Respiratory sleep certified training programme

Participants will learn to:

• Differentiate, diagnose and manage obstructive breathing disturbances during sleep.
• Select different mechanisms and apply to clinical practice, for example craniofacial and upper airway morphology, function and dysfunction of upper airway muscles, central respiratory control mechanisms.
• Recognise the limitations of screening methods.
• Consider risk factors and appraise them in therapeutic decisions.
• Integrate knowledge of the pathophysiology of the upper airway muscles in management of patients.
• Describe the characteristics of subjective impairment and signs.
• Describe the characteristics of the mouth, throat and craniofacial configuration.
• Explain the role of echocardiography, lung function and cardiological examination.
• Manage OSA caused by craniofacial and upper airway morphology and consider referral.
• Detect hypercapnic and hypoxic ventilatory response tests.
• Interpret oxygen and CO2 as a marker of respiratory response.
• Produce a sleep history and appraise sleep questionnaires.
• Differentiate diagnosis based on symptoms and discriminate comorbidities.
• Produce recommendations for treatment and consider treatment pathways.
• Valuate the cardiovascular, neurobehavioural, and metabolic consequences of OSA, for example, through interpretation of attention tests/vigilance tests, echocardiogram, and blood test on diabetes and lipids.

Participants will learn to:

• Describe the polygraphic and polysomnographic parameters of central sleep apnoea.
• Describe periodic breathing as a subtype of central sleep apnoea.
• Differentiate obstructive and central apnoeas and obstructive and central hypopnoeas.
• Describe the different phenotypes of central sleep apnoea.
• Define the epidemiology of central sleep apnoea.
• Critically estimate the clinical relevance of central sleep apnoea regarding daytime impairment and outcome.
• Describe risk factors and underlying diseases that may induce/be related to central sleep apnoea.
• Differentiate physiological phenotypes of central sleep apnoea, such as arousal-induced, sleep-wake-transition, etc., as compared to central sleep apnoea as a disease.
• Describe a hypothesis of pathophysiology of opioid induced sleep apnoea and central sleep apnoea in heart failure.
• Describe and differentiate treatment options such as oxygen, carbon dioxide, drugs, positive airway pressure options.
• Describe the role of CPAP in specific patients, including those with mixed OSA and CSA.
• Explain the adaptive servo-ventilation used in heart failure patients with a left ventricular ejection fraction of less than 45%.
• Describe the CPAP or adaptive support ventilation (ASV) in patients with opioid-induced sleep disordered breathing.
• Review trials in progress to assess O2 therapy in patients with CSA and the further role of ASV

Participants will learn to:

• Differentiate, diagnose and manage hypoventilation during sleep.
• Classify secondary hypoventilation syndromes.
• recognise symptoms, clinical presentation and pathophysiology of obesity hypoventilation syndrome.
• Explain consequences of obesity hypoventilation syndrome, such as polyglobulia and cor pulmonale.
• Explain the risks of obesity and offer advice on how to decrease body mass index through physical activity, training and diet.
• Analyse symptoms, clinical presentation and pathophysiology of hypoventilation in neuromuscular diseases.
• Review insights into different neuromuscular disorders of various origins, including disorders caused by accidents, operations, and familial inheritance.
• Compare respiratory failure stages in neuromuscular disorders.
• Define hypercapnic respiratory failure.
• Evaluate and diagnose daytime hypercapnia by control of blood gases, transcutaneous capnography, and body weight and clinical muscle assessment.
• Interpret blood gases.
• Assess indications for noninvasive ventilation, application or supervision of mask and interface.
• Perform respiratory muscle testing, such as maximal inspiratory pressure and maximal expiratory pressure.
• Relate the influence of comorbid respiratory disorders on breathing during sleep.

Participants will learn to:

• Describe different types of positive airway pressure therapy and assess the appropriate use of the different therapies.
• List various types of positive pressure interfaces and how these may suit different patients.
• Recognise the concepts of compliance and adherence.
• Initiate CPAP, auto-CPAP based/with prediction formula and select the appropriate device.
• Use NIV in obstructive lung disease such as COPD and neuromuscular diseases, such as motor neurone disease/amyotrophic lateral sclerosis (ALS).
• Acquire problem-solving strategies for CPAP and NIV.

