Sleep, sleep studies and sleep-

disordered
breathing: basic knowledge for the
anesthesiologist - 2017
Andrew P. Hall
Purpose of review
To provide a basic understanding of sleep physiology, the pathophysiology of
sleep-disordered breathing and the processes applied in undertaking and
assessing sleep studies.
Recent findings
It has become increasingly apparent that obstructive sleep apnoea is associated
with heightened perioperative risk. Furthermore, the condition still remains under-
diagnosed in patients presenting for surgery.
Summary
This review describes the physiology of sleep including sleep stages, sleep
monitoring, the normal hypnogram and investigation from simple overnight pulse
oximetry to full polysomnography. The pathophysiology of sleep-disordered
breathing is discussed; from simple snoring through obstructive sleep apnoea to
obesity hypoventilation syndrome. The relationship to metabolic syndrome is
explored.
Salient points in the interpretation of sleep study reports are presented.
Keywords
obstructive sleep apnoea, sleep-disordered breathing, sleep physiology

Sleep Regulation, Physiology and

Development, Sleep Duration and
Patterns, and Sleep Hygiene in Infants,
Toddlers, and Preschool-Age Children -
2017
Eleanor Bathory, MD,a and Suzy Tomopoulos, MDb

Sleep problems are common, reported by a quarter of parents with children under
the age of 5 years, and have been associated with poor behavior, worse school
performance, and obesity, in addition to negative secondary effects on maternal
and family well-being. Yet, it has been shown that pediatricians do not adequately
address sleep in routine wellchild visits, and underdiagnose sleep issues.
Pediatricians receive little formal training in medical school or in residency
regarding sleep medicine. An understanding of the physiology of sleep is critical
to a pediatrician’s ability to effectively and confidently counsel patients about
sleep. The biological rhythm of sleep and waking is regulated through both
circadian and homeostatic processes. Sleep also has an internal rhythmic
organization, or sleep architecture, which includes sleep cycles of REM and
NREM sleep. Arousal and sleep (REM and NREM) are active and complex
neurophysiologic processes, involving both neural pathway activation and
suppression. These physiologic processes change over the life course, especially
in the first 5 years. Adequate sleep is often difficult to achieve, yet is considered
very important to optimal daily function and behavior in children; thus,
understanding optimal sleep duration and patterns is critical for pediatricians.
There is little experimental evidence that guides sleep recommendations, rather
normative data and expert recommendations. Effective counseling on child sleep
must account for the child and parent factors (child temperament, parent–child
interaction, and parental affect) and the environmental factors (cultural,
geographic, and home environment, especially media exposure) that influence
sleep. To promote health and to prevent and manage sleep problems, the
American Academy of Pediatrics (AAP) recommends that parents start promoting
good sleep hygiene, with a sleeppromoting environment and a bedtime routine in
infancy, and throughout childhood. Thus, counseling families on sleep requires
an understanding of sleep regulation, physiology, developmental patterns,
optimal sleep duration recommendations, and the many factors that influence
sleep and sleep hygiene.

The genetics of circadian rhythms, sleep

and health
Aarti Jagannath, Lewis Taylor , Zeinab Wakaf , Sridhar R.
Vasudevan and Russell G. Foster - 2017
Circadian rhythms are 24-h rhythms in physiology and behaviour generated by
molecular clocks, which serve to coordinate internal time with the external world.
The circadian system is a master regulator of nearly all physiology and its
disruption has major consequences on health. Sleep and circadian rhythm
disruption (SCRD) is a ubiquitous feature in today’s 24/7 society, and studies on
shift-workers have shown that SCRD can lead not only to cognitive impairment,
but also metabolic syndrome and psychiatric illness including depression (1,2).
Mouse models of clock mutants recapitulate these deficits, implicating
mechanistic and causal links between SCRD and disease pathophysiology (3–
5). Importantly, treating clock disruption reverses and attenuates these adverse
health states in animal models (6,7), thus establishing the circadian system as a
novel therapeutic target. Significantly, circadian and clock-controlled gene
mutations have recently been identified by GenomeWide Association Studies
(GWAS) in the aetiology of sleep, mental health and metabolic disorders. This
review will focus upon the genetics of circadian rhythms in sleep and health.

Sleep environments and sleep

physiology: a review
Olga Troynikova , Chris Watsona , Nazia Nawaza – 2018
Sleep loss impairs task performance and post-physical activity recovery,
cognitive performance and mood, heightens fatigue and decreases vigour; poor
sleep quality impairs decision-making, the speed and accuracy of task
performance, and post-exercise recovery. Sleep time and quality are affected by
age, psychological and physiological conditions, culture and environmental
factors. Skin temperature, rapid temperature change and sweating during sleep
can significantly reduce sleep quality. Hence, the thermal properties of bedding
and sleepwear, both in steady-state and transient ambient temperature
conditions, are logically important factors. Research to date on sleeping thermal
microclimates and their effect on sleep quality is scarce. This present review
covers the fundamental elements of human sleep, highlighting physically active
people, such as athletes, and the influence of sleepwear and bedding on sleep
thermal microclimates, as well as the research methods that have been and could
be used in this field. This review identifies opportunity for future research direction
and approaches to understanding thermal environments that may support better
human sleep.

Neural Circuitry of Wakefulness and

Sleep - 2017
Thomas E. Scammell, Elda Arrigoni, and Jonathan O. Lipton

Sleep remains one of the most mysterious yet ubiquitous animal behaviors. We
review current perspectives on the neural systems that regulate sleep/wake
states in mammals and the circadian mechanisms that control their timing. We
also outline key models for the regulation of rapid eye movement (REM) sleep
and non-REM sleep, how mutual inhibition between specific pathways gives rise
to these distinct states, and how dysfunction in these circuits can give rise to
sleep disorders.