Sleep Medicine – Sleep Science Center

THIS ELECTIVE IS NOT OFFERED IN JULY.

PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Open to M3 and M4 Students

PURPOSE: According to 2015-2016 data by the CDC about 40% of adults and around 18% of children between the ages of 6-11 years are obese. According to estimate by Frost and Sullivan around 29.4 million American men and women are afflicted by obstructive sleep apnea which is around 12% of the US population. In adults obesity is the strongest risk factor for obstructive sleep apnea. More than half of the patients with obstructive sleep apnea are overweight or obese individuals (BMI 25-29.9 or >30).
In the pediatric population enlarged tonsils, adenoids and dental conditions (e.g. overbite) are the main causes in addition to birth defects as seen in Down’s Syndrome and Pierre-Robin. The annual economic burden of undiagnosed sleep apnea among U.S. adults is approximately $149.6 billion. The estimated costs include $86.9 billion in lost productivity, $26.2 billion in motor vehicle accidents and $6.5 billion in workplace accidents. Untreated sleep apnea also increases the risk of costly health complications such as hypertension, heart disease, diabetes and depression.
In the context of the recent debate about health care cost savings and the impact of untreated sleep apnea in lost productivity, accidents, increased health care utilization and medication costs the exposure of our next generation of medical students to this disease in particular and this specialty in general seems reasonable.
Sleep medicine incorporates other specialties like neurology, pulmonary medicine, preventive medicine, psychiatry, psychology, pediatrics, oral and bariatric surgery. A sleep elective rotation for M3-M4 students will expose them to all these fields and help understand and coordinate care for this particular patient population. The patients they will be learning from not only suffer from a multitude of diseases ranging from psychiatric mood disorders to anatomic deformities of the jaw and brain lesions. The medical students will need a multi prong approach which requires knowledge and coordination for a multi-modality treatment approach.
Students during this rotation will be expected to see new consults for evaluation of sleep related issues. This will require a thorough history taking and physical examination, impact of medications on sleep, undiagnosed sleep disorders and its impact on other comorbid conditions. Students will be exposed to different types of sleep disorders ranging from insomnia, narcolepsy, circadian rhythm disorders and sleep apnea. Students will have the opportunity to participate in review of different types of sleep studies including polysomnography and home sleep studies with the faculty. Students will learn to device a treatment plan which will include counseling about sleep hygiene, medications affecting sleep or positive airway pressure therapy for sleep apnea.

LEARNING OBJECTIVES:
What are the students’ expected learning outcomes? Ability to obtain accurate history about sleep complaints, sleep pattern; History of comorbid conditions and medications that can affect sleep; Identify medical conditions that can mimic sleep disorders.

Describe the information, skills, behaviors, or perspectives students will acquire through attendance and participation. Familiarity with questionnaires used to screen patients with high risk for sleep apnea including STOP-BANG, Berlin Questionnaire and for assessing other sleep disorders.
Physical examination for evaluation of jaw morphology, Mallampati scores, tonsillar grades and its effect on breathing during sleep.
Introduction to polysomnography and interpreting these with the faculty to identify different sleep disorders. Treatment modalities for mild-moderate- severe sleep apnea, parasomnias, narcolepsy, idiopathic hypersomnia and circadian rhythm disorders.

Outcomes or actions students can expect to demonstrate as a result of the educational experiences. Students will learn when to refer patients for sleep consultation and testing. Students will develop a plan for the initial testing and interpret those tests with the faculty. Based on the testing results the students would be expected to formulate a treatment plan. Students will understand the follow-up of sleep disorder patients in the clinic to substantiate treatment response and the efficacy of the prescribed therapy. Follow-up visits will include counseling about comorbid conditions including weight loss, smoking cessation, sleep hygiene and interpretation of compliance reports generated from positive airway pressure treatment devices. Besides, students will be expected to troubleshoot common therapy-related side effects and barriers encountered with the therapy.

COMPETENCIES:

Patient care
Obtain a full history and perform a skillful physical examination, formulate a differential diagnoses and clinical investigations necessary to diagnose or narrow the differential. Develop a management plan based on patient preferences and available options considering patient’s socioeconomic restrictions and different family / work needs. Counseling and education about the impact of sleep related diseases in patient safety, work related productivity and effects on comorbid conditions.
Medical Knowledge
Understanding of sleep disorders and its pathophysiology based on evidence based medicine. Epidemiology of sleep disorders in different age groups, different comorbid medical conditions and of different medications. Interpretation of investigations to diagnose different sleep, neurological and cardiac conditions. Pre-employment evaluation of sleep disorders in patients involved in professions where there is a public safety concern like bus/train drivers, pilots, and those operating heavy machinery.
Practice Based Learning
Understanding that sleep medicine like other medical specialties is an ever-changing field; how the practice is changing based on new research and changes in reimbursement. How this can affect the patients, and what the students can expect when practicing as an independent care provider.
Interpersonal Communication skills and Professionalism
UIC sleep center is a mix of ethnically diverse care providers and medical assistants. Our staff ranges from all over the world just like the patient population we see. Understanding different cultures will help students use the skills they learn here to communicate with staff and patients from a diverse background effectively. Understanding different cultural norms from the staff and patients can help our next generation of medical students to be good team players.
System Based Practice
Understanding the delivery of health care resources across different care plans is essential for an astute health care provider to understand the needs of the patients better. In addition, different choices made by patients based on the available resources and preferences will help the students understand the importance of explaining disease pathology and counseling. Students will also coordinate health care delivery by coordinating with providers through different specialties ranging from psychologist to psychiatrist, neurologist to surgeons, resulting in a more wholesome clinical experience.

INSTRUCTIONAL FEATURES:
Interesting case reviews, uncommon polysomnogram (PSG) findings, conferences at the sleep center, outpatient evaluation, interpretation of PSG, mean sleep latency testing, actigraphy and home sleep studies.

Students will be exposed to diverse patient populations with multiple comorbid conditions, occupational evaluation, pre-operative evaluation referrals from otolaryngology and bariatric surgery.