Back Module: S-RS-S5

Management of Complex Sleep

Module information

Module details

Title
Management of Complex Sleep
Type
Specialist
Module code
S-RS-S5
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

This module will provide trainees with a range of opportunities to explore the management and diagnosis of complex sleep disorder in either adult or paediatric services. Trainees will have the opportunity to perform PSG studies and scoring.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 2, 8 Training activities

Evaluate a local protocol for complex sleep investigations against national and international guidelines and make recommendations

 Type DTA Action View
# 2 Learning outcome 1, 2, 3, 6, 7 Training activities

Prepare patients for an overnight polysomnograph ensuring accuracy of signals and maintain effective communication and patient dignity at all times

 Type DTA Action View
# 3 Learning outcome 2, 8 Training activities

Develop or review an existing risk assessment for complex sleep investigations and present to the team

 Type DTA Action View
# 4 Learning outcome 2, 7 Training activities

Review referrals for patients referred for complex sleep investigations and identify the most appropriate investigation to answer the clinical question

 Type ETA Action View
# 5 Learning outcome 1, 4, 5 Training activities

Identify and correct artifactual anomalies in sleep study signals

 Type DTA Action View
# 6 Learning outcome 1, 2, 3, 4, 5, 6, 7 Training activities

Undertake Multiple Sleep Latency Tests (MSLT) and provide a report of the findings

 Type DTA Action View
# 7 Learning outcome 4, 5 Training activities

Perform sleep staging of nocturnal PSGs

 Type DTA Action View
# 8 Learning outcome 4, 5 Training activities

Perform respiratory analysis of a nocturnal PSGs

 Type DTA Action View
# 9 Learning outcome 4, 5 Training activities

Perform limb movement analysis of nocturnal PSGs

 Type DTA Action View
# 10 Learning outcome 4, 5, 7, 8 Training activities

Interpret and provide summary reports of the key findings of investigations undertaken for excessive daytime sleepiness.  To include results from

  • PSG
  • MSLT
  • Actigraphy/sleep log/sleep questionnaire
 Type DTA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Issue an actigraphy device to a patient, explaining the equipment and its role in their assessment.
  • Set up a patient for a nocturnal PSG and perform biocalibrations. Take action to correct any artefacts or technical problems identified.
  • Choose a PSG that has been scored and write a short report outlining the main findings in relation to the clinical history.

Observed Clinical Event Titles

  • Explain to a patient how to complete a sleepiness questionnaire and its role in their assessment.
  • Discuss and explain the behavioral requirements for an MSLT test with a patient.
  • Communicate to other healthcare professionals why a referral may not be appropriate to answer the clinical question.
  • Interpret and communicate progress of MSLT to other multidisciplinary team colleagues.

Learning outcomes

# Learning outcome
1

Prepare equipment and the environment in order to undertake complex sleep investigations.
2

Select appropriate investigations based on referral criteria.
3

Conduct complex sleep investigations.
4

Analyse and interpret data obtained from complex sleep investigations.
5

Prepare reports and answer the clinical question using the results of sleep investigations, with reference to the underlying symptoms and relevant technical factors.
6

Communicate effectively with a range of patients ensuring they are aware at all times of the purpose of their visit.
7

Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience.
8

Practice effectively as part of a multidisciplinary team to interpret complex scientific and technical data which will form part of the diagnosis and management plan.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Observe a polysomnography set up and data collection overnight to appreciate in real time, the subtle changes in sleep EEG as a patient falls asleep.
  2. Attend a new patient clinic to observe history taking in patients with suspected narcolepsy to appreciate the impact of the discussions on the patient.
  3. Attend a multidisciplinary team meeting to discuss the results and management plan for patients having sleep studies, to appreciate the patients journey prior to and following the multidisciplinary team discussion.
  4. Attend a medical consultant led ENT clinic and to appreciate the impact of the discussions on the patient.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

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

  1. Apply integrative knowledge of the anatomy and physiology associated with normal sleep and the clinical aspects, including the normal cardiorespiratory changes during sleep.
  2. Describe the pathophysiology of non-respiratory sleep disorders, relating changes in physiology due to neurodegenerative sleep disorders.
  3. Critically evaluate the tools, techniques and equipment used to assess and treat respiratory and neurological sleep disorders.

Indicative content

Anatomy and physiology associated with normal sleep:

  • The structure and physiology of the larynx, pharynx and nasal airways, and their relevance to sleep maintenance and airway patency during sleep
  • Normal structure and function and chemistry of the neural pathways relating to sleep and wakefulness, circadian rhythm generation and its interaction with body function

Pathophysiology of non-respiratory sleep disorders:

  • The physiology and structure of sleep throughout life and the pathophysiology of non-respiratory sleep disorders, relating changes in physiology due to neurodegenerative sleep disorders
  • Pathophysiology of non-respiratory sleep disorders, including insomnias, hypersomnias, parasomnias and sleep disorders related to other medical conditions

Tools, techniques and equipment used to assess and treat respiratory and neurological sleep disorders:

  • Continuous positive airway pressure (CPAP) and non-invasive ventilation in the treatment of obstructive sleep apnoea or obesity hypoventilation syndromes (OSAHS)
  • The theory, practice, parameters, advantages and limitations of non-ventilator techniques used in treating OSAHS
  • Effects and consequences of daytime sleepiness and sleep deprivation on whole body function, mental agility and memory consolidation, including the DVLA for fitness to drive regulations
  • Sleep polysomnography in the assessment of sleep and disorders of sleep and the role of video-polysomnographic recording in differential diagnosis
  • Principles of neurophysiological recording equipment and identification of the characteristics of the normal waveforms/variation, in the awake and sleep EEG
  • The use of psychological tools to treat hyper and hypo-somnolence
  • The uses and limitations of tests of vigilance and sleep maintenance
  • The assessment of excessive daytime sleepiness
  • Artefacts
  • Vigilance testing
  • MWT and vigilance testing
  • Electrode placement
  • EEG signal processing
  • Implications of drugs on test result
  • Physiological parameters of sleep
  • Basic understanding of pharmacodynamics to underpin the understanding of how common prescribed and non-prescribed drugs may influence test findings
  • Drug screening in MSLT
  • Describe the difference between MSLT and MWT and why one or other might be more appropriate in a given set of circumstances.

Diagnostic testing and limitations:

  • Normal sleep architecture
  • Pathological sleep architecture in sleep disorders (e.g. narcolepsy)
  • Indications/contraindications
  • Understand the indications and limitations of a multiple sleep latency test
  • Able to place electrodes accurately according to the 10:20 system
  • Able to identify and correct common sources of artefact (sweat or electrode popping)
  • Knowledge of recording parameters and filters
  • Able to confidently and reliably recognise sleep onset and REM sleep in real time while monitoring the recording
  • Study environment and testing conditions

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS1-3-22 Specialty title Respiratory & Sleep Science [2022] Action View
Specialty code SPS1-3-23 Specialty title Respiratory & Sleep Science [2023] Action View
Specialty code SPS1-3-24 Specialty title Respiratory & Sleep Science [2024] Action View
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