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Utility of ABG, capillary blood gas and venous blood gas
Diagnosis of A-B disorders: Henderson-Hasselbalch equation and the relationship between partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), pH and bicarbonates (HCO3)
A-B disorders: importance of the D(A-a) difference, fraction of inspired oxygen (FiO2), the alveolar gas equation and measuring oxygen shunts
Usage of questionnaires: Epworth sleepiness scale, STOP-BANG score, Berlin questionnaire and SF-36
Two-stage screening with limited sleep tests like nocturnal oximetry to further increase pre-test probability
Identification of high-risk patients, e.g. those with severe sleepiness, unstable cardiac disease, nocturnal arrhythmia or baseline hypoxaemia or those who drive or have another occupational risk
Methodology of different sleep tests (oximetry, respiratory polygraphy and full polysomnography (PSG))
Limitations of overnight oximetry, respiratory polygraphy (PG), and home versus hospital-based sleep studies
Appreciation of which patients to refer for PSG, g. those with an unclear diagnosis on respiratory polygraphy, with comorbidities, a poor treatment response or a suspected non-respiratory sleep disorder such as narcolepsy or restless leg syndrome
Identification of cases that require further specialised examinations, g.ear-nose-throat (ENT) review of the upper airway
Review of cardiovascular, respiratory and metabolic disorders often associated with OSA
High cardio-metabolic and driving risks associated with untreated OSA
Value of making lifestyle improvements including weight loss, exercise, adherence to drug treatment for hypertension or diabetes, smoking cessation and alcohol reduction
Distinguish mild, moderate and severe cases of OSA from normal results and upper airway resistance syndrome integrating add on to apnoea hypopnea index (AHI) parameters such as nocturnal hypoxic burden, or indices of Autonomic dysfunction, etc
Integrating the multicomponent grading system for OSA: the Baveno classification
Lifestyle interventions including weight loss, exercise, smoking cessation, alcohol reduction, avoidance of night sedation and sensible sleep hygiene measures
Role of ENT intervention
Role and types of mandibular advancement splints and other oral devices
Definition of positional sleep apnoea and the role of positional devices
Indications for continuous positive airway pressure (CPAP) therapy
Differences between fixed level CPAP, variable (automatic) CPAP (automatic positive airway pressure (APAP)), and bi-level positive pressure (BPAP) therapy
Identification of patients to refer for these interventions depending on local pathways
CPAP-related side effects such as interface problems, airway drying and sleep disturbance
Issues leading to poor adherence and how these may be addressed
TECSA: identify OSA patients at high risk of developing TECSA, how to diagnose and treat
Different ways of monitoring positive pressure therapy: clinic visits, data downloads from devices and telemonitoring
Follow-up including assessment of the efficacy of therapy in controlling OSA and also the impact on comorbidities and health-related quality of life
Importance of explaining the rationale and likely outcomes of treatment to patients and of providing advice about medico-legal aspects such as driving
Awareness and importance of following local guidelines on the diagnosis and management of OSAHS
Classification of the aetiology of CSA: idiopathic, heart failure-related and induced by a cerebrovascular cause (e.g. a cerebrovascular accident, opioid or other drug use and high altitude)
Differential symptoms and signs of OSA and CSA
Pathophysiology of different types of CSA
Recognition of which patients to refer for sleep studies
Types of positive pressure ventilation and different modes,g. bi-level positive airway pressure, volume ventilation, assured volume ventilation (average volume assured pressure support and intelligent volume assured pressure support) and other NIV modes
Principles of therapy titration with sleep studies and ABG measurement
Monitoring of NIV adherence and concepts of its improvements
Assessment of compliance and reasons for poor and good compliance
Indications for tracheostomy ventilation and which patients to refer for this
Potential role of NIV in palliative care and the importance of palliative therapy
Prevalence of OSAHS in patients with endocrine disorders (e.g. hypothyroidism and acromegaly) and metabolic disorders (e.g. diabetes mellitus and metabolic syndrome)
Impact of OSAHS treatment on underlying endocrine/metabolic disorders
Principles of the tests for assessing excessive daytime somnolence in patients with respiratory and non-respiratory sleep conditions, their advantages, their limitations and which patients to refer for these, including:
Sleep questionnaires
Sleep diary
Multiple Sleep Latency Test (MSLT)
Maintenance of Wakefulness Test (MWT) OSLER wake test
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