The growing field of sleep is the focus of this special annual issue.
Sleep-related problems affect 50 to 70 million Americans; of the more than 70 types of chronic disorders suffered by many, half go undiagnosed and untreated. Every year, sleep disorders, sleep deprivation, and sleepiness cost the national health care system $15.9 billion. In 1996, the National Center on Sleep Disorders Researchestablished within the National Heart, Lung, and Blood Institute (NHLBI) under a National Institutes of Health (NIH) provisiondeveloped a plan that called for stronger sleep research programs and technologies. Since then, funding for NIH sleep research has doubled.1 A NHLBI study found that between 1990 and 1998, diagnoses of sleep apnea in outpatients increased 12-fold.1 Clearly, as the subject of research, training, and treatment, sleepand specifically, the respiratory factor in sleepis growing. This first annual sleep issue of RT explores an array of sleep-related respiratory topics, among them sleep disorders in the elderly, sleep scoring, and new research.
But sleep is not the only topic covered in this issue. Also appearing is a new section, Letters, which we hope will encourage more interaction with our readers. We also feature a special report on severe acute respiratory syndrome (SARS). Both this virus and its story developed very fast, evolving to its current status as a coronavirus quickly identified by a network of 13 laboratories in 10 countries.2 SARS spreads easily and attacks healthy people, including health care workers, rendering its implications even more serious. Nevertheless, the number of people it has killed is small compared with most other headline-grabbing catastrophes. As of early May, SARS had taken almost 500 lives. About 36,000 Americans die of influenza in any given winter.3 More than 6,000 people have been infected by SARS; asthma kills 5,000 people every year. Further, there is now evidence that its victims may be less random than those of SARS. A recent study found that one in four children in Harlem suffers from asthma; this unduly high statistic might apply in other US inner cities as well. Most of New Yorks buses use natural gas, but seven still use diesel, the exhaust of which emits tiny particles believed to trigger asthma. Of those seven, five are in or near Harlem. In the apartments of poor urban settings, landlords often use heating oil with much higher sulfur content because it is cheaper. Other asthma triggers, such as dust mites, mold, mildew, and the feces of cockroaches, are also prevalent in poor communities.4
The successes that thus far can be reported about the diagnosis and treatment of SARS are largely attributable to the selfless, fast, hard work of the global scientific community. What strategies are we able, or willing, to undertake to stop the older, more mundane killers of pollution, asthma, and poverty?
1. National Center on Sleep Disorders Research Plan. Available at: www.nhlbisupport.com/sleep/research/research-a.htm. Accessed May 1, 2003.
2. Bloom BR. Lessons from SARS. Science. May 2, 2003;300:701.
3. Rutten T. A plea for careful SARS coverage. Los Angeles Times. April 30, 2003:E10.
4. Pérez-Peña R. Study finds asthma in 25% of children in central Harlem. New York Times. April 19, 2003:19.