Presentations
- Changes to appetite or weight
- Decreased energy
- Difficulty concentrating
- Difficulty waking up from sleep
- Extreme daytime sleepiness (EDS)
- Learning difficulties or behavioural problems
- Memory and speech difficulties
- Mood changes, such as anxiety and irritation
- Paradoxical hyperactivity
- School absenteeism
- Sleeping more than average
Conditions
- Hypersomnolence:
- hypersomnia associated with a psychiatric condition
- hypersomnia due to a medical condition
- idiopathic hypersomnia
- insufficient sleep syndrome
- narcolepsy type 1
- narcolepsy type 2
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- conduct an appropriate examination
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- establish a differential diagnosis
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- plan and arrange appropriate investigations
- recognise the clinical presentation
- take a comprehensive clinical history
Manage
- advocate and liaise with school authorities
- involve multidisciplinary teams
- prescribe therapies tailored to patients’ needs and conditions
- provide evidence-based management
- recognise potential complications of disease and its management, and initiate preventative strategies
Consider other factors
- consider age-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Disinhibited behaviours
- Hallucinations
Conditions
- Kleine–Levin Syndrome
- Menstruation-related hypersomnia
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- conduct an appropriate examination
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- establish a differential diagnosis
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- plan and arrange appropriate investigations
- recognise the clinical presentation
- take a comprehensive clinical history
Manage
- advocate and liaise with school authorities
- involve multidisciplinary teams
- prescribe therapies tailored to patients’ needs and conditions
- provide evidence-based management
- recognise potential complications of disease and its management, and initiate preventative strategies
Consider other factors
- consider age-appropriate treatment options based on maturity and mental understanding
- identify individual and social factors and the impact of these on diagnosis and management
- Behavioural and pharmacological strategies to manage EDS and the daytime consequences of sleep disorders
- Clinical context in which limited channel sleep studies might be useful, including tests performed in the home
- Clinical context in which multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) are indicated, and age-related limitations to these
- Common causes of hypersomnia, including:
- behavioural factors
- environmental factors
- medical
- medication use
- primary sleep disorders
- psychiatric conditions
- Common causes of persistent EDS in patients with treated obstructive sleep apnoea (OSA)
- Contents of the International Classification of Sleep Disorders (ICSD-3)
- Criteria for defining the severity of daytime sleepiness or inability to maintain wakefulness
- Daytime neurocognitive consequences of abnormalities of sleep-wake regulation
- Difference between fatigue, lethargy, tiredness, and sleepiness / drowsiness
- Essential features of a sleep study report used in clinical decision making
- Essential features of reports on tests of sleep propensity used in clinical decision making
- Genetics, presentation, and treatment of narcolepsy
- How disease states and medication use can affect sleep-wake regulation and EDS
- Impact of drowsiness / sleepiness on school and home safety
- Impact of MSLT and MWT findings on driving
- Impact of sleep disorders on quality of life and behaviour
- Important behavioural factors that influence subjective and objective sleepiness and neurocognitive function, such as chronic sleep restriction
- Important role of actigraphy and sleep diaries as part of the evaluation
- Indications for and the interpretation of common tests used in the evaluation of EDS and daytime consequences of sleep disorders
- Lifestyle implications of EDS and other sleep disorders
- Limitations of current available tests for assessment of EDS and daytime consequences of sleep disorders, and identify current research developments
- Models of sleep deprivation and sleep disruption, and the effects on daytime function
- Nature of the above tests, including details of how they are carried out
- Normal neurobiology and neuropharmacology of sleep-wake regulation
- Normative data for sleep architecture and tests of sleep propensity
- Other medical conditions that are associated with EDS, such as myotonic dystrophy and Prader–Willi syndrome
- Primary hypersomnias of central origin that are associated with EDS, including idiopathic hypersomnolence and narcolepsy
- Range of limited channel sleep studies available
- Recognise the actions of centrally acting pharmacological agents and their interactions with sleep
- The role of questionnaires and sleepiness scales in children
Investigations
- Assess severity of daytime consequences of sleep disorders
- Identify EDS or inability to maintain wakefulness based on tests of sleep propensity
- Interpret raw data from sleep studies, including:
- airflow parameters
- airway pressures
- body position
- chin electromyography
- effort parameters
- ECG
- electroencephalogram (EEG)
- electromyography (EMG)
- electro-oculogram (EOG)
- measures of CO2
- oxygen saturation
- Interpret results of investigations regarding EDS and daytime consequences of sleep disorders in the clinical context of the patient
- Perform a thorough history, examination, and sleep-specific assessment, including the use and limitations of sleepiness questionnaires with children
- Perform the relevant general physical, neurological, and respiratory examinations
- Synthesise patients’ symptoms and signs into comprehensive differential diagnoses, and plan further investigations if needed
- Take a thorough sleep history from the patient, as well as bed environment and sleep hygiene behaviour, including bedtime routine, diet, and screen time
Procedures
- Actigraphy
- MWT
- MSLT
- Polysomnography (PSG)
- Urine drug screen
- Determine optimal treatment settings from treatment sleep study parameters
- Determine the requirement for further evaluation in the event of an indeterminate limited channel sleep study
- Determine when MSLTs and MWTs might be appropriate
- Explain and manage drug misuse and withdrawal
- Explain behavioural strategies to reduce the symptoms of EDS and the daytime consequences of sleep disorders, such as sleep education and schedule modification, including the role of naps
- Explain lifestyle implications of EDS and daytime consequences of sleep disorders
- Explain public health and wider societal implications of the diagnosis of narcolepsy and related disorders, such as career choice and industrial safety
- Generate reports for diagnostic and treatment sleep studies
- Identify pathological hypersomnolence or inability to maintain wakefulness based on tests of hypersomnolence
- Interpret results, and formulate management plans
- Monitor the pharmacotherapies for central nervous system (CNS) disorders of hypersomnolence, including the surveillance of side effects and compliance
- Prescribe pharmacotherapy for REM intrusion symptoms, such as cataplexy, in NT1 patients
- Prescribe pharmacotherapy to reduce symptoms of EDS and daytime consequences of sleep disorders
- Recognise the indications for completion of a sleep diary:
- explain the completion of a sleep diary to patients, parents, or carers
- interpret sleep diaries, applying knowledge of normal sleep duration and timing according to age
- use sleep diary information to inform treatment decisions
- Recognise the limitations and clinical applicability of various types of limited channel sleep studies, including:
- cardiorespiratory sleep studies
- limited channel PSG studies
- overnight oximetry
- Recognition of wearable devices which are now widely available in the consumer market, as well as their limitations
- Surveillance of other disorders in patients with CNS disorders of hypersomnolence, such as increased risk of cardiovascular disease and appearance of obstructive sleep apnoea
