Editorial [Hot Topic:Sleep Medicine (Guest Editor: Salim Surani)]

For the last 20 years sleep medicine has been recognized as a separate clinical specialty. Pulmonary physicians first became involved in the arena of sleep medicine as obstructive sleep apnea and sleep related breathing disorders were recognized. Although sleep-disordered breathing had been recognized for centuries, it was not until recently that close attention was paid to this clinical entity. Charles Dickens, in 1836, gave a perfect description of sleep-disordered breathing with his classic writing about “Joe the fat boy”, now a synonym of obstructive sleep apnea syndrome (OSAS) [1]. The development of modern Sleep Medicine is closely linked to the discovery of the electrical activity of the brain. In 1875 in England Caton was the first to record brain electrical activity of animals [2]. Berger reported the “electroencephalogram of man” in Germany in 1929 [3]. In 1937, Loomis was the first to document the characteristic electroencephalogram (EEG) patterns of what is now called non rapid eye movement (NREM) sleep: vertex waves, sleep spindles, K complex, and Delta slowing [4]. Kleitman, in 1953, described rapid eye movement sleep (REM) and its correlation with dreaming [5]. In 1957 Dement and Kleitman [6], described the human sleep cycle of NREM sleep being followed by REM sleep. In 1968, standardized methods for characterizing normal sleep were published by Allan Rechtschaffen and Anthony Kales. In 1970, Guilleminault described obstructive sleep apnea, whereas for some the beginning was related to Colin Sullivan's findings about continuous positive airway pressure therapy (CPAP) in 1981 [7,8]. In 1993 it was Terry Young's article in New England Journal of Medicine about the prevalence of sleep-disordered breathing that led to the advent of the sleep medicine specialty [9]. The decade of the 1990s saw acceleration in the acceptance of sleep medicine throughout the world. In the United States, the National Center on Sleep Disorders Research (NCSDR) was established by statute as part of the National Heart, Lung, and Blood Institute of the National Institute of Health (NIH). Sleep related breathing disorders now appear to involve several organs and systems. There have been numerous studies published on the role of sleep related breathing disorder and the cardiovascular system, diabetes, polycystic ovarian syndrome, peri-operative assessment, and cerebrovascular accidents. In the current issue we have attempted to provide a review of some important correlations of sleep related breathing disorders and their effects on different organ systems. REFERENCES [1] Dickens C. The Pickwick Papers. Penguin Classics. Reprint of 1836-1837 Edition. London UK: Penguin Books; 1986. [2] Carlton R. The electric currents of the brain. Br Med J 1875; 2: 278. [3] Berger H. Uber das elektroenkephalogramm des menschen. Arch Psychiatr Nervenkr 1929; 97: 6-26. [4] Loomis Al, Harvey EN, Hobart GA. Cerebral states during sleep as studied by human brain potentials. Sci Mon 1937; 45(2): 191-192. [5] Aserinsky E, Kleitman N. Regularly occurring episodes of eye mobility and concomitant phenomenon during sleep. Science 1953; 118: 273-274. [6] Dement WC, Kleitman N. Cyclic variations in EEG during sleep and their relation to eye movement, body mobility and dreaming. Electroencephalogr Clin Neurophysiol 1957; 9: 673-690. [7] Guilleminault C, Dement W. 235 cases of excessive daytime sleepiness. Diagnosis and tentative classification. J Neurol Sci 1977; 31: 13-27. [8] Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnea by continuous airway pressure applied through the nares. Lancet 1981; 1: 862-865. [9] Young T, Palta M, Dempsey J, et al. The occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-1235.