Sleep Disorder Centre
The Sleep Disorder Centre was established in 1992, and provides a comprehensive service in sleep medicine for the south east of England. It employs 25 staff, including three consultant physicians and nine technicians, supported by administrative staff and secretaries.
The centre diagnoses and treats all aspects of adult sleep medicine, but respiratory disorders during sleep constitute the largest part of the workload. These include:
- sleep disordered breathing (SDB)
- hypoventilation syndromes (mostly related to increased body mass index)
- NREM parasomnias
- REM behaviour disorder
- sleep related movement disorders
- sleep related epilepsies and
- circadian rhythm disorders.
The centre is one of only a few in the UK with facilities for a full range of treatments for sleep disordered breathing, including continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), orthodontic services for mandibular advancement devices, and surgery including bi-maxillary osteotomy.
Although bed partners will observe and complain about sleep disordered breathing, the subject themselves is usually unaware of their condition, but may notice a decline in daytime function and motivation, often accompanied by excessive daytime sleepiness. Measuring daytime sleepiness is therefore an easy marker of symptoms. One commonly used scoring system is the Epworth Sleepiness Scale (ESS), a questionnaire that assesses the likelihood of accidently falling asleep whilst undertaking eight common daily activities.
Sleep at night is essential for good health. Excessive sleepiness during the day causes a reduction in quality of life, decreased ability to drive safely, decline in intellect, and can be an antecedent to falls in the elderly. Increasing levels of respiratory dysfunction are associated with the development of arterial hypertension and the onset of adult type II diabetes, with cardiovascular sequelae, including stroke and myocardial infarct.
Patient related outcome measurements (PROMs) include assessing the patient’s subjective improvement in daytime sleepiness and function using the ESS (Epworth Sleepiness Score 0-24), and is therefore an effective indicator of the efficacy of therapy.
To measure our effectiveness, a study looking at 100 randomly selected, demographically representative patients using CPAP equipment was undertaken. Our results are impressive, with patients generally seeing nearly a 60% reduction in daytime sleepiness, and amongst those patients who have a higher than 10 Sleepiness Score (Epworth Scale), their ESS has fallen by 10.3.
This is the first time this audit has been completed in this way at the QVH, and the department is continuing to invest in regularly measuring the ESS to ensure that patients continue to benefit from the treatment provided.
Dr Jonathan Ratoff
Consultant Respiratory Physician
Specialist interests: Obstructive sleep apnoea; non-invasive ventilation; interstitial lung disease; bronchoscopy; respiratory critical care
Dr Jonathan Ratoff qualified from King’s College Hospital Medical School, London in 1994. His early training led to membership of the Royal College of Physicians and then specialist training in Respiratory and General Medicine, in the South Thames region. During this period he completed clinical research towards his PhD thesis entitled: Airway T-cell Pathology in Smoking, Severe Asthma and COPD. Sub-specialty training posts were held at St. George’s and Royal Brompton Hospitals, London.
Dr Ratoff was appointed Consultant General and Respiratory Physician at Epsom and St. Helier NHS Trust in 2009.
He has developed specialist interests in obstructive sleep apnoea, non-invasive ventilation, interstitial lung disease, bronchoscopy, respiratory critical care medicine and medical education. He is a clinical supervisor, a tutor on MRCP and clinical skills courses and continues to collaborate in research studies. Data from his thesis and other projects continues to be published and presented at international meetings.
Dr Peter Venn
Specialist interests: Diagnosis and treatment of insomnia and treatments of obstructive sleep apnoea
Peter J Venn has been a Consultant Anaesthetist at Queen Victoria Hospital, East Grinstead, West Sussex since 1991. He qualified from The Middlesex Hospital Medical School in 1979 and after training as an SHO and registrar in London was a Senior Registrar in the Nuffield Department of Anaesthetics in Oxford.
He is past Head of the South Eastern School of Anaesthesia, past Regional Adviser to the Royal College of Anaesthetists for South Thames (East), past Chairman of the South Thames Specialty Training Committee, and an examiner for the Primary FRCA from 1997-2008. He is an elected member of Council of the Royal College of Anaesthetists, and past Editor of the Bulletin of the Royal College. He is past chairman of the Communications Committee for the RCA, and current chairman of the Professional Standards Committee.
He founded the Sleep Disorder Centre in 1992, now one of the largest centres in sleep medicine in the UK, and is a past council member and past Membership Secretary of the British Sleep Society. He has published extensively in sleep disorders and anaesthesia in journals and on the internet. He has lectured at home and abroad in both subjects.
Current clinical interests include the criteria for the treatment of patients with sleep disordered breathing using mandibular advancement splints and, more recently, with bimaxillary and saggital split osteotomy.
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