Abstract
This book promises to provide the practicing physician with a comprehensive guide to the ‘unique contextual setting in which sleep-disordered breathing (SDB) occurs in children’. In pursuit of these aims, the editors have assembled a large number (72!) of predominantly US-based experts and tasked them to provide ‘a pragmatic and useful resource’ on the latest developments in the field of paediatric SDB. The result achieves these ambitions admirably and in so doing is not only a useful resource for clinicians (doctors, nurses and physiologists alike) who deal with children and families with suspected problems with breathing whilst asleep but is also an inspiring learning tool.
The book comprises 42 chapters written individually by a selected author or group. It is divided into six parts, with each comprising a number of chapters on relevant subjects. They cover upper airway anatomy, sleep physiology, clinical and diagnostic evaluation of sleep and breathing in children, sleep disordered breathing in children with individual chapters on specific at risk or associated conditions, consequences or associated morbidity, and lastly on the treatment modalities available. Throughout all chapters, the text is concise yet detailed. A pleasing very readable addition to the writing style is that authors’ frequently incorporate practical information that provides the clinician the explanation and clarity applicable to practice.
Part 1, the normal upper airway, includes descriptions of anatomical changes during development, pharyngeal muscle structure and function, lymphoid tissues in the upper airway and nasal cavity anatomy. As these are clearly relevant topics in understanding the pathophysiology of SDB particularly in children, the editors chose to focus uniquely on these specific aspects of upper airway anatomy.
Part 2, sleep during development, covers the neurology of sleep and include neural mechanisms, chemoreceptors, metabolic and hormonal regulation, EEG and arousal. Whilst these are clearly relevant in a book on sleep, these chapters were possibly too detailed in a book designed as a clinical guide, but nevertheless serve as useful references for further reading.
The four following parts cover assessment, presentation, consequences and treatment and thereby provide the reader with a comprehensive overview of the clinical care of most presentations of SDB. Many such readers in the United Kingdom will not have local access to sleep laboratories with polysomnography. They will, however, be faced with patients presenting with symptoms suggestive of SDB. These four ‘clinical’ parts cover all aspects of the four topics and in so doing provide a comprehensive synopsis to answer the challenges facing clinicians on, for example, how the child might present (not only with snoring but also possibly with say behavioural or neurocognitive problems), which children are at risk (obesity, neuromuscular disorders and respiratory disorders), whether there are screening tests of value (overnight oximetry) and the values of treatment options. This book will certainly guide them in their practice.