1.8.2 Dream Recall
1.8.3 General Characteristics of Dreams
1.8.4 Correlation Between Wakefulness and Dream
1.8.5 Function of Dreams
1.9 Questions
Further Reading
2: Diagnostic Methods
2.1 History Taking
2.1.1 Sleep-Related Personal Anamnesis
2.1.2 Sleep-Related History Compiled by Third Parties
2.1.3 History Taking Regarding Sleepiness, Fatigue, and Daytime Performance
2.1.4 Further History Taking for Differential Diagnostic: Assessment of Possible Origins of Sleep Disorders
2.2 Laboratory Parameters for Sleep Disorders
2.3 Sleep Questionnaire
2.3.1 Insomnia Questionnaire
2.3.2 Questionnaires for the Assessment of Sleep-Related Breathing Disorders
2.3.3 Questionnaire Regarding Restless Legs Syndrome
2.4 Physical Examination
2.5 Actigraphy
2.6 Outpatient Step-by-Step Diagnostics for Sleep-Related Breathing Disorders and Polygraphy Systems
2.7 Polysomnography (PSG)
2.7.1 Standard Parameters of Polysomnography (PSG)
2.7.1.1 Measurement of Blood Pressure During Sleep
2.7.2 Parameters to Be Reported for Polysomnography (PSG)
2.7.2.1 Sleep Scoring Data
2.7.2.2 Phenomenology and Classification of Arousals
2.7.3 Polysomnography (PSG) in Patients with Insomnia
2.7.4 Polysomnography (PSG) in Patients with Periodic Limb Movements in Sleep and Patients with Restless Leg Syndrome
2.7.5 Polysomnography (PSG) in Cases of Bruxism
2.7.6 Polysomnography (PSG) in Cases of REM Behavior Disorders
2.7.7 Polysomnography (PSG) in Cases of Rhythmic Movement Disorders in Sleep
2.7.8 Polysomnography (PSG) in Cases of Sleep-Related Breathing Disorders
2.8 Examination of Sleepiness- and Fatigue-Related Daytime Impairments
2.8.1 Diagnostics of Daytime Sleepiness
2.8.1.1 Diagnostic Procedures of Central Nervous System Alertness
Multiple Sleep Latency Test (MSLT)
Maintenance of Wakefulness Test (MWT)
Pupillographic Sleepiness Test
2.8.1.2 Diagnostic Procedures to Assess Vigilance
Vigilance Test According to Quatember and Maly
Sub-test of Vigilance of the Test Battery for Attentional Performance
2.8.1.3 Diagnostic Procedures to Assess Selective Attention
Achievement Motivation Test Series, Version 3.00 of the Vienna Test System
Go/NoGo of the Test Battery for Attentional Performance
2.8.1.4 Diagnostic Procedures to Assess Divided Attention
Test of Divided Attention of the Test Battery for Attentional Performance
Vienna Determination Unit
2.8.1.5 Subjective Diagnostic Questionnaires for Assessment of Sleepiness-Related Impairments
Stanford Sleepiness Scale (SSS)
Epworth Sleepiness Scale (ESS)
2.9 Questions
Further Reading
3: Insomnia
3.1 Classification of Insomnia Disorders
3.2 Chronic Insomnia Disorder
3.2.1 Definitions
3.2.1.1 Subtype of Psychophysiological Insomnia
3.2.1.2 Subtype of Paradoxical Insomnia
3.2.1.3 Subtype of Idiopathic Insomnia
3.2.1.4 Subtype of Insomnia Caused by a Mental Disorder
3.2.1.5 Subtype of Insomnia Resulting from Inadequate Sleep Hygiene
3.2.1.6 Subtype of Insomnia due to Psychiatric Disease, Medical Condition, or Drug and Substance Consumption
3.2.2 Etiology and Pathogenesis
3.2.2.1 Developmental Model of Chronic Insomnia
