Sleep HERMES: a European Core Syllabus in respiratory disorders during sleep

W. De Backer, A. Simonds, V. Horn, S. Andreas, M. Bonsignore, P. Calverley, V. Donic, P. Levy, S. Mitchell, W. McNicholas, M. Morrell, W. Randerath, R. Riha, H. Trang, J. Verbraecken, P. Palange
Breathe 2011 8: 61-68; DOI: 10.1183/20735.005611

Figures

Tables

  • Table 1 Participation in and results of the online surveys
    Invited participantsResponse rateDifferent countriesPaediatric module mandatory for paediatriciansPaediatric module optional for other specialistsItems reaching consensus
    Level 1Level 2Level 3
    Survey 1
     Task Force7
     National respondents2121 (100%)21
     Assembly 426466 (25%)30
     All respondents28587 (31%)35
    Survey 2
     Task Force1412 (85.7%)7100%77.8%380
     National respondents2112 (57.1%)2081.2%75%1314
     Assembly 426434 (12.9%)3078.6%78.6%202
     All respondents29958 (19.4%)2583.3%77.6%002
    Survey 3
     Task Force1413 (92.9%)7106246
     National respondents2115 (71.4%)1380186
     Assembly 426443 (16.3%)25112212
     All respondents29971 (23.7%)30105215
  • Table 2 Countries represented during all three rounds of the survey
    RomaniaPolandDenmark
    UKPortugalSaudi Arabia
    GreeceSwedenAlbania
    ItalySwitzerlandChile
    GermanyAustraliaCroatia
    BelgiumCyprusCzech Republic
    FranceEgyptEcuador
    SpainTurkeyJapan
    IrelandFinlandLuxembourg
    Slovak RepublicTaiwanRussia
    BrazilIranSerbia
    NetherlandsAndorraSlovenia
    AustriaBulgaria
    LithuaniaCanada
  • Appendix 1: Respiratory sleep medicine syllabus
    MODULE 1 "Physiology and anatomy of sleep and breathing"Level 1Level 2Level 3
    1 Neuroanatomy and neurobiology of sleep
     1.1 Regulation of the sleep–wake cycle including arousals•
     1.2 Sleep across lifespan•
    2 Breathing during sleep and wakefulness
     2.1 Control of breathing during sleep and wakefulness•
     2.2 Anatomy and function of the upper airway•
     2.3 Respiratory mechanics and ventilation•
    3 Homeostatic regulation during sleep
     3.1 Autonomic and cardiovascular regulations•
     3.2 Metabolic regulation•
    MODULE 2 "Respiratory conditions"Level 1Level 2Level 3
    1 Definitions of sleep disordered breathing (OSA, OSAS, CSA, CSAS, CSR, OHS, UARS, Snoring)•
    2 Obstructive sleep apnoea (OSA)
     2.1 Epidemiology of and risk factors for OSA•
      2.1.1 Obesity•
      2.1.2 Age•
      2.1.3 Sex•
      2.1.4 Other comorbidities•
     2.2 Pathophysiology of OSA
      2.2.1 Craniofacial and upper airway morphology•
      2.2.2 Function and dysfunction of upper airway muscles•
      2.2.3 Central respiratory control mechanisms•
     2.3 Clinical aspects of OSA•
      2.3.1 Symptoms•
      2.3.2 Physical examination including upper airways•
     2.4 Consequences of OSA
      2.4.1 Neurobehavioural (sleepiness, cognitive and psychiatric)•
      2.4.2 Cardiovascular•
      2.4.3 Metabolic•
    3 Central sleep apnoea (CSA) and Cheyne–Stokes respiration (CSR)
     3.1 Epidemiology of and risk factors for CSA/CSR•
      3.1.1 Primary CSA•
      3.1.2 Secondary CSA•
     3.2 Pathophysiology of CSA/CSR
      3.2.1 Primary CSA•
      3.2.2 Cardiovascular disorders•
      3.2.3 Opioid induced•
      3.2.4 High altitude•
     3.3 Clinical aspects of CSA
      3.3.1 Symptoms•
      3.3.2 Physical examination•
     3.4 Consequences of CSA
      3.4.1 Neurobehavioural (sleepiness, cognitive and psychiatric)•
      3.4.2 Cardiovascular•
    4 Hypoventilation syndromes
     4.1 Central hypoventilation syndrome•
     4.2 Obesity hypoventilation syndrome•
     4.3 Neuromuscular disorders•
    5 Comorbid respiratory disorders
     5.1 Asthma•
     5.2 Chronic obstructive pulmonary disease•
     5.3 Restrictive lung disorders•
    6 Comorbid nonrespiratory disorders
     6.1 sleep in renal failure patients under dialysis (high rate of sleep problems)•
    MODULE 3 "Nonrespiratory conditions"Level 1Level 2Level 3
    1 Classification•
    2 Insomnia
     2.1 Primary insomnia•
     2.2 Secondary insomnia•
    3 Parasomnia and movement disorders during sleep
     3.1 Periodic leg movement disorder and “restless legs” syndrome•
     3.2 REM-related disorders•
     3.3 Non-REM-related disorders•
    4 Hypersomnia
     4.1 Narcolepsy•
     4.2 Idiopathic hypersomnia•
    5 Circadian rhythm disorders
     5.1 Sleep–wake rhythm disorders•
     5.2 Shiftwork and sleep•
    6 Psychiatric aspects of sleep•
    MODULE 4 "Clinical assessment"Level 1Level 2Level 3
    1 Sleep history•
    2 Differential diagnosis of hypersomnolence, tiredness, sleepiness, fatigue•
    3 Application of diagnostic algorithms•
    4 Questionnaires on sleep•
    5 Quality of life•
    6 Assessment of surgical and anaesthesia risks•
    7 Predisposing factors•
    8 Comorbidity assessment•
    MODULE 5 "Diagnostic techniques"Level 1Level 2Level 3
    1 Polysomnography
