Dr. Mark W Elliott
Dr. Dipansu Ghosh
Specialist nurses & physiotherapists
Healthcare assistants & administrative staff
Leeds is a leading centre for Respiratory Sleep Medicine and Research in the UK. Our service was set up by Dr Elliot in 1990, an internationally recognised expert in the field of sleep and non invasive ventilation.
We provide a complete service for the diagnosis & management of sleep disordered breathing and chronic respiratory failure.
Our aim is to provide a quick & efficient service minimizing delays between tests, seeing a specialist & starting treatment.
The diagnostic tests available include:
• Overnight oximetry (measurement of oxygen levels continuously overnight),
• Respiratory variable sleep study (a more detailed study of breathing during sleep )
• Overnight measurement of carbon dioxide levels ( TOSCA)
• The Oxford Sleep Resistance Test (OSLER – a measure of daytime sleepiness),
• Actigraphy, (recording of activity over seven days for complex sleep / wake disorders)
• Electroencephaolgraphy (electrical activity of the brain) and multiple sleep latency testing (MSLT) – measurement of brain activity and a test of daytime sleepiness.
• Tests of respiratory muscle strength
• Assessment of risk of having an accident due to sleep apnoea (see “research” section below).
The investigations are reviewed by specialists and discussed with patients in clinic. Once a diagnosis of obstructive sleep apnoea (OSA) is established we offer continuous positive airways pressure (CPAP) through clinics lead by specialist nurses. Follow up is provided through nurse led clinics and we offer telephone follow up to minimize the need for hospital visits. Complicated cases are discussed in a Multidisciplinary meeting (MDT).
We also work closely with orthodontists at the Leeds Dental Institute to provide mandibular repositioning devices (MRDs or MADs).
We have more than 6000 patients under our care on CPAP and we offer treatment to more than 600 new cases of sleep apnoea each year.
We also manage patients with non-respiratory sleep disorders.
Leeds has been a pioneering centre for non-invasive ventilation (NIV) and is well known all over the world for its contribution to developing acute NIV in patients with respiratory failure. We provide our acute NIV service through a 10 bedded Respiratory Care Unit, with daily consultant lead ward rounds 365 days a year. There is a Specialist Respiratory Registrar in the hospital 24 hours per day.
We have also provided a domiciliary home ventilation service since 1990 & have more than 800 patients on home ventilation under our care. We welcome referrals of patients, who might develop respiratory failure at some stage in their life, at an early stage so that we can assess the risk, monitor their progress and prevent problems before they occur.
These include patients with:
• A wide variety of muscle diseases – in particular Motor Neurone Disease, Duchenne Muscular Dystrophy and myotonic dystrophy. However any patient with a muscle problem can develop respiratory muscle weakness and the possibility should be considered.
• Chest wall deformity, particularly early onset scoliosis and thoracoplasty.
Other patients treated with long term NIV include
• Obesity related breathing disorders
• Lung diseases, particularly COPD
We also look after patients who are ventilated via a tracheostomy, who often have other complex needs.
We provide both in-patient & out-patient set up for NIV. Once patients are established on NIV they are followed up in dedicated specialist led clinics which include a doctor, a nurse & a physiotherapist. Our team also provides domiciliary visits for more complicated patients.
We also provide a service for patients who undergo tracheostomy on an Intensive Care Unit as a result of a severe acute illness and who are then unable to breathe without a machine; we are able in some cases to liberate the patient completely from ventilator support, in others to remove the tracheostomy and establish them on non-invasive ventilation, or if this not possible to facilitate discharge with a tracheostomy and a ventilator.
We work closely with our assessment service for patients requiring supplemental oxygen at home and provide the full range of oxygen delivery devices.
We have been active in research in the field of sleep related breathing disorders and respiratory failure for many years.
Current projects include development of tools to help advise patients with sleep apnoea about whether they are at higher risk of having an accident or not. This is a very difficult area with major consequences: advising a patient that they are safe to drive when they are not could have disastrous consequences for them and others, However preventing someone from driving who poses no greater risk than the general population may be a disaster for them. We have used these tools in complex clinical cases on a number of occasions and are happy to accept referrals.
We are also involved in multi-centre research projects about the use of NIV; currently HOT-HMV and OPIP.