|Title||Diagnosis of non respiratory related sleep disorders RS|
By the end of this module the Clinical Scientist in HSST, with respect to the diagnosis and management of patients with non- respiratory related sleep disorders, will be able to analyse, synthesise, evaluate and apply their knowledge, perform a range of technical procedures and clinical skills and demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and critically apply their expert knowledge with respect to:
- the neurological control of sleep, wakefulness and circadian rhythms
- the principles of electroencephalogram (EEG) recordings, in particular with reference to the relationship between EEG and neurological structure and function
- how different montages effect the recording and sensitivity to potential diagnosis, recalling the differences between Rechtschaffen and Kale (R and K) and the American Academy of Sleep Medicine (AASM, 2007) rules for event scoring
By the end of this module the Clinical Scientist in HSST will also analyse, synthesise, evaluate and apply their expert knowledge with respect to the predisposing factors, presentation, differential diagnoses and management of non-respiratory-elated sleep disorders including:
- Narcolepsy, with or without cataplexy
- Idiopathic Hypersomnia
- Circadian sleep disorders:
- Delayed Sleep Phase Disorder
- Advanced Sleep Phase Disorder
- Irregular Sleep-Wake Rhythm
- Free-Running Circadian Rhythm Sleep Disorder
- Jet Lag Disorder
- Shift Worker Disorder
- Circadian Rhythm Sleep Disorder due to medical condition or due to drug or substance use
- Confusional Arousals
- Sleep Walking
- Sleep Terrors
- REM sleep behaviour disorder
- Nightmare Disorder
- Sleep Related Hallucinations
- Sleep Related Eating Disorder
- Sleep Paralysis
- Sleep Related Dissociative Disorders
- Sleep Enuresis
- Sleep Related Groaning
- Exploding Head Syndrome
- Parasomnias due to medical conditions
- Parasomnias due to drug or substance use
- Sleep related movement disorders:
- Restless legs syndrome (RLS)
- Periodic Limb Movement Disorder (PLMD)Shift Worker Disorder
- Excessive Fragmentary Myoclonus (EFM)
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST, with respect to non-respiratory related sleep disorders, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:
- select the appropriate test of choice
- interpret full polysomnography using the 20 10 system for electrode placement
- design and select the appropriate montage, dependent on the suspected diagnosis
- recognise artefacts and make appropriate adjustments to eliminate them during the recording, for example re-referencingdesign and select the appropriate montage, dependent on the suspected diagnosis
- recognise artefacts in recordings and make the appropriate adjustment to eliminate them from the analysis, for example, loss of signal, sweat sway, ECG interference etc.
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:
- obtain informed consent.
- take a comprehensive history, understanding the predisposing factors and presenting features of sleep disturbed breathing, including snoring history, witnessed apnoeas, Epworth sleepiness score, co-morbidities.
- make a basic clinical examination of the upper airway, including the assessment of the Mallampati score.
- perform analysis of all signals according to AASM / SIGN guidelines.
- interpret sleep study results taking into account history and clinical examination
- produce a clear and informative report.
- communicate with patients and families on diagnosis and implications of a range of respiratory-related sleep disorders.
- interpret biochemical assessments, including but not limited to:
- Full blood count
- Ferritin levels
- Thyroid function test
- HLA typing
- Urine drug screening
- Cerebral spinal fluid hypocretin
- OGTT, HbA1 and blood glucose results
- advise on the best course of treatment, including communication and liaison with other clinical teams such as Ear, Nose and Throat, Maxillofacial Surgery, Diabetes and Endocrine, Bariatric surgery.
- reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- adopt a multi-disciplinary approach to the diagnosis and treatment of patients with a range of sleep disordered breathing conditions.
- maintain patient confidentiality at all times.
- be enthusiastic in continuous improvement of diagnostic services, with particular reference to auditing practice, evidence based practice, new and improved technologies.
- promote the importance of active participation by Clinical Scientists in multidisciplinary clinical team meetings.