Program Structure

At the end of the Sleep Medicine Fellowship, fellows will be able to:

1. Interview patients about their sleep-related complaints.
2. Identify the relationship between the patient's sleep habits and daytime functioning and explain to patients how one affects the other.
3. Gather relevant diagnostic information/testing relevant to various sleep disorders and summarize it to support the History and Physical exam when available.
4. Perform a physical exam focused on identification a variety of sleep disorders in adults and children with none to multiple complex medical conditions.
5. Develop a differential diagnosis for sleep-related complaints.
6. Recommend diagnostic work up, including selected sleep studies when applicable, based on findings from the history and physical exam and based off of the working diagnosis.
7. Score, interpret and report results of sleep studies including polysomnograms, home sleep apnea tests, positive airway pressure titrations, multiple sleep latency tests, actigraphy, maintenance of wakefulness test, etc. based on up to date American Academy of Sleep Medicine guidelines. Fellows must interpret a minimum of 200 sleep studies (polysomnography, at least 40 for adults and 40 from children), score a minimum of 25 recordings (at least five adults and five pediatrics) and 25 multiple sleep latency tests during this training period.
8. Recognize the limitations of tests provided by the Sleep Laboratory in the diagnosis and management of patients with sleep disorder.
9. Recognize and overcome artifacts in recorded data channels.
10. Translate results in simple terms to patients and/or their caregivers.
11. Recommend treatment plans and appropriate follow up.
12. Identify opportunities for multi-disciplinary management and collaboration with other specialists.
13. Identify gaps in knowledge and opportunities for research in sleep medicine.
14. Recognize differences between pediatric and adult sleep disorders in terms of clinical presentation, management and treatment, as well as polysomnographic features.
15. Provide longitudinal care of patients throughout the year by seeing patients in follow-up to evaluate the efficacy of the treatment plan established.
16. Understand basic operations of the outpatient office and sleep laboratory as the medical director, including how to handle the human resource element and financial aspects of the sleep center.

At the end of the Pediatric Sleep Medicine rotation, the Sleep Medicine Fellows will be able to:

1. Interview parents/caregivers, and pediatric patients when applicable, about their sleep- related habits and complaints.
2. Examine the relationship between the patients' sleep habits/complaints and daytime functioning and their environment.
3. Perform physical exam for pediatric patients focused on evaluation for a variety of sleep disorders.
4. Develop a differential diagnosis for sleep-related complaints in the pediatric patient population.
5. Recommend diagnostic work up, including selected sleep studies when applicable, based on findings from the history and physical exam and based off of the working diagnosis.
6. Score, interpret and report results of sleep studies including polysomnograms, positive airway pressure titrations, multiple sleep latency tests, etc. based on up to date American Academy of Sleep Medicine guidelines. Fellows will interpret at least 40 pediatric polysomnographic studies and score a minimum of five studies during this training period.
7. Translate results in simple terms to patients and/or their caregivers.
8. Recommend treatment plans and appropriate follow up.
9. Identify opportunities for multi-disciplinary management and collaboration with other specialists.
10. Identify gaps in knowledge and opportunities for research in pediatric sleep medicine.
11. Recognize differences between pediatric and adult sleep disorders in terms of clinical presentation, management and treatment, as well as polysomnographic features.

At the end of the Neurology “Amyotrophic Lateral Sclerosis (ALS) Multidisciplinary Clinic” Sleep Medicine rotation, the Sleep Medicine Fellows will be able to:

1. Experience the multidisciplinary outpatient evaluation and management of patients with neuromuscular disorders and, more specifically, ALS.
2. Recommend evaluation for respiratory failure secondary to neuromuscular diseases and identify clinical indications for invasive and non-invasive positive pressure ventilation.
3. Prescribe non-invasive positive pressure ventilation for treatment of respiratory failure secondary to neuromuscular diseases.
4. Interpret data from ventilators and recommend targeted interventions based on objective downloads (including tele-monitoring) and subjective reports from patients and caregivers.
5. Recognize indications for monitoring of oximetry and carbon dioxide levels.
6. Identify patients that may benefit from sleep study evaluation or advanced titrations in the Sleep Center.
7. Identify the roles of the different specialists in the multidisciplinary team approach.