3.2.2.2 Risk Factors for the Development of Chronic Insomnia
3.2.3 Polysomnographic Findings
3.3 Short-Term Insomnia Disorder
3.4 Other Insomnia Disorders
3.5 Isolated Symptoms and Normal Variants
3.5.1 Excessive Time in Bed
3.5.2 Short Sleeper
3.6 Diagnostics of Insomnia
3.7 Therapy of Insomnia
3.7.1 Psychoeducation
3.7.1.1 Information About Sleep
3.7.1.2 Inadequate Behaviors Related to Insomnia
3.7.1.3 Good Sleep Hygiene
3.7.2 Cognitive-behavioral Therapy of Insomnia
3.7.2.1 Bedtime Rituals
3.7.2.2 Cognitive Techniques
Cognitive Restructuring
Rumination Chair
Stopping Thoughts
3.7.2.3 Sleep Restriction
3.7.2.4 Stimulus Control
3.7.2.5 Group Therapy and Insomnia Workshops
3.7.3 Pharmacotherapy of Insomnia
3.7.3.1 Benzodiazepine Receptor Agonists (BZRAs)
3.7.3.2 Benzodiazepines (BZDs)
3.7.3.3 Treatment Strategies Regarding BZDs and BZRAs
Standard Interval Therapy
Controlled Interval Therapy
Quota-Interval Therapy
Low-Dose Long-Term Therapy
Low-Dose Combination Therapy
3.7.3.4 Melatonin and Melatonin Receptor Agonists
3.7.3.5 Hypocretin/Orexin Antagonists
3.7.3.6 Second-line Hypnotics
Antidepressants
Neuroleptics
Antihistamines
Alcohol Derivatives
Phytotherapeutics
3.8 Questions
Further Reading
4: Sleep-Related Breathing Disorders
4.1 Breathing Disorders without Obstruction
4.1.1 Definitions
4.1.1.1 Central Sleep Apnea Syndromes
4.1.1.2 Sleep-Related Hypoventilation and Hypoxemia Syndrome
4.1.2 Etiology and Pathophysiology
4.1.2.1 Regulation of Breathing
4.1.2.2 Central Sleep Apnea Syndrome
4.1.2.3 Hypoventilation or Hypoxemia Syndromes
4.1.3 Epidemiology
4.1.4 Clinical Presentation
4.1.4.1 Central Sleep Apnea Syndromes
4.1.4.2 Hypoventilation or Hypoxemia Syndromes
4.2 Obstructive Sleep-Related Breathing Disorders
4.2.1 Definitions
4.2.2 Etiology and Pathophysiology
4.2.2.1 Anatomical Models
4.2.2.2 Functional Models
4.2.3 Epidemiology
4.2.4 Clinical Presentation
4.3 Snoring
4.3.1 Definitions
4.3.2 Etiology and Pathophysiology
4.3.3 Epidemiology
4.3.4 Clinical Presentation
4.4 Diagnostic Procedures
4.4.1 Examination Procedures and Sleep-Related Medical Diagnostics
4.4.1.1 Diagnostics in Cases of Central Sleep Apnea Syndromes
4.4.1.2 Diagnostics in Cases of Sleep-Related Hypoventilation or Hypoxemia Syndrome
4.4.1.3 Diagnostics in Cases of Obstructive Sleep Apnea
4.4.2 Differential Diagnoses
4.5 Therapeutic Principles
4.5.1 Therapeutic Principles in Cases of Snoring
4.5.2 Therapeutic Principles in Cases of Sleep Apnea
4.6 Ventilation Therapy
4.6.1 Different Types of Noninvasive Ventilation Therapy
4.6.1.1 Positive Pressure Ventilation in Cases of Spontaneously Breathing Patients
CPAP
APAP
Bilevel-S
C-Flex, EPR, SoftPAP, and A-Flex
4.6.1.2 Positive Pressure Ventilation in Cases of Disturbed Respiratory Drive
Bilevel-T
Bilevel-S/T
4.6.1.3 Positive Pressure Ventilation in Cases of Cheyne-Stokes Respiration
4.6.1.4 Practical Aspects
4.6.1.5 Accessories and Masks
4.6.1.6 Undesired Side Effects of Positive Pressure Ventilation
4.6.2 Ventilation Therapy in Cases of Central Sleep Apnea Syndromes
