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 five consultants (from parent specialities of chest medicine, neurology and anaesthetics), 15 technicians and 19 administrative staff.
Over 3,000 new referrals are received each year from all over the south of England. It is one of the six largest centres in the UK, admitting up to 42 patients for inpatient studies a week, with 15 outpatient clinics a week, and day case admissions for therapy each weekday.
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.
In February 2018, the sleep disorder centre expanded its Sussex outpatient clinic, moving to The Arundel Surgery in Arundel. This weekly clinic enabled patients in the coastal part of West Sussex to be seen by our specialists closer to home. Find out more about the clinic.
Talk to your GP about NHS treatment
To get referred with a sleep problem on the NHS, you should initially consult your GP who will advise you further. Your GP may suggest a referral to a specialist first (often in ENT surgery for snoring), or may suggest a referral straight to QVH. Where your problem is one of difficulty sleeping, sleep walking or sleep talking, odd behaviour or movements whilst asleep, your GP may write to QVH for an expert opinion first and we will contact you to make an outpatient appointment to assess your problem and give advice. The NHS does not undertake treatment for complaints of snoring unless this is associated with disorder of breathing in sleep.
How to make a sleep centre referral – information for health professionals.
Dr Jonathan Ratoff
Consultant Respiratory Medicine/GIM
Specialist interests: respiratory medicine; general medicine
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, Dr Ratoff completed a period of clinical research focusing on Airway T-cell Pathology in smoking, severe asthma and COPD and has published in this area. Subspecialty training posts were held at St. George’s (airway intervention and intensive care) and Royal Brompton Hospitals (cystic fibrosis and interstitial lung disease), London.
Dr Ratoff was appointed Consultant General and Respiratory Physician at Epsom and St. Helier NHS Trust in 2009. His clinical practice also includes sessions at the Royal Marsden Hospital and Queen Victoria Hospital, East Grinstead. He is experienced in all areas of outpatient and inpatient care of general medical patients and participates regularly in the acute medical on call rota. Within respiratory medicine, his special interests include the diagnosis of lung cancer and its multi-disciplinary treatment and the management of pleural disease. Dr Ratoff also runs a specialist sleep disorder clinic.
His extensive experience performing practical procedures includes bronchoscopy +/- biopsy, chest drain aspiration/insertion and the insertion of pleural catheters.
Dr Ratoff is a keen educator and enjoys teaching junior doctors. He also runs education days for local GPs and is the education lead for pleural procedure training. He has run practical procedure training courses for KSS Deanery and published in this area.
Outside of medicine he enjoys music, cinema, skiing and playing tennis.
Dr Peter Venn
Consultant Anaesthetist and Clinical Lead
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. In 2015, he was Vice President of The Royal College of Anaesthetists.
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. He has a particular interest in patients with insomnia.
“Every contact I’ve had the centre, be it cheery admin staff calling regarding appointments through to ‘sleeping over’, has been completely positive and I want to thank everyone of you.”
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