Diagnosis of Non Respiratory Related Sleep Disorders NS

Details

Title

Diagnosis of Non Respiratory Related Sleep Disorders NS

Type

Stage Two

Module code

HPS255

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to the diagnosis and management of non- respiratory-related sleep disorders in both adult and paediatric age (including neonates), will be able to analyse, synthesise, evaluate, perform and master a range of technical and clinical skills, including interpretation of full polysomnography. The Consultant Clinical Scientist will also be able to recognise and diagnose respiratory-related sleep disorders and produce a supervised clinical report of this finding to referring teams. They will be expected to consistently demonstrate the attitudes and behaviours expected of a Consultant Clinical Scientist treating patients with respect, compassion and kindness, and ensuring the safety of the patient at all times.

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;
• how different montages affect 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;
• protecting patients of paediatric age and vulnerable adults from maltreatment, abuse, neglect, or exploitation (safeguarding).

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;exploding head syndrome
• Functional Outcomes of Sleep Questionnaire (FOSQ).

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:

• 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 a 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 syndromesleep hypoventilation.
  • 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).

By the end of this module the Clinical Scientist in HSST will be able to identify those attending the clinic with a respiratory-related sleep disorders and feed this back clearly to the referring team, including:

• obstructive sleep apnoea;
• upper-airway resistance syndrome (UARS);
• central sleep apnoea (CSA);
• sleep hypoventilation.

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 a range of technical skills and will:

• select the appropriate test of choice;
• interpret full polysomnography using the 10-20 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 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;
• 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 clinical report;
• communicate with patients and families on diagnosis and implications of a range of non-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
  • CSF hypocretin
  • OGTT, HbA1 and blood glucose results
• critically 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.