Presentations
- Awaking gasping or choking
- Cognitive impairment
- Driving or occupational risk
- Early morning headaches
- Excessive daytime sleepiness
- Impaired sleep quality
- Loud snoring
- Mood changes
- Poor concentration
- Witnessed apnoea
Conditions
- Familiarity with the International Classification of Sleep Disorders (ICSD-3)
- Isolated snoring
- Sleep apnoea:
- central
- obstructive
- treatment-emergent central sleep apnoea
- Sleep hypoventilation disorders, such as obesity hypoventilation
- Sleep-related hypoxemia disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Central sleep apnoea due to high-altitude periodic breathing
- Congenital central alveolar hypoventilation syndrome
- Idiopathic central alveolar hypoventilation
- Primary central sleep apnoea
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Hypoventilation
- Indications and application of non-invasive ventilation (NIV) versus invasive ventilation for hypercapnic respiratory failure
- Physiology of ventilatory drive and gas exchange
- Role and pathophysiology of sleep-related hypoventilation in acute and chronic hypercapnic respiratory failure, including obesity, neuromuscular / chest wall disease, reduced central drive, and diseases that chronically increase respiratory load, such as chronic obstructive pulmonary disease (COPD)
- Role of cough assist devices and sputum clearance in patients with neuromuscular weakness
- Role of tracheostomy in airway management
- Use of bilevel non-invasive positive pressure ventilation in managing both acute and chronic hypercapnic respiratory failure
Oxygen therapy
- Assessment process for oxygen therapy
- Delivery systems and use of oxygen therapy in continuous positive airway pressure (CPAP) and NIV
- Indications and guidelines for use of oxygen therapy related to sleep breathing disorders
- Potential adverse effects of oxygen therapy
Sleep apnoea
- Awareness of new technologies in the management of obstructive sleep apnoea (OSA)
- Central role of CPAP in treating OSA, including side effects, factors affecting compliance, and strategies for improving compliance with treatment
- Clinical diagnosis and management of OSA complicated by respiratory failure and/or right heart failure, such as where sleep-disordered breathing (SDB) overlaps with other diseases, such as gross obesity or COPD
- Clinical features of OSA and the differential diagnoses of OSA symptoms
- Epidemiology of SDB and effects of age, gender, obesity, and race on prevalence of SDB, and recognise lesser-known associations
- Occupational and lifestyle implications of SDB
- Pathophysiology of central sleep apnoea and the different types, such as:
- Cheyne–Stokes respiration
- hypercapnic
- non-hypercapnic
- Pathophysiology of OSA and the different phenotypes, as well as its impact upon treatment choice
- Public health implications of SDB, including impact on:
- cardiovascular morbidity and mortality
- diabetes, metabolic syndrome, obesity, and other comorbid medical conditions
- driving, work performance, and emotional / psychological health
- Role of upper airway surgery in the management of snoring and OSA
- Understand the concept of loop gain
Investigations
- Evaluate clinical investigations and circumstances to formulate patients’ individual treatment strategies
- Interpret polysomnography (PSG) findings in patients on ventilatory support, and make recommendations about treatment settings
- Interpret PSG raw data, including:
- scoring respiratory events
- sleep staging and arousals
- oximetry and PTtcCO2 monitoring
- Recommend participation in PSG reporting concordance program at training site
- Select and interpret appropriate respiratory function tests and radiology investigations
- Understand the definition of hypoventilation during wakefulness and sleep (including NREM and REM), how to distinguish the different types of hypoventilation, and how to assess with PSG
- Understand new technology for measuring sleep, such as wearables and nearables, and their strengths and weaknesses
- Understand the different types of sleep studies (level 1 to 4), and the strengths and weaknesses of each
- Understand the role of PSG and limited sleep studies in optimising NIV settings, patient-machine synchrony, and triggering and mask interface
- Understand the role of telemonitoring and remote monitoring of NIV in patients with hypercapnic respiratory failure
Procedures
- Assist with weaning from invasive to NIV
- Apply oxygen delivery systems, such as nasal prongs, masks, and high-flow circuits
- CPAP and auto-titrating positive airway pressure (APAP):
- adjustment of device settings
- interpretation of machine data
- prescribe CPAP based on ambulatory APAP titration
- selection and application of nasal and full-face masks
- troubleshooting treatment problems
- use of chin straps
- use of humidification circuits
- Non-invasive bilevel positive-pressure ventilation:
- adjustment of device settings
- interpretation of machine data
- monitoring patient progress
- selection and application of masks
- troubleshooting treatment problems
- use of humidification circuits
- Oral appliance therapy
- Apply a multidisciplinary approach in the management of sleep-related breathing disorders, recognising the roles of other medical, nursing, and allied health professionals
- Assess the contribution of SDB to respiratory failure, with particular reference to nocturnal hypoventilation
- Explain the public health implications of the high prevalence of SDB in a local context (hospital / local community) and on a national / international scale
- Identify Australian and Aotearoa New Zealand ‘Fitness to Drive’ guidelines and local driver licensing requirements, and assess and advise patients with SDB regarding fitness to drive
- Manage basic tracheostomy care, and refer for specialist assistance when indicated
- Manage complications from hypercapnic respiratory failure and/or heart failure
- Manage the transition from in-hospital to home care, applying knowledge of available support services and home care teams
- Recognise the role of community, rehabilitation, and palliative care services in the management of patients with chronic respiratory failure
- Recognise when referral to another specialist is indicated
- Synthesise history and examination to produce provisional and differential diagnosis, and formulate and undertake management plans
- Understand current available weight loss strategies
