Tuesday, June 28, 2005

The Future of Sleep Medicine

It is an exciting time for the field of sleep medicine. ICSD-2, the 2nd edition of the International Classification of Sleep Disorders, was introduced at the 19th Annual Meeting of the Associated Professional Sleep Societies. In many ways the ICSD-2 is a big improvement over the original ICSD. For example, there are now separate criteria for adult and pediatric obstructive sleep apnea- this is important since adult and pediatric OSA usually have different etiologies (adenotonsilar hypertrophy in kids and obesity/craniofacial abnormalities in adults). Unfortunately, where to draw the line between children and adults is unclear, though most sleep specialists draw it at puberty.
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Another development in sleep medicine is a revision of the R+K scoring manual. There was a lot of debate about the proposed revisions at the 19th Annual Meeting. The new manual should be available in late 2006. The committee revising R+K hopes to simplify the criteria for the ending and beginning of REM sleep. Stage 3+4 will probably be combined into one stage. The scoring of periodic limb movements may be revised. Unfortunately, no one is able to agree on what exactly a "hypopnea" is; and there is little consensus about what if any degree of saturation should be required to score a hypopnea. The lack of a standard definition of a hypopnea limits research into Obstructive sleep apnea, it would be easier to compare studies if there was a standard definition.

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