Thoracic and Sleep Medicine

Sleep Medicine

Advanced Training Program in Sleep Medicine

Level I:
"To enable the trainee to have a proportion of clinical practice in Paediatric Sleep Medicine, and to report paediatric sleep studies".

Training shall be approved prospectively by the Thoracic and Sleep Medicine SAC, and include the equivalent of 12 months full-time training in a paediatric sleep facility; this may be undertaken Post-FRACP.

The objectives of this training are :

• Knowledge of the changes in normal sleep physiology (sleep patterns, sleep states and EEG) that occur with growth and maturation.
  
• Understanding of the changes in normal respiratory physiology, including ventilatory control, gas exchange and mechanics during sleep.
  
• Experience in the diagnosis and management of respiratory disorders that are either exclusively sleep-related, or exacerbated by sleep, including the use of respiratory support devices (CPAP and pressure and volume-cycled non-invasive ventilation) and oxygen therapy. At this level, you should have actively participated in the institution of CPAP therapy for at least 10 patients.
  
• Knowledge of the symptomatology and management of non-respiratory sleep disorders, particularly those that are encompassed in the differential diagnosis of sleep apnoea.
  
• A thorough understanding of polysomnographic techniques, and interpretation of polysomnography in children. Thus, at this level you should be adept at the reporting of paediatric sleep studies in infants and in older children. You should have scored a minimum of 50 sleep studies (including 15 infants <6 months), with the first 10 in each age category (less than, and greater than 6 months) supervised on an epoch-epoch basis, and scoring abilities be deemed appropriate for the unit before unsupervised scoring is undertaken.

Level II:
"To enable the trainee to have a career in paediatric sleep medicine".
It is recommended that you undertake the equivalent of 24 months of full-time training in clinical sleep medicine. You are encouraged to undertake further training in a complementary discipline eg neurology, developmental paediatrics, child psychiatry, and to acquire experience in more than one institution. Dual recognition in Paediatric Thoracic Medicine and Paediatric Sleep Medicine, requires the completion of at least 4 years of Advanced Training (two years core training in each).

The training would result in objectives as above (Level I) as well as an advanced knowledge/skills of the following:

• The changes in normal sleep physiology (sleep patterns, sleep states and EEG) that occur with growth and maturation.
  
• Changes in normal respiratory physiology, including ventilatory control, gas exchange and mechanics during sleep.
  
• Competent diagnosis and management of respiratory disorders that are either exclusively sleep-related, or exacerbated by the superimposition of sleep, including the use of respiratory support devices (CPAP and pressure and volume-cycled non-invasive ventilation) and oxygen therapy.
  
• Detailed knowledge of the symptomatology and management of non-respiratory sleep disorders.
  
• A thorough understanding of polysomnographic techniques, and interpretation of polysomnography in children. At this level you must be adept at the reporting of paediatric sleep studies in infants and in older children. You should be able to demonstrate an ability to trouble-shoot problems in polysomnography, so that you can provide quality control of data acquired and interpreted under your supervision.
  
• Knowledge of and skills in the critical appraisal of current literature, and research in the field of paediatric sleep medicine. This should be of a standard that would be publishable in a peer-reviewed medical journal.
  
• If in this stream, you are encouraged to attend at least one meeting of the Australasian Sleep Association during the period of Advanced Training.

Essential Procedural skills for Specific Training in Paediatric Sleep Medicine (Levels I and II)

Full polysomnography, MSLT, oximetry, transcutaneous and/or end-tidal CO2 monitoring, and the instigation of non-invasive respiratory support devices, including nocturnal nasal-mask ventilation and CPAP.

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