Regarding polysomnography and polygraphy, participants will learn to:

• Define, describe and differentiate apnoeas and hypopnoeas.
• Describe and define other breathing disturbances, such as periodic breathing, atactic breathing and treatment emergent central sleep apnoea.
• Differentiate phasic and sustained oxygen desaturations.
• Distinguish between the apnoea-hypopnoea-indices based on polysomnography (in relation to total sleep time) and polygraphy (in relation to measurement time).

In polysomnography only, participants will also learn to:

• Describe parameters such as electroencephalogram (EEG), electrooculography (EOG), electromyography (EMG), microphone, flow, thermistor, effort, oxygen saturation, electrocardiogram (ECG), movement and body position.
• Analyse sleep stages.
• Describe variations of sleep parameters during the lifetime.
• Describe somnological disorders other than sleep related breathing disorders, such as insomnia, periodic limb movements/restless leg syndrome and narcolepsy, and their polysomnographic characteristics.

Regarding the evaluation of daytime sleepiness, participants will learn to:

• Evaluate daytime sleepiness based on self-assessment questionnaires, technical tests and electrophysiological tests.
• Describe the Epworth Sleepiness Scale as a validated self-assessment questionnaire, describe the test and interpretation of the results.
• Describe the Stop-Bang-Questionnaire as a combined tool, including symptoms and risk factors.
• Describe technical tests, such as driving simulator or vigilance test, as objective additional tools for the evaluation of sleepiness and daytime performance.
• Describe the Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT), describe the interpretation of their results, and the relevance of MSLT and MWT in the evaluation of driving performance and narcolepsy

• Online modules
  • Clinical physiology
  • Diagnostic approaches
  • Medicolegal aspects
  • Learning resources
• Sleep and Breathing Conference
  • 22 April 2023 from 10:30 – 12:00 CET
  • Clinical update: Obstructive sleep apnoea
    • Definition, epidemiology, pathophysiology, clinical features and diagnosis
    • Consequences and treatment approaches
• Online assessment
  • 20 multiple choice questions

• Online modules
  • Diagnosis
  • Clinical physiology
  • Treatment and management
  • Learning resources
• Sleep and Breathing Conference
  • 22 April 2023 from 08:30 – 10:00 CET
  • Clinical update: Central sleep apnoea
    • Recognition and differentiation
    • How to treat
• Online assessment
  • 20 multiple choice questions

• Online modules
  • General pathophysiology of hypoventilation
  • Obesity hypoventilation syndrome
  • Hypoventilation and COPD
  • Obesity OSA and COVID-19
  • Learning resources
• Sleep and Breathing Conference
  • 22 April 2023 from 12:45 – 14:15 CET
  • Clinical update: Hypoventilation syndromes
    • Physiopathology
    • From diagnosis to treatment modalities and outcomes
• Online assessment
  • 20 multiple choice questions

• Online modules
  • Skills-based simulator training in noninvasive ventilation
  • CPAP and NIV treatment
  • PAP therapy and home NIV for COPD patients with SDB
  • Pathophysiology of SDB and hypoventilation in COPD
  • Other treatment modalities
  • Learning resources
• Sleep and Breathing Conference
  • Skills workshop: CPAP & NIV
    • Workstation 1: Different positive airway pressure modes in non-invasive ventilation
    • Workstation 2: Overview of different types of masks
    • Workstation 3: Solutions for humidification and overview of different heated tubes
  • 20 April 2023 from 15:15 – 17:45 CET or
  • 21 April 2023 from 09:00 – 11:30 CET
• Online assessment
  • 20 multiple choice questions

• Online modules
  • Polysomnography: principles and practice
  • Setting up polysomnography and polygraphy in adults and children
  • Assessment of excessive daytime sleepiness
  • Medicolegal aspects
  • Learning resources
• Sleep and Breathing Conference
  • Skills workshop: Diagnostic techniques
    • Workstation 1: Setting up polysomnography and polygraphy in adults and children
    • Workstation 2: Interpreting polysomnography and polygraphy in children
    • Workstation 3: Interpreting polysomnography and polygraphy in adults
    • Workstation 4: Evaluation of daytime sleepiness
  • 20 April 2023 from 09:00 – 11:30 CET or
  • 21 April 2023 from 15:15 – 17:45 CET
• Online assessment
  • 20 multiple choice questions