Sleep Diagnostics in Paediatrics

Details

Title

Sleep Diagnostics in Paediatrics

Type

Stage Two

Module code

HPS173

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply their knowledge to be competent in the management, delivery, interpretation and reporting of a paediatric sleep diagnostic service within scope of practice of 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 paediatric respiratory-related sleep disorders including: 

• Obstructive Sleep Apnoea (Paediatric).
• Upper-Airway Resistance Syndrome (UARS).
• Primary Central Sleep Apnoea (CSA).
• 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.
• a variety of paediatric specific sleep–breathing disorders and syndromes and how they would present in an investigation and how they would be treated. e.g. syndromes we see are craniofacial (e.g. Crouzon, Pfeiffer, Treacher-Collins), Achondroplasia, ucopolysaccharidoses (Hunter’s, Hurler’s, Morquios), Neuromuscular, Congenital Central hypoventilation syndrome.
• Child safeguarding.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST, with respect to sleep diagnostics in paediatrics, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery to:

•  select the most suitable test for diagnosis.
• to appropriately document the record (either paper or electronically as the night progresses e.g. ‘patient snoring’, ‘obstructive breathing’.
• communicate a written study summary at the morning and complete handover to the day staff.
• perform full polysomnography using the appropriate system for electrode placement.
• design and select the appropriate montage, dependent on the suspected diagnosis.select the most suitable test for diagnosis.
• recognise artefacts and make appropriate adjustments to eliminate them during the recording, for example re-referencing e.g. artefacts – add in CO2 monitoring – be it transcutaneous (e.g. baseline drift, change in baseline post re-siting) or end- tidal (cannulae/thermistor displacement) and the latter also for nasal flow measurement artefact. Transcutaneous etc – be aware of operating temperature and when to re-site the sensor.

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.
• obtain a comprehensive history, understanding the predisposing factors and presenting features of sleep disordered breathing, including snoring history, witnessed apnoeas, Epworth sleepiness score, co-morbidities.
• 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 (if possible) and families on diagnosis and implications of a range of respiratory-related paediatric 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.
• 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:

• recognise the importance of child safeguarding.
• adopt a multi-disciplinary approach to the diagnosis and treatment of children 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.