4.6.2.1 Primary Central Sleep Apnea and Central Sleep Apnea Due to a Medical Disorder
4.6.2.2 Cheyne-Stokes Respiration
4.6.3 Ventilation Therapy in Cases of Sleep-Related Hypoventilation and Hypoxemia
4.6.3.1 Sleep-Related Hypoventilation and Hypoxemia Syndromes that Are Not Caused by Bronchial Obstruction
4.6.3.2 Sleep-Related Hypoventilation and Hypoxemia Caused by Bronchial Obstruction
4.6.4 Ventilation Therapy in Cases of Obstructive Sleep Apnea
4.6.4.1 Indication
4.6.4.2 Practical Aspects
4.6.4.3 Therapeutic Effects
4.7 Therapeutic Alternatives
4.7.1 Conservative Procedures
4.7.1.1 Weight Loss
4.7.1.2 Behavioral Changes
4.7.1.3 Medication
4.7.1.4 Nocturnal Oxygen Therapy
4.7.2 Device-Based Procedures
4.7.2.1 Increase of Muscle Tone
4.7.2.2 Avoiding the Supine Position
4.7.2.3 Mandibular Advancement Devices
Practical Aspects
Patient Selection
Acceptance and Side Effects
Therapeutic Effects
4.8 Surgical Therapy
4.8.1 Indications and Contraindications
4.8.2 Selection of the Surgical Therapy
4.8.3 Surgery of the Nose
4.8.4 Surgery of the Soft Palate
4.8.4.1 Surgical Treatment of the Soft Palate in Cases of Snoring
Radiofrequency Surgery
Soft Palate Implants
4.8.4.2 Surgical Treatment of the Soft Palate in Obstructive Sleep Apnea
4.8.5 Surgery of the Retrolingual Space
4.8.6 Hypoglossal Nerve Stimulation
4.8.7 Maxillofacial Surgery
4.9 Questions
Further Reading
5: Hypersomnia Disorders
5.1 Narcolepsy
5.1.1 Definitions
5.1.2 Etiology and Pathophysiology
5.1.3 Epidemiology
5.1.4 Clinical Presentation
5.1.5 Diagnostic Procedures
5.1.6 Sleep Diagnostics
5.1.7 Differential Diagnostics
5.1.8 Therapy
5.1.8.1 Non-drug Therapy
5.1.8.2 Drug Therapy
5.1.8.3 Treatment of Comorbid Sleep Disorders
5.2 Idiopathic Hypersomnia
5.2.1 Definitions
5.2.2 Etiology and Pathophysiology
5.2.3 Epidemiology
5.2.4 Clinical Presentation
5.2.5 Diagnostics
5.2.6 Sleep Diagnostics
5.2.7 Differential Diagnostics
5.2.8 Therapy
5.3 Other Hypersomnias
5.3.1 Insufficient Sleep Syndrome
5.3.2 Recurrent Hypersomnias
5.4 Questions
Further Reading
6: Circadian Rhythm Sleep–Wake Disorders
6.1 Basics and Diagnosis
6.2 Sleep–Wake Phase Disorders
6.2.1 Delayed Sleep–Wake Phase Disorder
6.2.2 Advanced Sleep–Wake Phase Disorder
6.3 Irregular Sleep–Wake Rhythm Disorder
6.4 Non-24-Hour Sleep–Wake Rhythm Disorder
6.5 Sleep Disorders in Cases of Jetlag or Shift Work
6.5.1 Sleep Disorder in Cases of Jetlag
6.5.2 Sleep Disorder in Cases of Shift Work
6.6 Circadian Sleep–Wake Disorders Not Otherwise Specified
6.7 Therapy
6.8 Questions
Further Reading
7: Parasomnias
7.1 Pavor Nocturnus
7.1.1 Definitions
7.1.2 Etiology and Pathophysiology
7.1.3 Epidemiology
7.1.4 Clinical Presentation
7.1.5 Diagnostics
7.1.6 Sleep Diagnostics
7.1.7 Differential Diagnostics
7.1.8 Therapy
7.2 Sleepwalking
7.2.1 Definitions
7.2.2 Etiology and Pathophysiology
7.2.3 Epidemiology
7.2.4 Clinical Presentation
7.2.5 Diagnostics
7.2.6 Sleep Diagnostics
7.2.7 Differential Diagnostics
7.2.8 Therapy
7.3 Nightmares
7.3.1 Definitions
7.3.2 Etiology and Pathophysiology
7.3.3 Epidemiology
7.3.4 Clinical Presentation
7.3.5 Diagnostics
7.3.6 Sleep Diagnostics
