|Title||Diagnosis of respiratory related sleep disorders|
By the end of this module the Clinical Scientist in HSST, with respect to the diagnosis and management of patients with 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 predisposing factors, presentation, differential diagnoses and management of respiratory-related sleep disorders including:
- Obstructive Sleep Apnoea (Adult) (OSA).
- Obstructive Sleep Apnoea (Paediatric).
- Upper-Airway Resistance Syndrome (UARS).
- Primary Central Sleep Apnoea (CSA).
- Central Sleep Apnoea induced by drugs.
- Central Sleep Apnoea induced by medical conditions / trauma.
- Cheyne-Stokes Respiration (CSR).
- High Altitude Periodic Breathing.
- Obesity Hypoventilation Syndrome (OHVS).
- Sleep related hypoventilation / hypoxaemia due to neuromuscular and chest wall disorders.
- Sleep related hypoventilation / hypoxaemia due to lower airways obstruction.
- Sleep related hypoventilation / hypoxaemia due to pulmonary paranchymal or vascular pathology.
- Idiopathic sleep related non-obstructive alveolar hypoventilation
By the end of this module the Clinical Scientist in HSST will also be able to analyse, synthesis, evaluate and apply their expert knowledge to discuss the various subjective methods of assessing sleepiness and hypersomnolence including:
- Epworth Sleepiness Score (ESS).
- Stanford Sleepiness Scale (SSS).
- Sleep-Wake Activity Inventory-EDS Scale (SWAI-EDS).
- Fatigue Severity Scale (FSS).
- Modified (Dallas) ESS.
- Functional Outcomes of Sleep Questionnaire (FOSQ).
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST, with respect to 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
- perform 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-referencing
- 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:
- 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 with recommendations for further diagnostics and/or treatments.
- communicate with patients and families on diagnosis and implications of a range of respiratory-related sleep disorders.
- 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. 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.
- 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.
- appreciate the complex history patients with sleep disordered breathing may have and make a holistic approach to diagnosis