Sleep Disorders Clinic |
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Stanford's Sleep Disorders Clinic addresses serious health problems in a venue that some patients, and even some physicians, fail to grasp as a medical issue. To learn more about the relationship between sleep disorders and the role of other subspecialists and referring physicians, Fact File talked with Alexander A. Clerk, clinic medical director; Christian Guilleminault, professor of psychiatry and a pioneer in sleep research and treatment; Bruce Adornato, a Palo Alto neurologist and medical director of the Stanford Sleep Clinic in San Francisco; and George Liddell, the clinics' administrative manager.
2. The Stanford facility performs about 1,700 polysomnograms annually, while the San Francisco satellite performs about 400. About 500 ambulatory studies, which provide basic diagnosis using take-home monitoring, are expected to be performed at each site this year. A total of 1,500 patient consultations and follow-up visits are expected in 1998 in San Francisco, and 4,000 to 5,000 are expected in Palo Alto. 3. Overnight studies, reimburs-able by most insurance plans, include a physician interpretation and basic treatment plan. 4. Stanford's Palo Alto and San Francisco sleep clinics are accredited by the American Sleep Disorders Association (ASDA). All attending physicians are board certified in their primary specialties and in sleep disorders medicine. Only physicians with an existing board certification are eligible for ADA certification as sleep medicine specialists. 5. Attending physicians at Stanford are Guilleminault, Clerk, staff neurologist Clete Kushida, staff pediatric neurologist Rafael Pelayo and three postdoctoral fellows. Treating subspecialty patients under clinic auspices are otolaryngologists Nelson Powell and Robert Riley, pioneers in radiofrequency treatments for airway obstructions; craniofacial specialist Kasey Li, a clinical faculty member in psychiatry; and faculty neonatologist Ronald Ariagno, an authority on sudden infant death syndrome. William Dement, Berry Professor of Psychiatry and Behavioral Sciences, maintains an active research and teaching role. Dement directs the Stanford Sleep Disorders and Research Center, the academic umbrella for the clnic and related sleep research at Stanford. In San Francisco, attending physicians include Adornato and Kushida, as well as staff physicians Christopher Brown, a pulmonologist and director of intensive care services at California Pacific Medical Center, and Rowena Korobkin, a Stanford pediatric neurologist. Chief technologists are Angela Giacomini, Palo Alto, and Teresa Quinonez, San Francisco. 6. Sleep disorders can be divided into six categories:
* Disorders of initiating and maintaining sleep (insomnia). About 25 percent of the patients at Stanford Sleep Disorders Clinic suffer from insomnia, a widespread condition affecting a substantial proportion of the U.S. population. After a diagnosis to rule out other causes for insomnia, treatment can consist of counseling and carefully monitored prescription drug treatment.
* Disorders of excessive daytime sleepiness (snoring and sleep apnea). Highly specialized treatments include continuous positive airway pressure (CPAP); oral appliances designed to open the airway by bringing the jaw, tongue and soft palate forward; surgery to correct physical abnormalities; and uvuolpalatopharyngoplasty (UPPP), which removes excess tissue at the back of the throat. A new radiofrequency treatment provides a far less invasive method of removing excess tissue. Other techniques include a tracheotomy for persons suffering from severe cases of obstructive sleep apnea, supplemental oxygen for CPAP users with existing lung or heart disease and, occasionally, medication for mild cases of obstructive sleep apnea and some cases of central apnea.
* Parasomnias (somnambulism, nocturnal violence, REM [rapid eye movement] sleep behavior disorder, nocturnal seizures, bruxism [teeth grinding], sleep starts, rhythmic-movement disorder). A carefully determined course of medication or behavior therapy can effectively treat most of these disorders. A protective device can prevent dental damage from bruxism.
* Sleep disorders due to medical and psychiatric conditions. This requires a customized interdisciplinary program and close coordination among the sleep team and colleagues treating other components of the patients' conditions.
* Narcolepsy. Medication, with dosage tailored to ensure a good balance between control of symptoms and unwanted side effects, can be combined with behavioral treatment and adjustments in lifestyle. At this time, control, not cure, is the goal.
* Circadian rhythm disorders (jet lag, shift work). Short-term medication can be effective for jet lag. Public education and public policy advocacy can be useful for minimizing the effects, and sometimes the duration, of rotating shift work. 7. Bruce Adornato, clinical associate professor of neurology, graduated in 1972 from UC San Diego medical school. He completed his neurology residency at UCSF and at the National Institutes of Health, Medical Neurology Branch, Bethesda, Md. Adornato practiced for six years at the Palo Alto Medical Foundation and in 1983 left for private neurology practice. In addition to his practice, Adornato co-founded in 1986 the first accredited sleep clinic in San Francisco at California Pacific Medical Center. The clinic, still under Adornato's direction, was sold to Stanford in 1996. Alex Clerk graduated from the University of Ghana Medical School in 1975. He left his West African nation to serve a residency in psychiatry at Loma Linda University in California from 1980 to 1983, joining the faculty there while also serving as chief of the mental hygiene clinic at Loma Linda Veterans' Administration Hospital and as a consulting psychiatrist with the Riverside County Mental Health Department. Clerk came to Stanford in 1989 for a sleep medicine fellowship. In 1990 he was appointed staff physician and associate director of the Stanford Sleep Disorders Clinic. A year later, he was named to his current post as director. Christian Guilleminault, professor of psychiatry and behavioral sciences, is a pioneer in sleep disorders research. Guilleminault received his medical degree from the University of Paris in 1968. He came to Stanford as a visiting assistant professor in 1972. He became associate professor, with tenure, in 1980. Five years later, he was promoted to full professor. Since 1977, he has served as associate director of the Stanford Sleep Disorders and Research Center, the academic umbrella for the clinic and related sleep research at Stanford. George Liddell came to Stanford last October from a position as manager of Santa Clara Valley Medical Center's South Valley Clinic. Liddell, who has 15 years' experience in health care administration in the Bay Area, was admitted to the California Bar last September after receiving a law degree from Santa Clara University a year earlier. He received a masters of public administration degree from California State University Hayward in 1987.
8. Sleep clinic physicians are available for telephone consultations with primary care physicians. Call (650) 723-6601 in Palo Alto or (415) 923-3336 in San Francisco.
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