Sleep in Neurological Practice

This is the second issue of Seminars in Neurology devoted to sleep disorders. The main objective of the first issue, published in September 2004, was to provide a basic framework for understanding the major sleep disorders. This issue describes the functional neuroimaging techniques to study the science of sleep disorders, and discusses sleep disorders in association with other neurological disorders, including headache, chronic pain, neurodegenerative disorders, multiple sclerosis, neuromuscular disorders, and stroke. Patients with neurological disorders often present with symptoms that result from underlying sleep disorders. Their neurological disorder may be exacerbated or caused by a sleep disorder. The neurocognitive consequences of sleep deprivation are reviewed, as well as psychiatric disorders associated with sleep disruption and the physiology and psychology of dreams.

Contributors to this issue come from all over the world and have made incredible contributions to medicine. This issue begins with an article by Dr. Eric Nofzinger, Director of the Sleep Neuroimaging Research Program at the University of Pittsburgh School of Medicine which outlines the use of functional imaging in sleep. Dr. Nofzinger has pioneered the use of functional neuroimaging techniques such as positron emission tomography (PET) to define the brain mechanisms of insomnia, sleep apnea, sleep deprivation, aging, and several psychiatric conditions. Dr. Claudio Bassetti reviews sleep and stroke. Dr. Bassetti is currently at the University of Bern in Zurich where he is Vice-Chairman of the Department of Neurology and Vice-Chairman of the Swiss Neurological Society. Dr. Bassetti was a sleep fellow at our institution where he studied with Dr. Michael. S. Aldrich, and has since published extensively on the relationship between sleep apnea and stroke. Dr. Antonio Culebras, Chair of the Sleep Section of the American Academy of Neurology and Chair of the Sleep Research Group of the World Federation of Neurology, discusses sleep in neuromuscular diseases. He performed some of the first sleep recordings in patients with myotonic dystrophies and other muscular dystrophies. Drs. Chokroverty, Bhatt, and Podder address sleep in neurodegenerative disorders. Dr. Chokroverty is Co-Director of Neurology (Clinical Neurophysiology and Sleep Medicine) at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. He is also Chief Editor of the journal Sleep Medicine and President of the World Association of Sleep Medicine. I will provide a review of sleep disorders in the geriatric patient population. Drs. Fleming and Pollack discuss sleep disorders in multiple sclerosis patients. Dr. Fleming, a recent graduate from our sleep fellowship program, is currently in private practice in Washington State. He developed an interest in fatigue associated with multiple sclerosis after several encounters and successful management of these patients in our clinic. His current interests include telemedicine in the field of sleep disorders and the association between sleep apnea and cardiovascular diseases. Dr. Pollack, another pioneer in sleep research, is Professor of Neurology at the Cornell Medical Center. He performed important research about sleep and aging and the use of stimulants in sleep disorders. Drs. Jeanetta Rains and Steven Poceta review sleep-related headache syndromes. Dr. Poceta is currently practicing at the Scripps Clinic. Few physicians have as extensive experience in sleep-related headaches as Dr. Poceta. Dr. Rains' research has focused on exploring the overlap symptom pattern between sleep disorders and headaches and illuminating specific relationships among these disorders. Considerations of insomnia in neurologic diseases are addressed by Drs. Federica Provini, Carolina Lombardi, and Elio Lugaresi from the Department of Neurological Science at the University of Bologna in Italy. Dr. Lugaresi is credited with the discovery of the prion disease, fatal familial insomnia (FFI) in 1986. Later on, in 1992, his group discovered that FFI is linked to a point mutation at codon 178 which is also found in Creutzfeld-Jakob Disease. His group is actively involved in research focusing on sleep-related movement disorders, particularly restless legs syndrome (RLS) and sleep apnea.