At the end of the Behavioral Sleep Medicine Rotation, the Sleep Medicine Fellows will be able to:

1. Engage in the differential diagnosis of insomnia and the circadian rhythm sleep-wake disorders (CRSD).
2. Identify the presumed pathophysiology of insomnia and CRSDs, considering the roles of physiology, pharmacology, cognition, and behavior.
3. Recognize common comorbidities of insomnia, including depression, anxiety, alcohol abuse, acute or chronic stress and chronic pain.
4. Develop appropriate multicomponent treatment interventions for insomnia, the CRSDs, nightmare disorder, and some parasomnias.
5. Identify patients with insomnia who will benefit from and implement cognitive behavioral therapy for insomnia (CBT-I).
6. Discuss advantages and disadvantages of pharmacotherapy, CBT-I and combination treatment for insomnia.
7. Identify factors responsible for non-adherence or suboptimal adherence to positive airway pressure (PAP) therapies in sleep disordered breathing and observe BSM clinicians addressing these factors.

At the end of the Outpatient Sleep ENT rotation, the Sleep Medicine Fellows will be able to:

1. Participate in the ambulatory assessment of new and follow-up patients, but more specifically those referred to ENT with sleep disorders.
2. Recommend diagnostic work up and treatment of common ENT comorbidities of sleep disorders.
3. Gain experience in the assessment of airway size and patency. Identify grading methods for upper airway obstruction.
4. Observe and/or participate in nasopharyngolaryngoscopies and drug induced sleep endoscopies (DISE).
5. Identify patients that benefit from referral to ENT.
6. Identify patients that will benefit from surgical intervention in the treatment of sleep disorders including obstructive sleep apnea and understand selection of patients form different surgical approaches.
7. Recognize potential for collaboration with other specialties/disciplines including pediatrics, dentistry, and craniofacial surgery.

At the end of the Bariatric Surgery rotation, the Sleep Medicine Fellows will be able to:

1. Identify patients that benefit from referral to bariatric/metabolic surgery and surgical intervention.
2. Recognize challenges/pathways to support patients from identification/referral to treatment.
3. Participate in the ambulatory assessment of new and follow-up patients, specifically those referred for surgical/metabolic weight management with comorbid sleep disorders.
4. Identify different bariatric surgical procedures/ be able to discuss with patients (indications, benefits, risks of each approach).
5. Recommend sleep disorders screening, sleep-focused diagnostic work up and treatment peri-bariatric surgery.
6. Identify peri-operative complications and interventions to decrease peri-operative risks related to bariatric surgery.
7. Recommend follow up/treatment of sleep disorders after bariatric surgery.

Fellows are expected to attend multidisciplinary conferences. These conferences include:

1. A weekly conference to discuss interesting or challenging cases, and tele-medicine (remote monitoring of PAP equipment for selected patients). This conference is, once a month, substituted by Journal Club discussions. The Sleep Medicine Fellows will be responsible for coordinating these conferences.
2. Weekly Sleep Medicine Grand Rounds (CME approved/ credited).
3. Monthly Research Conference, Quarterly multidisciplinary grand rounds (Sleep medicine, Allergy, ENT, Pulmonary).
4. Additional educational activities scheduled during the week.
5. Participation in the Illinois Sleep Society meeting and SLEEP meeting.

Preliminary clinic schedule assignment including fixed weekly and rotating clinics is provided on a separate file to sleep medicine fellows prior to the start of the academic year.

We use the EPIC system for our clinic calendar, both for outpatient appointments and for scheduling sleep studies.

No evening or weekend call is required.

Other trainees from RUSH and outside institutions participate with rotating electives and will share the outpatient clinic assignments with the fellows. The outpatient clinical rotation at RUSH University Medical Center/Sleep Disorders Service and Research Center is meant to provide the rotating medical students, physician assistant students, residents, and fellows with exposure to patients with common sleep complaints.