7.3.7 Differential Diagnostics
7.3.8 Therapy
7.4 REM Sleep Behavior Disorder
7.4.1 Definitions
7.4.2 Etiology and Pathophysiology
7.4.3 Epidemiology
7.4.4 Clinical Presentation
7.4.5 Diagnostics
7.4.6 Sleep-Related Diagnostics
7.4.7 Differential Diagnostics
7.4.8 Therapy
7.5 Other Parasomnias
7.5.1 Sleep Drunkenness
7.5.2 Isolated Sleep Paralysis
7.5.3 Enuresis
7.5.4 Sleep-Related Eating Disorders
7.6 Questions
Further Reading
8: Sleep-Related Movement Disorders
8.1 Restless Legs Syndrome
8.1.1 Definition
8.1.2 Etiology and Pathophysiology
8.1.3 Epidemiology
8.1.4 Clinical Presentation
8.1.5 Diagnostic Procedures
8.1.6 Sleep Diagnostics
8.1.7 Differential Diagnoses
8.1.8 Therapy
8.1.8.1 General Therapeutic Principles
8.1.8.2 l-DOPA
8.1.8.3 Dopamine Agonists
8.1.8.4 Opioids
8.1.8.5 Other Substances and Treatment Modalities of RLS
8.2 Periodic Leg Movement Disorders During Sleep
8.2.1 Definition
8.2.2 Etiology and Pathophysiology
8.2.3 Epidemiology
8.2.4 Clinical Presentation
8.2.5 Examination Procedures
8.2.6 Sleep Diagnostics
8.2.7 Differential Diagnoses
8.2.8 Therapy
8.3 Sleep-Related Leg Cramps
8.3.1 Definition
8.3.2 Etiology
8.3.3 Epidemiology
8.3.4 Clinical Presentation
8.3.5 Diagnostics
8.3.6 Therapy
8.4 Bruxism
8.4.1 Definition
8.4.2 Etiology
8.4.3 Epidemiology
8.4.4 Clinical Presentation
8.4.5 Diagnostics
8.4.6 Therapy
8.5 Sleep-Related Rhythmic Movement Disorder
8.5.1 Definition
8.5.2 Epidemiology
8.5.3 Clinical Presentation
8.5.4 Diagnostics
8.5.5 Therapy
8.6 Questions
Further Reading
9: Isolated Symptoms, Normal Variants, and Other Sleep Disorders
9.1 Isolated Symptoms, Normal Variants, and Unresolved Issues
9.1.1 Long and Short Sleepers
9.1.2 Sleep-Talking and Sleep-Related Groaning: (Somniloquy and Catathrenia)
9.1.3 Sleep-Related Movement Anomalies
9.2 Other Sleep Disorders
Further Reading
10: Secondary Sleep Disorders
10.1 Sleep Disorders Caused by Organic Diseases
10.1.1 Insomnia as a Symptom of Organic Diseases
10.1.1.1 Endocrine Diseases
10.1.1.2 Chronic Pain
10.1.1.3 Neurological Diseases
10.1.1.4 Respiratory Diseases
10.1.2 Hypersomnia as a Symptom of Organic Diseases
10.1.2.1 Endocrine Diseases
10.1.2.2 Cardiovascular Diseases
10.1.2.3 Respiratory Diseases
10.1.2.4 Renal Dysfunction
10.2 Sleep Disorders and Mental Disorders
10.2.1 Insomnia Complaints as Symptom of Mental Disorders
10.2.1.1 Affective Disorders
10.2.1.2 Anxiety Disorders
10.2.1.3 Posttraumatic Stress Disorder
10.2.2 Hypersomnia Complaints as Symptom of Mental Disorders
10.2.2.1 Atypical or Seasonal Affective Disorder
10.2.2.2 Schizophrenia
10.3 Questions
11: Sleep Disorders in Children
11.1 Sleep Disorders in Children and Adolescents
11.1.1 Sleep and Sleep Development of Childhood and Adolescence
11.1.1.1 Development of Sleep
11.1.1.2 Sleep Duration
11.1.1.3 Parents’ Behavior and Impact of Children’s Sleep Disorders on Parents
11.1.2 Sleep Disorders of Childhood and Adolescence
11.1.2.1 Insomnia in Childhood and Adolescence
Acute Insomnia/Short-Term Insomnia
Chronic Insomnia
11.1.2.2 Sleep-Related Movement Disorders in Childhood