Psychiatric disorders associated with sleep disruption are reviewed by Dr. Lois Krahn, Chair of the Department of Psychiatry and Psychology at the Mayo Clinic Scottsdale. Dr. Krahn has evolved an interest in the overlap between sleep disorders and psychiatric conditions. Dr. Alan Eiser, a Clinical Psychologist in the Department of Neurology at the University of Michigan, has an extensive experience in the application of psychotherapy in sleep medicine. He has also been active in sleep medicine education and exposure to sleep medicine among psychiatrists. Dr. Eiser has studied dreaming in depression and the psychological aspects of sleep disorders in insomnia, parasomnias, and dreaming. Dr. Eiser reviews recent advancement in the understanding of the physiology and psychology of dreams, an area that has received little attention in the literature. Drs. Timothy Roehrs and Thomas Roth discuss sleep and pain. Dr. Roehrs, Director of Research at the Sleep Disorders and Research Center of Henry Ford Health System, studies the psychopharmacology of sleep and daytime alertness and the causes and consequences of daytime sleepiness. Dr. Roth is the Division Head of the Sleep Disorders Center at the same institution. His research focuses on sleep loss and sleep fragmentation. Dr. Roth is a pioneer in the field of sleep medicine. He is past editor of the journal Sleep, past Chairman of the National Center on Sleep Disorders Research Advisory Board at the National Institute of Health, and past President of the Sleep Research Society, the American Sleep Disorders Association, and the National Sleep Foundation. The neurocognitive consequences of sleep deprivation are reviewed by Drs. Jeffrey Durmer and David Dinges. Dr. Durmer, Director of the Emory Sleep Laboratory and Egleston Children's Sleep Program, studies the etiology, expression, and genetic factors involved in the development of neurologic disorders that disrupt sleep and wake processes. Dr. Dinges studies aspects of sleep need and circadian biology that induce excessive sleepiness and alter human neurobehavioral and cognitive functions, as well as health and safety. Their article helps shed light on the politically charged topic of sleepiness and fatigue in graduate medical training. This issue concludes with case presentations composed by previous University of Michigan sleep fellows from 2003 to 2004: Drs. Eric Clemons, Rahul Kakkar, Douglas Kirsch, and Mihaela Teodorescu. Dr. Clemons is a psychiatrist who along with Dr. Kirsch has since joined the faculty of the Department of Neurology at the University of Michigan. Dr. Clemons is interested in the application of sleep medicine in psychiatry and neurobehavioral models for the treatment of insomnia. Dr. Kirsch studies the quality-of-life measurements in patients with sleep disorders, and treatment alternatives for obstructive sleep apnea. Dr. Teodorescu is a research fellow at our institution with interests in studying the relationships between pulmonary disorders and primary sleep problems. Dr. Kakkar is currently a Critical Care Medicine Fellow, in the Division of Pulmonary and Critical Care Medicine at Henry Ford Hospital. His interests include upper airway physiology and sleep disorders in critically ill patients.

I would like to thank all of the authors for their outstanding contributions and bringing this project to a successful completion. I would also like to thank Dr. Ronald Chervin, Director of the Michael S. Aldrich Sleep Disorders Laboratory for his creative ideas for topics, outstanding suggestions, support, and encouragement as a mentor and a good friend. I would also like to thank Linda Hagan for her excellent suggestions during numerous discussions of the work. I would like to give special thanks to Dr. Karen Roos, Editor in Chief of Seminars in Neurology. I first met Karen after she invited me to attend her course, “Infectious Diseases of the Nervous System,” at the 56th American Academy of Neurology Annual Meeting. I found Karen's style as a teacher to be among the best I had ever encountered. She is truly an outstanding lecturer, charming and dynamic, warm and personable. Much of the success of Seminars in Neurology as a teaching-styled publication is owed to her

Finally, on behalf of all the authors, I would like to dedicate the volumes on sleep to my teacher and mentor, Dr. Michael S. Aldrich. Dr. Aldrich, who founded the University of Michigan Sleep Disorders Center, was a consummate clinician, researcher, and educator. Until his untimely death in July 2000, Dr. Aldrich was a pioneer neurologist in the relatively young field of sleep medicine. Many of the authors have been privileged to meet and work with him in the past and remember him as a quiet, brilliant, magnificent human being. He continues to serve as role model for many of us who also find themselves fascinated by the scientific frontier defined by the intersection of sleep medicine and neurology.