Disorders of Sleep

Details

Title

Disorders of Sleep

Type

Stage One

Module code

HPS217

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge with respect to presentation and diagnosis of non-respiratory sleep disorders. They will be competent to identify the required specialist assessments to form a structured differential diagnostic evaluation leading to further investigation or treatment of disorders of sleep, with a focus on non-respiratory disorders of sleep. They will perform a range of technical procedures and clinical skills and consistently demonstrate the attitudes and behaviours necessary to undertake the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge of the clinical presentation, investigation, diagnosis and management of non-respiratory disorders of sleep:

• the neurological control of sleep, wakefulness and circadian rhythms;
• how different montages effect the recording and sensitivity to potential diagnosis.

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-related sleep disorders, including:

• classification of sleep disorders;
• differential diagnosis of sleep disorders versus epilepsy;
• narcolepsy, with or without cataplexy;
• idiopathic hypersomnia;
  • delayed sleep phase disorder
  • advanced sleep phase disorder
  • irregular sleep-wake rhythmcircadian sleep disorders:
  • free-running circadian rhythm sleep disorder
  • jet lag disorder
  • shift worker disorder
  • circadian rhythm sleep disorder due to medical condition or to drug or substance use
•  parasomnias:
  • 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)
  • excessive fragmentary myoclonus (EFM)
• sleep staging and polygraphic features of non-respiratory sleep disorders;
• 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)
• sleep staging criteria;
• manual and automated methods of staging.

The Clinical Scientist in HSST will also be expected to discuss the presentation, differential diagnoses and management of respiratory-related sleep disorders.

Clinical scientific research topics:

• structural and functional neuroimaging;
• vascular biology;
• genomics.

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 competent to identify the required specialist assessments to form a structured differential diagnostic evaluation. They will perform and master specialised, complex neurophysiological investigations in non-routine patients. They will also be able to demonstrate a critical understanding of current research and its application to the field of disorders of sleep. They will also be expected to contribute to the supervision, teaching and assessment of colleagues.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice an appropriate range of clinical and communication skills to and will:

Clinical examination:

• obtain informed consent;
• take a relevant focused history (see Stage 1(ii) Advanced History Taking and Clinical Examination), understanding the predisposing factors and presenting features of sleep-disturbed breathing, including snoring history, witnessed apnoeas, Epworth sleepiness score, co-morbidities.

Investigation:

• identify and evaluate appropriate clinical neurophysiological procedures that are appropriate to achieve a differential diagnosis, taking into account special circumstances, contraindications, confounding factors and risks;
• interpret the relevance of structural neuroimaging data;
• present accurate, clear and concise documentation of patient data;
• explain results simply and effectively to both clinicians and, where appropriate, patients;
• advise and communicate effectively with patients, relevant clinicians and the public, and other healthcare professionals working within the multidisciplinary team;
• interpret biochemical assessments, including but not limited to:
  • full blood count
  • ferritin levels
  • thyroid function test
  • HLA typing
  • urine drug screening
  • CSF hypocretin
  • OGTT, HbA1 and blood glucose results
• advise on the best course of treatment, including communication and liaison with other clinical teams;
• 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.