ABSTRACT
Sleep Medicine has only recently been recognized as a specialty of medicine. Its development is based on an increasing amount of knowledge concerning the physiology of sleep, circadian biology and the pathophysiology of sleep disorders. This review chronicles the major advances in sleep science over the past 70 years and the development of the primary organizations responsible for the emergence of Sleep Medicine as a specialty, sleep disorders as a public health concern and sleep science as an important area of research.
Subject(s)
History of Medicine , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/history , Sleep , Specialization , Chronobiology Disorders/diagnosis , Dopamine/metabolism , Education , History, 20th Century , History, 21st Century , Humans , Iron Deficiencies , Licensure , Polysomnography/methods , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/metabolism , REM Sleep Behavior Disorder/physiopathology , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/metabolism , Restless Legs Syndrome/physiopathology , United StatesABSTRACT
PURPOSE: The purpose of the present study was to evaluate a clinically practical classification system for tongue-base narrowing and to assess intrarater and interrater reliability of the proposed system. PATIENTS AND METHODS: A population of 248 consecutive patients with polysomnographically proven upper airway obstructive pathology were evaluated (using the hypotonic method) for evidence of upper airway narrowing with the commonly available techniques of fiberoptic nasopharyngoscopy, clinical examination and lateral cephalometric analysis. RESULTS: Four basic patterns of tongue-base narrowing have been discerned to occur in awake adult patients with diagnosed obstructive upper airway pathology. These include type A (high tongue base), type B1 (high tongue base with retroepiglottic narrowing), type B2 (diffuse tongue-base narrowing), and type 3 (isolated retrogepiglottic narrowing). These recognized patterns have been found to have high intraexaminer and interexaminer reliability. No statistical correlation was found between tongue-base pattern and severity of obstructive sleep apnea, age, or facial skeletal pattern. Males had a higher percentage of type C pattern, and the type A pattern patients tended to have a higher body mass index. CONCLUSIONS: Potential future uses of this classification system include the ability to more practically assess and describe anatomic locations of tongue-base narrowing and to permit an improved means of comparing the results of various surgical and nonsurgical therapies.
