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  • Updated 12.24.2020
  • Released 11.04.1993
  • Expires For CME 12.24.2023

Sleep and medical disorders

Introduction

Overview

The understanding of sleep has received revitalized attention in recent years due to increasing recognition of the involvement of sleep disorders in numerous medical conditions. The authors discuss advances in this rapidly growing field and summarize the interactions between sleep disorders and medical illnesses, focusing on the impact of medical illness on sleep. The bidirectional relationship between medical illnesses and sleep disorders is also discussed.

Key points

• Sleep disturbances are common in medical disorders.

• Numerous medical disorders cause or are associated with sleep disorders such as poor sleep quality, insomnia, hypersomnia, obstructive sleep apnea, and restless legs syndrome.

• Moreover, sleep disorders such as sleep apnea can worsen a medical disorder, such as arterial hypertension or diabetes mellitus.

• The management of sleep disorders associated with medical conditions requires a multimodal approach with a tailored treatment plan addressing sleep hygiene, medication usage, and management of comorbidities.

Historical note and terminology

The interaction between sleep disorders and medical disease has long been recognized. In ancient Greece, Democritus (c. 460 – c. 370 BC) believed that physical illness was the cause of daytime sleepiness, and that poor nutrition was the primary cause of insomnia (32). In 1896, acromegaly was the first endocrine disorder recognized to be associated with heavy snoring and excessive daytime sleepiness (140). Burwell and colleagues published their classic description of obesity hypoventilation (Pickwickian) syndrome in 1956. The misconception that respiratory failure was the cause of excessive daytime sleepiness was not corrected until 1966 when Gastaut and associates polysomnographically monitored the sleep of these patients and documented repetitive episodes of upper-airway obstruction, leading to the discovery of obstructive sleep apnea (146). In the 1970s, Lugaresi and colleagues reported the corollary of obstructive sleep apnea in nonobese patients as sole cause of hypersomnia and identification of the importance of snoring and hypersomnolence as diagnostic indicators (103). Thus, medical and sleep disorders are commonly comorbid, and oftentimes exhibit reciprocal effects.

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