11.1.2.3 Sleep–Wake Rhythm Disorders
Delayed Sleep Phase Syndrome
Advanced Sleep Phase Syndrome
Irregular Sleep–Wake Rhythm
11.1.2.4 Hypersomnia
11.1.2.5 Sleep Disorders and Psychological Disorders
Anxiety Disorders and Sleep Problems
Depression and Sleep Problems
Posttraumatic Stress Disorders and Sleep Problems
Attention-Deficit/Hyperactivity Disorder and Sleep Problems
Emotion Regulation and Sleep
Aggression and Sleep
Autism and Sleep
11.1.2.6 Sleep Disorders and Other Comorbid Disorders
Epilepsy and Sleep
Headaches and Sleep
Atopic Dermatitis and Sleep
Functional Abdominal Pain and Sleep
Chronic Inflammatory Bowel Disease and Sleep
11.1.3 Etiology and Pathophysiology
11.1.4 Epidemiology
11.1.4.1 Chronification
11.1.5 Clinical Presentation
11.1.6 Examination Procedures
11.1.6.1 History Taking
11.1.6.2 Sleep Protocol
11.1.6.3 Questionnaires on Parents’ Information
Children’s Sleep Habits Questionnaire (CSHQ)
Sleep Disturbance Scale for Children (SDSC)
11.1.6.4 Questionnaires for Self-Reporting
Children’s Sleep Comic (CSC)
Sleep Self-Report (SSR)
Screening of Pediatric Sleep Disorders (PSS-J)
Epworth Sleepiness Scale for Children (ESS-C)
Nightmares Effects Questionnaire (NEQ)
11.1.6.5 Interviews
Diagnostic Interview of Pediatric Sleep Disorders (DIKS)
Sleep Inventory for Children and Adolescents (SI-KJ)
Diagnostic Interview of Adolescent Sleep Disorders (DIAS)
11.1.6.6 Test Psychological Examinations
11.1.6.7 Physical Examination
11.1.7 Sleep Medical Diagnostics
11.1.7.1 Actigraphy
11.1.7.2 Polysomnography
11.1.8 Differential Diagnostics
11.1.9 Insomnia Therapy in Childhood
11.1.9.1 Sleep Education and Sleep Hygiene
11.1.9.2 Stimulus Control and Structured Bed Routine
11.1.9.3 Extinction
11.1.9.4 Positive Reinforcement
11.1.9.5 Relaxation Techniques
11.1.9.6 Cognitive Restructuring
11.1.9.7 Imaginative Techniques/Modern Hypnotherapy
11.1.9.8 Bedtime Restriction
11.1.9.9 Age-Oriented Interventions
11.1.9.10 Treatment of Infants and Children of Preschool Age
Mini-KiSS Training: Treating Early Childhood Sleep Disorders
11.1.9.11 Treatment of Schoolchildren
KiSS Training: Treating Sleep Disorders in Schoolchildren
11.1.9.12 Treatment of Adolescents
JuSt Training: Sleep Training of Adolescents
11.1.10 Therapy of Other Pediatric Sleep Disorders
11.1.10.1 Treatment of Delayed Sleep Phase Syndrome
11.1.10.2 Treatment of the Advanced Sleep Phase Syndrome
11.1.11 Drug Therapy
11.1.12 Rehabilitation Measures
11.2 Sleep-Related Breathing Disorders in Children
11.2.1 Nonobstructive Sleep-Related Breathing Disorders
11.2.1.1 Congenital Central Alveolar Hypoventilation Syndrome
11.2.1.2 Primary Sleep Apnea of Infancy
11.2.1.3 Sleep-Related Hypoventilation Syndrome
11.2.2 Obstructive Sleep-Related Breathing Disorders
11.2.2.1 Definitions
11.2.2.2 Etiology and Pathophysiology
11.2.2.3 Epidemiology
11.2.2.4 Clinical Presentation
11.2.2.5 Examination Procedures
11.2.2.6 Sleep-Related Medical Diagnostics
11.2.2.7 Differential Diagnoses
11.2.2.8 Treatment
Conservative Treatment
Device-Related Therapy
Surgical Therapy
11.3 Questions
References
Index