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Atlas of
SSleep
leep Medicine
Third Edition
Atlas of Sleep Medicine
Robert J. Thomas • Sushanth Bhat
Sudhansu Chokroverty
Editors
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
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To my patients, whose misfortunes and the never-ending struggle to reduce
their pain motivated this work.
To my wife Subha Ramani, who never fails to keep me happy, honest, and
grounded, including “you cannot save the world.” Well, I will try.
To my friend Sudha Seshadri, for memories created, experiences shared, and
some lessons learnt.
To Rena Holzer and Kimberly Campbell, nurse practitioners extraordinaire,
for holding the metaphorical fort, enabling this indulgence.
Robert J. Thomas
Dedicated to my parents and family, and with gratitude to all the students,
residents, and fellows who, over the years, have kept the spirit of learning
alive during busy clinics, hectic rounds, and piles of pending notes and sleep
study reports.
Sushanth Bhat
Preface
One more Atlas? For centuries, visual depiction of pathology has been a core feature of medi-
cal sciences. As new technologies have entered the field, the visuals have become more detailed
and complex and been taking forms never previously imagined. The teaching and learning
potential of visual imagery is nearly infinite, with so many possible interpretations of any indi-
vidual “work.” The First Edition of the Atlas of Sleep Medicine (2005), led by the incompara-
ble Dr. Sudhansu Chokroverty and where I was privileged to assist (with Dr. Meeta Bhatt),
aimed to “teach sleep medicine through images.” The field of sleep medicine/science is
extraordinarily rich with physiological and pathological patterns, blending elements from
already visually rich areas of medicine, including neurophysiology, recording technologies,
pulmonology, cardiology, and neurology. We hoped to tap into these riches for large-scale
benefit and think that we reasonably succeeded. The Second Edition in 2013 continued with
that goal.
There was some hesitation about embarking on a Third Edition. Clearly, there had been
tremendous progress in sleep sciences/practice, but was there enough new visual material? Dr.
Chokroverty stepped back slightly to hand me the responsibility to shepherd this edition, and
we also welcomed a new co-editor, Dr. Sushanth Bhat. It was quickly evident that there was
SO MUCH new visual information! Even better, leading proponents of the art and science of
sleep medicine were willing to share their riches—and thus, this Third Edition. We do not
pretend that this is a “Textbook of Sleep Medicine” but a journey through some of the most
exciting data realms and elements of the field.
This Third Edition attests to the vibrancy of sleep medicine in general, and the change
across editions reflects the evolution of the field and some future directions, which the editors
are grateful to have the opportunity to showcase.
vii
Acknowledgments
To the numerous contributors to this Atlas—no words of appreciation may be adequate. They
contributed time, effort, and knowledge during an incredibly difficult period for humanity,
with a specific type of toll on healthcare providers and researchers. This book was “conceived”
just prior to the Covid-19 pandemic, and of all the challenges we anticipated, the virus was not
one of them. The publishers and our managing editor Lee Klein showed infinite patience as
deadlines showed distinct shape-shifting, but here we are finally.
Dr. Chokroverty would like to acknowledge his wife, Manisha Chokroverty, for her patience
and forbearance during the production of this edition despite her considerable disability and
comorbidities.
