Sleep Deprivation: Clinical Issues, Pharmacology, and Sleep Loss Effects
http://www.100md.com
《新英格兰医药杂志》
Chronic sleep deprivation, which probably affects at least one third of American adults, causes daytime sleepiness and disrupts daily life. Episodes of acute sleep deprivation may be even more common and occur across a spectrum of ages and occupations. In this scholarly and extensively referenced book, which brings together commentary and discussion from a large group of expert investigators, readers will find detailed accounts of many obvious and not-so-obvious problems concerning sleep deprivation. For example, how is sleep deprivation manifested in infants, adolescents, and adults? What clinical tests of psychomotor vigilance and unintentional tendency to sleep are available to determine whether a pilot, a truck driver, or a physician can do his or her job safely under conditions of acute or chronic sleep deprivation? Does the failure of a physician to warn a sleep-deprived patient of potential third-party injury or death constitute negligence? How does sleep deprivation affect "cognitive readiness" in the military? The reader may be surprised to learn that people who get a greater-than-normal amount of sleep appear to have a higher risk of death than those who get less sleep and that insomniacs, in principle among the least rested of all, do not appear to have increased mortality.
Highlights of the book include a remarkable medicolegal perspective on sleep deprivation, a discussion of its social effects, a detailed and apparently unbiased chapter on stimulant therapy, lucid discussions of environmental and behavioral therapies aimed at ameliorating the effects of sleep deprivation, and a scientifically compelling chapter on the recuperative value of naps. There are also authoritative chapters on subjective and objective testing for the tendency to fall asleep and psychomotor vigilance; the effects of inadequate sleep on the performance of children, adolescents, and physicians; and the effects of sleep deprivation on driving, round-the-clock operations, and commercial and public transportation.
The book is not successful in all ways. Given the dense and difficult biologic and sociological information to be reviewed, the uninitiated reader would have been better served by an early overview and a biologic and clinical definition of sleep deprivation, along with a perspective on its importance. The epidemiologic and sociological effects of sleep deprivation are not discussed until page 195, long after the appearance of the numerous perspectives and strategies used in testing for such effects. There are also chapters that contain excellent discussions of sleep disorders in special populations, but they tend to dilute the effect of the discussion of sleep deprivation as a whole.
This book highlights the frustrating paucity of empirical data from well-designed investigations into the many important questions regarding the biology of sleep deprivation. Despite Sun Tzu's 2300-year-old admonition in The Art of War to avoid fatigue in the military arena, it is not yet precisely clear to what extent human cognitive and social performance is affected by acute or chronic sleep deprivation or by the disorders that lead to the condition. The lesson, it appears, is that we must now develop a newfound respect for the adverse possibilities of sleep deprivation in all its biologic forms and move on with scientific investigation into those aspects that are most compelling to the individual and society.
Robert C. Basner, M.D.
Columbia University
College of Physicians and Surgeons
New York, NY 10032(Clete A. Kushida. 589 pp.)
Highlights of the book include a remarkable medicolegal perspective on sleep deprivation, a discussion of its social effects, a detailed and apparently unbiased chapter on stimulant therapy, lucid discussions of environmental and behavioral therapies aimed at ameliorating the effects of sleep deprivation, and a scientifically compelling chapter on the recuperative value of naps. There are also authoritative chapters on subjective and objective testing for the tendency to fall asleep and psychomotor vigilance; the effects of inadequate sleep on the performance of children, adolescents, and physicians; and the effects of sleep deprivation on driving, round-the-clock operations, and commercial and public transportation.
The book is not successful in all ways. Given the dense and difficult biologic and sociological information to be reviewed, the uninitiated reader would have been better served by an early overview and a biologic and clinical definition of sleep deprivation, along with a perspective on its importance. The epidemiologic and sociological effects of sleep deprivation are not discussed until page 195, long after the appearance of the numerous perspectives and strategies used in testing for such effects. There are also chapters that contain excellent discussions of sleep disorders in special populations, but they tend to dilute the effect of the discussion of sleep deprivation as a whole.
This book highlights the frustrating paucity of empirical data from well-designed investigations into the many important questions regarding the biology of sleep deprivation. Despite Sun Tzu's 2300-year-old admonition in The Art of War to avoid fatigue in the military arena, it is not yet precisely clear to what extent human cognitive and social performance is affected by acute or chronic sleep deprivation or by the disorders that lead to the condition. The lesson, it appears, is that we must now develop a newfound respect for the adverse possibilities of sleep deprivation in all its biologic forms and move on with scientific investigation into those aspects that are most compelling to the individual and society.
Robert C. Basner, M.D.
Columbia University
College of Physicians and Surgeons
New York, NY 10032(Clete A. Kushida. 589 pp.)