I apologize to my patients when I’m running behind in clinic. It’s a sign of respect for their time and lets them know I’m aware of the delay (and trying my best). But if we’re being honest, even when we’re on time, neurologists are usually late. By the time we evaluate most patients with symptomatic presentations in the clinic or the hospital, we are seeing the neurologic manifestations of underlying disorders that have developed over months, years, or decades. We’ve all seen patients with acute stroke who have had years of latent hypertension, or a patient with new disabling neuropathy after decades of diabetes. The simple fact is that we don’t conventionally have the opportunity for early intervention to maintain brain health rather than treat neurologic disease. This issue of Continuum, dedicated to sleep neurology, gives us exactly that opportunity.
Sleep neurology occupies a distinctive corner of our specialty. Sleep is not a disorder. It’s a ubiquitous yet mysterious state in which we spend almost one-third of our lives. We now know that disorders of sleep provide a window into neurologic function and dysfunction. Close observation of sleep can serve as a crystal ball predicting future neurologic problems, illustrated by the connection between dream enactment and the development of synucleinopathies. The identification and treatment of sleep disorders can reduce the risk of future neurologic catastrophe, as in obstructive sleep apnea and stroke. A better understanding of sleep physiology can give us meaningful pathophysiologic insight into enigmatic neurodegenerative disorders like Alzheimer disease. An appreciation of sleep neurology yields an uncommon opportunity in our field: a means for prospective maintenance of brain health.
In this Sleep Neurology issue of Continuum, you will find a definitive overview of an evolving field. Serving as guest editor for this issue, Dr Anita Shelgikar has assembled an authoritative list of topics, authors, and articles, covering everything a neurologist needs to know about sleep physiology and pathophysiology. Dr Pablo R. Castillo introduces the issue with an article that will satisfy any reader looking to binge on the intricate neuroanatomy and neurophysiology of a complex state. Next, Dr Samuel A. Taylor Jr provides a thoughtful approach to sleep disorders in the clinical neurology setting. Drs Margaret Blattner and Kiran Maski thoroughly review central disorders of hypersomnolence including narcolepsy and idiopathic hypersomnia. In her article on obstructive sleep apnea, Dr Karin G. Johnson covers everything neurologists need to know about a major population health problem and source of neurologic morbidity. The enigmas of REM and non-REM parasomnias are wonderfully summarized by Drs Roneil Malkani and Andrew R. Spector in their respective articles on these essential topics. Dr Meena Khan delivers a complete discussion of nocturnal movement disorders, including the highly prevalent restless legs syndrome. Disruptive circadian rhythm disorders are carefully outlined in the article authored by Dr Flavia B. Consens. Drs Scott Kutscher and Christine Juang explain the latest developments in the treatment of insomnia. Neurologists should be familiar with the sleep disturbances associated with neurologic disorders, and these are comprehensively reviewed by Dr Joyce K. Lee-Iannotti. The distinctive presentations and management of sleep disorders in childhood deserve their own review, and Dr Althea Robinson Shelton’s article provides a superbly written discussion of pediatric sleep neurology. In the last of the clinical review articles, Dr Oleg Y. Chernyshev outlines the potentially disastrous consequences of chronic sleep deprivation.
As always, after reading or listening to the content in this issue, subscribers can obtain up to 20 AMA PRA Category 1 CreditsTM toward self-assessment CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program [Section 3] of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada with our posttest, written for the print issue by Drs D. Joanne Lynn and Allyson R. Zazulia.
We are committed to delivering Continuum content to our subscribers when and where they want to enjoy it. Audio interviews with our expert authors are posted on the journal’s website at ContinuumJournal.com and on the Continuum Audio online platform and mobile app, with separate self-assessment CME credits available. Verbatim audio recordings of each article are available to subscribers through our Continuum Read Aloud program found at the article level at ContinuumJournal.com and on the AAN’s Online Learning Center at continpub.com/CME.
We are proud of Continuum’s longstanding commitment to delivering high-quality clinical education for neurologists and others who care for neurology patients. We are also aware that there are many nonclinical topics that are of central importance to clinicians and patients. For this reason, I am thrilled to announce a new Continuum article series called Selected Topics in Neurology Practice. These articles will have a consistent presence in Continuum issues and discuss a diverse range of topics, including health disparities and equity, systems of care, health policy, medical economics, quality improvement, medical ethics, advocacy, and likely others. Under the guidance of Dr Pearce Korb, our Associate Editor of Selected Topics in Neurology Practice, the articles in this series will complement the issues to which they are assigned.
The inaugural Selected Topics in Neurology Practice article is included with this issue, and I can’t imagine a more fitting topic or authors to lead off the series. Health policy clearly has broad implications for medicine and neurology; given the pervasive role sleep plays in our lives, outwardly non-health-related policies have unintended effects on sleep and therefore population health. In their article, “Implications of Sleep Health Policy: Daylight Saving and School Start Times,” Drs Karin G. Johnson (pulling double duty in this issue) and Beth A. Malow provide a wonderful summary of how time zone, Daylight Saving, and school start time policies lead to negative health consequences on a large scale. In addition, they review past and ongoing advocacy efforts to improve policies that relate to sleep health.
I can’t overstate my gratitude to Dr Shelgikar for her leadership in creating and refining this issue, and to our authors for sharing their clinical expertise. This issue contains exciting new changes for Continuum, and thanks to our editorial staff and leadership team we have more changes coming soon. Foremost, I’m grateful to you, our readers and listeners, without whom we would not have this wonderful journal to share.
LYELL K. JONES JR, MD, FAAN