ix
Contents
Introduction������������������������������������������������������������������������������������������������������������������������� 1
Robert J. Thomas, Sushanth Bhat, and Sudhansu Chokroverty
Neuronal Circuits, Anatomical Substrates, and Mechanism of Sleep-Wakefulness����� 5
Sudhansu Chokroverty, Sushanth Bhat, and Robert J. Thomas
xi
xii Contents
Motor Disorders in Sleep��������������������������������������������������������������������������������������������������� 459
Sushanth Bhat, Liudmila Lysenko, Stacey D. Elkhatib Smidt, Federica Provini,
Marco Zucconi, Mauro Manconi, and Sudhansu Chokroverty
Cardiac Arrhythmias��������������������������������������������������������������������������������������������������������� 485
Robert J. Thomas, Sudhansu Chokroverty, and Sushanth Bhat
Sleep and Epilepsy ������������������������������������������������������������������������������������������������������������� 511
Lino Nobili, Angelica Montini, Marco Zucconi, Sudhansu Chokroverty, and
Federica Provini
Contents xiii
CPAP, Bilevel, APAP, High and Low Loop Gain Syndromes����������������������������������������� 595
Robert J. Thomas
Adaptive Servo Ventilation������������������������������������������������������������������������������������������������� 657
Robert J. Thomas
Oral Appliances for Obstructive Sleep Apnea Syndrome (OSAS) Therapy����������������� 671
Fernanda R. Almeida and Mona M. Hamoda
Sleep Disturbances in Autoimmune Encephalitis������������������������������������������������������������ 741
Margaret S. Blattner
Video-Clinical (SHE, FFI, RBD, and Others) ����������������������������������������������������������������� 757
Federica Provini and Greta Mainieri
Narcolepsy: Unequivocal Diagnosis After Split-Screen, Video-Polysomnographic
Analysis of a Prolonged Cataplectic Attack��������������������������������������������������������������������� 759
Mark Eric Dyken, Deborah C. Lin-Dyken, and Jason Maxfield
Obstructive Sleep Apnea Associated with Cerebral Hypoxemia ����������������������������������� 763
Mark Eric Dyken, Christine L. Glenn, and George B. Richerson
The REM Sleep Behavior Disorder Leading to a Subdural Hemorrhage��������������������� 769
Mark Eric Dyken, Deborah C. Lin-Dyken, and Mark Raymond Dyken
Isolated Sleep Paralysis: An REM-“Sleep” Polysomnographic Phenomenon, as
Documented with Simultaneous Clinical and Electrophysiologic Assessment������������� 773
Mark Eric Dyken, Deborah C. Lin-Dyken, and Nivedita Jerath
Confusional Arousal����������������������������������������������������������������������������������������������������������� 777
Mark Eric Dyken, Deborah C. Lin-Dyken, and Nivedita Jerath
Sleepwalking����������������������������������������������������������������������������������������������������������������������� 779
Mark Eric Dyken, Deborah C. Lin-Dyken, and Siddharth Bajpai
xiv Contents
Part IX Epilogue
Epilogue������������������������������������������������������������������������������������������������������������������������������� 811
Robert J. Thomas, Sushanth Bhat, and Sudhansu Chokroverty
Index������������������������������������������������������������������������������������������������������������������������������������� 813
Contributors
xv
xvi Contributors
Zara Duquette Department of Health, Kinesiology and Applied Physiology, Center for
Studies in Behavioral Neurobiology and PERFORM Center, Concordia University, Montreal,
QC, Canada
Mark Eric Dyken The Department of Neurology, The University of Iowa Roy J. and Lucille
A. Carver College of Medicine, Iowa City, IA, USA
Mark Raymond Dyken Department of Neurology, University of Iowa Roy J. and Lucille
A. Carver College of Medicine, Iowa City, IA, USA
The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
Stacey D. Elkhatib Smidt JFK Neuroscience Sleep Center, Hackensack Meridian JFK
University Medical Center, Edison, NJ, USA
JFK Neuroscience Institute, Hackensack Meridian-Health JFK University Medical Center,
Edison, NJ, USA
Raffaele Ferri Sleep Research Centre, Department of Neurology IC, Oasi Research
Institute—IRCCS, Troina, Italy
John A. Fleetham University of British Columbia, Vancouver, BC, Canada
Wolfgang Ganglberger Department of Neurology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, USA
Christine L. Glenn Department of Neurology Sleep Disorders Center, University of Iowa
Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
Mona M. Hamoda Department of Oral Health Sciences, Faculty of Dentistry, University of
British Columbia, Vancouver, BC, Canada
Jisu Han Neuroscience Sleep Center, Hackensack Meridian JFK University Medical Center,
Edison, NJ, USA
Evan Hathaway Brain Electrophysiology Laboratory Company, Eugene, OR, USA
Timothy F. Hoban Departments of Pediatrics and Neurology, The Michael S. Aldrich Sleep
Disorders Laboratory, University of Michigan, Ann Arbor, MI, USA
Birgit Högl Sleep Disorders Clinic, Department of Neurology, Medical University of
Innsbruck, Innsbruck, Austria
Phillip Huyett Department of Otolaryngology-Head and Neck Surgery, Harvard Medical
School, Boston, MA, USA
Nivedita Jerath AdventHealth, Winter Park, FL, USA
Miranda Lim Department of Psychology, University of Oregon, Eugene, OR, USA
Deborah C. Lin-Dyken The Division of Developmental and Behavioral Pediatrics,
The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
Ran R. Liu Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Phan Luu Department of Psychology, University of Oregon, Eugene, OR, USA
Liudmila Lysenko Ochsner Health System, New Orleans, LA, USA
Greta Mainieri Department of Biomedical and Neuromotor Sciences, University of Bologna,
Bologna, Italy
Raman K. Malhotra Sleep Medicine Section, Department of Neurology, Washington
University School of Medicine, St. Louis, MO, USA
Contributors xvii
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