Clinical Training | CurriculumSleep Medicine
All fellows in the Sleep Medicine Fellowship Program complete 12 months of clinical training based at the University of Chicago Medical Center, a tertiary care referral hospital serving the south side of Chicago and northwest Indiana. Clinical activities include:
- Adult and pediatric sleep disorders clinics
- Adult interdisciplinary neuromuscular disorders-advanced respiratory care (ARC) clinic
- Adult and pediatric behavioral sleep medicine
- Adult CPAP management clinic
- Inpatient sleep medicine consultation service
- Adult and pediatric sleep study interpretation
- Portable monitoring sleep study interpretation
- MSLT/ MWT/ actigraphy/ sleep log interpretation
- Evaluation of outside referral sleep study orders
Adult and Pediatric Record Interpretation
Four half-day sessions are dedicated to interpretation of polysomnograms and home sleep testing under the direct supervision of a faculty member. Additionally, during these sessions the fellows learn to assess all types of primary data that contribute to the accurate diagnosis of sleep disorders such as MSLT’s, MWT’s, history, sleep logs, actigraphy, and pulmonary function testing. Reading sessions may also include fellows in pulmonary and critical care, residents in neurology or pediatrics, and medical students. The clinical sleep laboratory is active every day of the week and generates approximately 2,500 polysomnograms per year, studies are also conducted in the pediatric intensive care unit and portable monitors in inpatients.
Each week sleep medicine fellows have 2 in-person half-day clinics, and 1-2 patients on virtual-platform/telemedicine for behavioral sleep medicine that start on the second quarter of the year.
Sleep Medicine outpatient training is provided during the entire fellowship in a continuity clinic in the UChicago Sleep Center Hyde Park Campus. The clinic has 1:1 fellow to faculty staffing to review findings and to discuss patient care issues. Additional time is used for directed teaching of topics important to outpatient sleep medicine. Fellows assume primary responsibility for managing their patients and have a dedicated panel of patients throughout their fellowship. The clinic and the sleep laboratory are integrated into one, which allows seamless integration of evaluation and testing.
Fellows rotate through the Neurology outpatient clinic under the supervision of our sleep medicine core-faculty. In these clinics fellows are exposed to general sleep medicine patients as well as to a wide variety of comorbid sleep and neurologic disorders. These clinics are in the Center for Advanced Medicine in Hyde Park campus. A daytime sleep technologist accompanies the fellow to support for mask fittings and device downloads.
Fellows rotate through the pediatric neurology sleep clinic at Comer’s Children Hospital located in Hyde Park UChicago Medicine Campus. These are one half-day clinic session with our Pediatric Sleep Medicine Program Director assessing children 0 to 18 years-old presenting with a wide range of sleep disorders. Fellows on this rotation usually take primary responsibility of pediatric sleep study reading as well, resulting in a well-rounded pediatric sleep medicine experience.
Behavioral Sleep Medicine
Starting the second quarter of the sleep medicine, in the fall, sleep medicine fellows attend BSM telemedicine visits. This training involves following patients throughout their CBT experience, and literature review, teaching points debriefing after the sessions.
Inpatient Sleep Medicine Consultation Service
Adult: As required by the ACGME, fellows evaluate inpatients for appropriateness of sleep study testing inpatient and expediting of CPAP equipment. This involves assessment of current medical comorbidities and determination of timing and type of testing if needed. Our administrative staff then coordinates if testing is needed in the hospital, and a report created for the primary team for coordination of domiciliary CPAP. Cases are discussed on Friday’s conferences in a small group setting. Faculty staff an advanced respiratory care inpatient consult service for domiciliary non-invasive or invasive ventilation assessment that is elective for sleep medicine fellows to join when of interest for their career development depending on the focus of their anticipated clinical practice setting.
Pediatric: Fellows work with pediatric sleep medicine faculty (neonatology and neurology-pediatrics) to evaluate complex inpatients for in-hospital polysomnography and oxygen, caffeine, PAP or ventilation titration accordingly. Usually the fellow on-call is primarily responsible for these consultations and completed together with our faculty at bedside. This opportunity provides additional pediatric sleep-medicine teaching normally out of reach to sleep medicine fellows.
Sleep-ENT and Drug Induced Sleep Endoscopy (DISE) Rotation
The ENT-Sleep Faculty provides DISE services for the evaluation of upper airway in patients with sleep apnea. Fellows participate in DISE and DISE-PAP in a dedicated endoscopy suite using state of the art equipment. In addition, fellows rotate through the sleep-ENT clinics and learn about the evaluation and treatment of patients with sleep disorders and comorbid upper airway disease and seeking surgical sleep apnea treatment.
Advanced Respiratory Care Clinic Rotation
Fellows on this rotation will evaluate and treat patients with neuromuscular disorders or respiratory muscle weakness or advanced COPD etc. in need for domiciliary invasive or non-invasive ventilation and respiratory care. Fellows will staff patients 1:1 with pulmonary-sleep faculty to interpret pulmonary function tests and learn airway mechanics and in-clinic ventilation titration. Fellows gain a thorough understanding of pulmonary function testing, management of ventilators, cough assists, home suction, etc.
Diaphragmatic Pacing Activation
The University of Chicago is home to a dedicated electrophysiology (EP) heart care center, and a center for excellence for diaphragmatic pacing for central sleep apnea. We are part of a multi-center, prospective, open label, non-randomized study to collect safety and effectiveness data in subjects with central sleep apnea implanted with the remedē System (rēST study). Fellows have the opportunity to work with sleep faculty in the activation and follow up, as well as polysomnography titration of diaphragmatic pacers.
Multiple in-person hands-on activities are carried out throughout the year to improve proficiency in the management of CPAP, NIV (BPAP and home ventilators), ASV, hypoglossal nerve stimulation and diaphragmatic pacing, oral appliances, and other innovative devices.
Teaching is our highest priority: not just sleep medicine but teaching our fellows how to convey knowledge and an enthusiasm for learning to others. We are home to a wide range of trainees, from Pritzker School of Medicine students to residents (internal and visiting) and fellows (PCCM, neurology, pediatric), and we are proud that our fellows act as teachers frequently.
Fellows collaborate with plastics surgery and orthodontics for patients with craniofacial abnormalities or requiring maxillo-mandibular advancement. Sleep dentistry and weight management specialists also contribute to lectures and education of the fellows.
Sleep Medicine Fellowship