     1.2 Sensors•
     1.3 Measurement techniques (including filters, calibration)•
     1.4 Scoring EEG according to R&K and AASM•
     1.5 Scoring respiratory disturbances•
     1.6 Scoring movements during sleep•
     1.7 Evaluation of ECG•
     1.8 Interpretation of polysomnography•
     1.9 PTT•
    2 Assessment of daytime sleepness
     2.1 MSLT•
     2.2 MWT•
     2.3 Non-EEG-based sleep tests•
    3 Cardiorespiratory monitoring during sleep
     3.1 Polygraphy scoring: settings, trends and pitfalls•
     3.2 Interpretation of cardiorespiratory polygraphy•
     3.3 Oximetry•
    4 Actigraphy•
    5 (Nocturnal) capnography•
    MODULE 6 "Treatment and follow up"Level 1Level 2Level 3
    1 Treatment of respiratory sleep disorders
     1.1 Positive airway pressure (PAP) treatment•
      1.1.1 PAP principles and machines•
      1.1.2 PAP interfaces•
      1.1.3 PAP titration•
     1.2 OSA
      1.2.1 Treatment algorithms•
       1.2.1.1 Patient education including life style modificaiton, sleep hygiene, PAP use•
       1.2.1.2 Positional treatment•
       1.2.1.3 PAP treatment (including CPAP, auto-CPAP and BPAP)•
       1.2.1.4 Oral devices/Mandibular repositioning splints•
       1.2.1.5 Surgery of the upper airway (including radiofrequency ablation technique)•
       1.2.1.6 Bariatric surgery•
       1.2.1.7 Drug treatment•
       1.2.1.8 Recognition and initial treatment of comorbidities•
      1.2.2 Follow-up and compliance•
     1.3 CSA
      1.3.1 Treatment algorithms•
       1.3.1.1 Optimising treatment of underlying disorders•
       1.3.1.2 PAP treatment (including CPAP and BPAP)•
       1.3.1.3 Adaptive servo ventilation•
       1.3.1.4 Oxygen therapy•
       1.3.1.5 Drug treatment•
       1.3.2 Follow-up and compliance•
     1.4 Hypoventilation/chronic respiratory insufficiency
      1.4.1 Treatment algorithms•
       1.4.1.1 Noninvasive ventilation•
      1.4.2 Follow-up and compliance•
    2 Treatment of nonrespiratory sleep disorders
     2.1 Pharmacological•
     2.3 Non-pharmacological•
    MODULE 7 "Medicolegal aspects of sleep disorders"Level 1Level 2Level 3
    1 Medicolegal aspects of sleep disorders•
    MODULE 8 "Paediatric"Level 1Level 2Level 3
    1 Physiology
     1.1 Ontogenesis and maturation of sleep in the first years of life•
     1.2 Ontogenesis and maturation of control of breathing in the first years of life•
    2 Respiratory conditions
     2.1 Physiopathology, diagnosis and assessment of apnoea in infants/of ALTE•
     2.2 Physiopathology, epidemiology, diagnosis and assessment of sleep disordered breathing in children•
      2.2.1 Obstructive sleep apnoea•
       2.2.1.1 including risks, clinical aspects and consequences (neurocognitive mainly)•
      2.2.2 Sleep hypoventilation syndromes and central sleep apnoeas•
       2.2.2.1 including neuromuscular conditions and CCHS•
      2.2.3 Comorbid respiratory disorders
       2.2.3.1 including allergic respiratory disorders and asthma, BPD and cystic fibrosis•
    3 Non respiratory conditions
     3.1 Narcolepsy and other hypersomnias•
     3.2 ADHD and other behavioral disorders•
     3.3 Crossover between hypersomnias, behavioural disorders and SDB in children•
    4 Clinical assessment•
     4.1 Sleep history and clinical assessment of an infant•
     4.2 Sleep history and clinical assessment of a child•
     4.3 Indications for respiratory and nonrespiratory investigations•
    5 Diagnostic techniques
     5.1 Polysomnography
      5.1.1 Sensors•
      5.1.2 Scoring EEG in an infant/in a child•
      5.1.3 Scoring breathing in an infant/in a child•
      5.1.4 Normative data in an infant/in a child•
      5.1.5 Interpretation and report of polysomnography in an infant/in a child•
     5.2 Cardiorespiratory monitoring in children•
      5.2.1 Validity and reliability of polygraphy•
      5.2.2 Polygraphy scoring rules and report•
     5.3 Oximetry•
     5.4 Assessment of daytime sleepiness
      5.4.1 MSLT and MWT: scoring rules, normative data•
    6 Management
     6.1 Apnoeas in infants•
     6.2 OSA•
      6.2.1 Treatment options•
       6.2.1.1 Tonsillectomy and/or adenoidectomy and other ENT procedures•
       6.2.1.2 Craniofacial procedures•
       6.2.1.3 Orthodontic procedures•
       6.2.1.4 CPAP treatment•
       6.2.1.5 Lifestyle management•
       6.2.2 Indications
     6.3 Sleep hypoventilation syndromes•
      6.3.1 Indications for noninvasive ventilation or tracheostomy ventilation•
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Sleep HERMES: a European Core Syllabus in respiratory disorders during sleep
W. De Backer, A. Simonds, V. Horn, S. Andreas, M. Bonsignore, P. Calverley, V. Donic, P. Levy, S. Mitchell, W. McNicholas, M. Morrell, W. Randerath, R. Riha, H. Trang, J. Verbraecken, P. Palange
Breathe Sep 2011, 8 (1) 61-68; DOI: 10.1183/20735.005611
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