Sleep disorders: diagnosis and treatment

Sleep medicine is evolving rapidly. This Journal Conference summarizes recent and upcoming developments in sleep-monitoring technology, our understanding of the underlying physiology of sleep disorders and the relationships of sleep disorders to other health problems, the treatment of sleep disorders, and regulatory matters in sleep medicine. Sleep medicine is a growing field, partly because of the obesity epidemic and partly because of an increasing recognition of how sleep disorders cause and/or exacerbate serious conditions such as heart disease, and how poor sleep increases societal costs (eg, decreased work/school productivity, and motor vehicle accidents from hypersomnolence). Some key questions that remain to be answered include: What are the best metrics for diagnosing the severity of sleep apnea? What outcomes are most relevant to evaluate the efficacy of therapy? What is the best type of positive airway pressure (PAP) therapy for each category of sleep disorder? What is the best approach to treatment when positive airway pressure does not work? How often should sleep studies be repeated? What are the indications for re-titration of the PAP level? What will happen to sleep laboratories, especially if reimbursement is reduced and portable unattended sleep studies gain in popularity? Could non-sleep-specialists interpret sleep studies? What is the role of increased nasal resistance in producing upper-airway obstruction? What is the influence of chronic sinusitis on adherence to PAP therapy? How do gender differences affect the incidence, morbidity, and outcomes of sleep apnea? What are the needs of special populations with sleep disorders, such as children, patients with mental impairment, psychiatric patients, and ICU patients?