Introduction to Respiratory and Sleep Science

Module details

Title

Introduction to Respiratory and Sleep Science

Type

Rotation

Module code

S-RS-R1

Credits

10

Phase

1

Requirement

Compulsory

Aim of this module

This module will introduce trainees to the practices and principles of Respiratory and Sleep Science and the wider multidisciplinary team delivering care for patients.

Training activities

Assessments

Complete 1 Case-Based Discussion

Complete 1 DOPS or OCE

Direct Observation of Practical Skills Titles

• Apply an appropriate infection control procedure.
• Perform height and weight measurements prior to testing.
• Calculate a sleepiness score.
• Accurately measure resting SpO₂ on a patient attending clinic.
• Under supervision, calibrate a spirometer.

Observed Clinical Event Titles

• Gather a patient history relevant to the specialty from a patient, patient representative, or member of the multidisciplinary healthcare team.
• Present a patient history relevant to the specialty to a member of the multidisciplinary healthcare team.
• Explain the clinical relevance of an observed test to another healthcare professional.

Learning outcomes

Learning outcomes

On successful completion of this module the trainee will know and be able to:

1. Apply integrative understanding of the anatomy of the respiratory system, including structure and function, control of breathing (nocturnal and diurnal) and apply and extend knowledge to the specialism of Respiratory and Sleep Science.
2. Critically examine the diversity of respiratory and sleep disorders that result in referral to the service, including the pathophysiology of common lung and sleep disorders causing excessive daytime hypersomnolence and presenting signs and symptoms.
3. Describe and evaluate the range of respiratory and sleep science diagnostic techniques used to diagnose, monitor and manage disorders of respiration and of sleep.
4. Critically evaluate the measurement principles of the techniques used to assess full lung function tests and overnight oximetry, recognising the limitations of equipment and techniques used.
5. Appraise the range of reference values used in the assessment of normality and the use of guidelines to assess disease severity.
6. Critically discuss how respiratory and sleep diagnostic techniques are used in the primary/community care setting.
7. Critically evaluate the role of quality assurance in the maintenance of equipment used in the diagnosis of respiratory and sleep disorders.

Indicative content

Introduction to respiratory physiology and sleep

• Normal anatomy and physiology of the respiratory and sleep systems
• Control of breathing
• Development of the respiratory system
• Respiratory mechanics
• Basic full lung function testing
• Investigations and procedures carried out in the diagnosis and treatment of respiratory disease and sleep disorders
• Basic assessments of sleepiness and measurement techniques

Planning and preparing for investigations

• Indications for and contraindications to testing
• Health and safety, including safe handling of reagents
• The requirements for pre-test instructions and their implications on testing
• Basic clinical assessment of patients
• Monitoring of patients during assessment
• The requirements for accurate demographics and patient data
• Patient confidentiality and Data Protection Act

Investigations

• Spirometry
  • Flow and volume measuring devices
  • Advantages and disadvantages of different measuring devices
• Measurement parameters, to include FEV1, FVC, VC, PEF, FEV1/FVC ratio, FEV1/VC ratio, FEF and PIF
  • Acceptability and reproducibility
  • Common errors in measurement
• Lung volumes
  • Methods for measuring lung volumes
  • Advantages and disadvantages of different measuring devices
  • Measurement and calculated parameters, to include VC, FRC, TGV, ERV, RV and TLC
  • Acceptability, reproducibility and end points
  • Common errors in measurement
  • Gas analysers
  • Gas cylinders and special gases used in diagnostic investigations
  • Relevant gas laws and Boyle’s law
• Gas transfer
  • Methods for measuring gas transfer
  • Advantages and disadvantages of different measurement techniques
  • Acceptability, reproducibility and end points
  • Measurement parameters, to include TLCO, KCO and VA
  • Common errors in measurement
• Oximetry
  • Uses of oximetry, e.g. spot check and overnight monitoring
  • Interpretations and limitations of overnight studies
  • Measurement principles
  • Definitions, e.g. SpO2 and SaO2, desaturation and hypoventilation
  • Artefact identification
• Multichannel sleep studies
  • Advantages and disadvantages of multichannel studies when compared to other methods of sleep analysis
  • Measurement principles
  • Definitions of commonly measured parameters and events, e.g. central and obstructive apnoeas and hypopnoeas, sleep stages and arousals

Interpretation/Reporting

• Differentiate between normal, obstructive and restrictive spirometry
• Effects of common respiratory pathology on lung volumes and gas transfer. Pathology to include COPD, asthma, interstitial lung disease, chest wall disorders, neuromuscular disorders and obesity
• An awareness of the impact of other factors on investigation results, e.g. anaemia, polycythaemia and carbon monoxide
• Identification of normal and abnormal oxygen saturations
• Identification of abnormal sleep stage distributions

Reference equations

• Parameters for assessment of normality, e.g. percentage of predicted, standardised residuals and normal ranges
• Limitations of current reference equations
• Selection of equations according to age and race
• ARTP/BTS Guidelines (1994)
• ATS/ERS Standards (2005)
• NICE CPAP HTA (2009)
• NICE COPD Guidelines (2010)
• SIGN National Clinical Guidelines for the management of OSAHS (2003)

Calibration and quality assurance

• Characteristics of measuring equipment and their evaluation
• Routine care of gas analysers
• Linearity testing
• Definitions of calibration, verification and quality control
• Use of biological and physical quality control

Infection control

• Communicable diseases and microbiological hazards
• Sterilisation and disinfection methods
• Common methods for prevention of cross-infection
  • Hand washing
  • Bacterial filters
  • Single patient use items

Principles of calibration and quality assurance for all measurements undertaken in Respiratory and in Sleep Science

• Normal variability for each of the procedures performed
• Application of quality control strategies to ensure accuracy of results
• Mean, coefficient of variation, standard deviation and run control charts
• Diurnal variability and external influences
• How to deal with errors and equipment faults

Emergencies

• Recognition of life-threatening events/deterioration of patient
• Awareness of emergency procedures