Introduction to Respiratory and Sleep Science

Module details

Title

Introduction to Respiratory and Sleep Science

Type

Rotation

Module code

SPS102

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will enable trainees to gain the underpinning knowledge, skills and experience of Respiratory and Sleep Science by introducing the range of respiratory and sleep diagnostic and therapeutic services provided in the specialism and the interaction with patients and patient-centred practice. Trainees will be expected to perform some routine respiratory and sleep investigations and develop and build their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2,3,4,5	Competency Control of infection risks pre, during and post investigations, and actions taken to manage these.	Action View
# 2	Learning outcome 1,2,3,4,5	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 3	Learning outcome 1,2,3,4,5	Competency Select suitable technology for each type of investigation, choosing and adapting the appropriate technique, patient position and machine settings for each patient.	Action View
# 4	Learning outcome 1,2,3,4,5	Competency Obtain a suitably completed request form, greet the patient, and check patient ID and recent clinical history.	Action View
# 5	Learning outcome 1,2,3,4,5	Competency Explain the procedure for each type of investigation to the patient, address any procedure-related questions they may have and provide information on how the patient will be informed of the results.	Action View
# 6	Learning outcome 1,2,3,4,5	Competency Gain informed consent for each investigation.	Action View
# 7	Learning outcome 1,2,3,4,5	Competency Prepare the environment, equipment and patient for investigations to include: spirometry lung volumes gas transfer overnight oximetry limited multichannel sleep studies.	Action View
# 8	Learning outcome 1,2,3	Competency Make height, weight and other appropriate measurements in accordance with standardised procedures, adapting them where necessary.	Action View
# 9	Learning outcome 1	Competency Obtain accurate spirometry measurements.	Action View
# 10	Learning outcome 2	Competency Obtain accurate measurements of lung volumes.	Action View
# 11	Learning outcome 3	Competency Obtain accurate measurements of gas transfer.	Action View
# 12	Learning outcome 4	Competency Obtain an accurate overnight pulse oximetry recording	Action View
# 13	Learning outcome 5	Competency Obtain an accurate limited multi-channel sleep study	Action View
# 14	Learning outcome 1,2,3	Competency Interpret technically data from adult patients and generate a report for: spirometry lung volumes gas transfer.	Action View
# 15	Learning outcome 4,5	Competency Interpret technically data from overnight pulse oximetry and generate a report.	Action View
# 16	Learning outcome 6	Competency Perform routine calibration/quality control/verification of full lung function testing equipment, to include printouts of volume verification at different flow rates.	Action View
# 17	Learning outcome 7	Competency Document local patient diagnostic and treatment pathways (e.g. COPD and OSHAS).	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Perform and analyse Spirometry in an adult patient	DOPS
Perform and analyse Lung Volumes in an adult patient	DOPS
Perform and analyse Gas Transfer in an adult patient	DOPS
Administration and response to a bronchodilator	DOPS
Perform and analyse Limited multichannel sleep study in an adult patient	DOPS
An appropriate activity agreed with your Training Officer	OCE

Learning outcomes

1. Perform, analyse and develop skills in the interpretation of routine spirometry in patients referred for routine investigation.
2. Perform, analyse and develop skills in the interpretation of the measurement of lung volumes in patients referred for routine investigation.
3. Perform, analyse and develop skills in the interpretation of the measurement of gas transfer.
4. Perform, analyse and develop skills in the interpretation of overnight oximetry studies.
5. Perform a limited multichannel sleep study.
6. Assist in the routine maintenance, calibration and quality assurance procedures on the equipment used to undertake spirometry lung volumes, measurement of overnight pulse oximetry and continuous positive airway pressure (CPAP) equipment.
7. Document local patient diagnostic and treatment pathways (e.g. chronic obstructive pulmonary disease [COPD] and obstructive sleep apnoea hypoventilation syndrome [OSHAS]).

Learning outcomes

1. Describe 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. Discuss 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. Describe 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. Describe the range of reference values used in the assessment of normality and the use of guidelines to assess disease severity.
6. Discuss how respiratory and sleep diagnostic techniques are utilised 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 reagent
• 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, 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, 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, hypoventilation
  • Artefact identification
• Multi channel 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, 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

Guidelines

• 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, 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

Activities

• Observe history taking in patients with respiratory signs and symptoms, develop and practise the skill of history taking and present your history findings for a range of patients, and suggest appropriate investigations based on this information.
• Observe a range of routine investigations undertaken in Respiratory and Sleep Science and critically evaluate how these investigations contribute to the diagnosis, management and care of patients, and the range of needs of people with disabilities within a typical care pathway for patients with common respiratory diseases and disorders of sleep.
• Attend outpatient clinics and/or in patient ward rounds and/or physiologist/nurse-led clinics and discuss with your supervisor the diagnostic pathways linked to Respiratory and Sleep Science, for example COPD, OSAHS.
• Attend outpatient clinics and/or inpatient ward rounds to gain experience of the linkages between Respiratory and Sleep Science and other clinical specialisms in the investigation of respiratory diseases and disorders of sleep.
• Attend a clinic where patients with respiratory and/or disorders of sleep attend for non-pharmacological treatment, for example a stop smoking clinic, dietetic clinic, exercise session.
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with disorders of the respiratory system or disorders of sleep.