Maharashtra University of Health Sciences, Nashik. Syllabus. Fellowship Course in Sleep Medicine

Transcription

1 Maharashtra University of Health Sciences, Nashik Syllabus Fellowship Course in Sleep Medicine

2 Appendix A a) Title of the Fellowship Course: Fellowship Course in Sleep Medicine b) Duration of Course: 1 year c) Objectives of the Course: To train Physicians in the Branch of Sleep Medicine d) Details of available teaching and infrastructural facilities: Department of Pulmonary Medicine /Neurology with a dedicated Sleep Laboratory. e) Faculty required with their qualification and experience: Professor/ Associate Professor or Consultant (MD/DNB Pulmonary/Respiratory Medicine or DM /DNB Neurology) with at least 5years of experience in the field. f) Designations of the faculty and details of the department: Institutes to apply with required details. g) Paramedical and non-teaching staff required: 1 Sleep technician h) Availability of clinical material: Adequate/inadequate Text Books 1. Kryger MH, Roth T, Dement W, editors. Principles and Practice of Sleep Medicine. Philadelphia: W.B.Saunders Company; Ferber R, Kryger M. editors. Principles and practice of sleep medicine in the child. Philadelphia: W.B.Saunders Company; E-Learning Resources American Thoracic Society This web-based resource holds relevant statements on sleepiness and sleep apnea and the utility of cardiopulmonary monitoring. American Academy of Sleep Medicine MEDSleep. A program developed by the National Center on Sleep Disorders Research NHLBI s Sleep Academic Award Program. The MEDSleep website provides a comprehensive library of more than 100 web-based sleep curricular-based materials, which can be downloaded free of charge on most curricular elements for sleep medicine and neurobiology of sleep. European Respiratory Society s Web-based Learning Programme in Sleep Medicine

3 This program is currently in development. Australasian Sleep Society The website hosted has many portals to the sleep web world. National Center on Sleep Disorders Research The NCSDR of the NHLBI has web-based educational materials on its website designed for health professionals, including information on sleep apnea and restless legs syndrome. Sleep Home Pages This site is operated by Web Science International with support provided in part from the National Institute of Mental Health. The site provides the Sleep Syllabus, which was originally developed by members of the Sleep Research Society. National Sleep Foundation s Sleep Medicine Alert These web-based alerts provide reviews on sleep topics, including circadian rhythms and sleep-related breathing disorders. American Sleep Apnea Association This association has web-based materials tailored for patients and health care professionals concerning sleep apnea and treatment options. Sleep Medicine Home Page This web-based resource provides many resources including topics covering sleep physiology and clinical sleep medicine, and also lists sleep-related professional associations and foundations with their websites. Restless Legs Foundation The Restless Legs Foundation provides a medical bulletin written for health professionals, which is updated yearly, and which clearly outlines the diagnosis, pathophysiology, and treatment of restless legs syndrome and periodic limb movement disorder. i) Academic calendar for the course: 1 year (July-June)

4 j) Eligibility criteria for participants: MD (Pulmonary Medicine), MD (Medicine), MD (Paediatrics), MD (Physiology), DM (Neurology) k) Syllabus for the course: Overview: Sleep medicine has evolved to something of a sub-specialty area with relevance across a number of fields, including respiratory medicine, cardiology, neurology, surgery and dentistry, with wider implications for health sciences and public health. The program aims to provide up-to-date information on theory and practice of sleep medicine through distance education; the courses provide training in clinical, theoretical and research techniques in the field of sleep medicine and help to establish criteria for best practice in the field. These courses are suitable for those already working in the area of sleep medicine, or for those wishing to undertake a career change. The courses provide a firm basis for vocational training in this discipline. Course Outcomes: These courses provide students with the opportunity to gain an excellent understanding of the theoretical and practical aspects of sleep medicine. As sleep medicine is relevant to so many areas of medicine and health care, it enables students to competently incorporate the new skills into their current practice. The courses also equip students with the skills to undertake research in this growing area of medicine.

5 Course Curriculum I. Normal Sleep and Its Variations a. Sleep anatomy b. Sleep physiology c. Sleep staging d. Effects of aging on sleep e. Effects of sleep deprivation f. Altitude and environmental effects g. Epidemiology of sleep-disorders II. Diagnostic methods and procedures A. Sleep-related history and physical examination 1. History, including sleep wake behavior ( sleep log or sleep diary ), snoring, day time sleepiness by Epworth sleepiness scale, accident proneness, etc. 2. Medication-related effects on sleep 3. Directed examination of the patient (BMI, Neck circumference, abdominal girth, waist/hip ratio, ear, nose throat examination, airway, chest wall, lung and cardiac examination) 4. Differential diagnosis and pretest probability of sleep-disordered breathing as well as of other sleep disorders 5. Comorbidity (Craniofacial abnormality, endocrinological problems like hypothyroidism/cushings, congestive heart failure, gastro-oesophageal reflux, anxiety/depression or other psychiatric abnormalities) B. Diagnostic Tests 1. Upper airway Anatomy Lateral cephalometry, CT scan, MRI, endoscopy 2. Polysomnography a. How to perform b. Indications for testing c. Choosing the appropriate level of polysomnography d. Recognize awake and sleep (non-rem/rem) states e. Recognize hypopneas and apneas (obstructive, central, mixed) f. Recognize classic examples of other specific conditions (PLMs) g. Recognize flow limitation and respiratory effort related arousals f. Polysomnographic interpretations 2. Ancillary tests: technique, indication, and interpretation a. Multiple Sleep Latency Test b. Maintenance of Wakefulness Test III. Sleep Disorders A. Obstructive sleep apnea 1. Natural history 2. Diagnosis 3. Treatment a. Ventilatory support (CPAP, bilevel treatment, oxygen) b. Surgical management, including UPPP and bariatric surgery c. Behavioral and pharmacologic options 4. Definitions of outcome B. Central sleep apnea (Cheyne-Stokes respiration) and its management C. Other sleep disorders

6 1. Circadian rhythm disorders 2. Insomnia and sleep hygiene 3. Periodic limb movement 4. Narcolepsy D. Sleep issues in other disorders 1. Pulmonary diseases (respiratory failure, COPD, restrictive lung disease, asthma) 2. Cardiac disease (CHF, angina, hypertension) 3. Neuromuscular diseases 4. Obesity 5. GERD E. Paediatric sleep disorders F. Assessments of the hospitalized patient 1. Perioperative screening and management 2. Management of previously unrecognized sleep-disordered breathing