Section of Pulmonary Medicine Training Programs

ACGME Accredited Sleep Medicine Fellowship Program
The Department of Medicine under the section of Pulmonary and Critical Care offers three ACGME-approved positions per year for its one year clinical fellowship training program in Sleep Medicine. The Sleep Fellowship program at the University of Chicago, under the direction of Dr. Babak Mokhlesi, Assistant Professor of Medicine, draws upon the enormous resources and diversity of our University. We take pride in our multidisciplinary approach to Sleep Medicine with faculty members with expertise in pulmonary, neurology, pediatric neurology, endocrinology, and ear nose and throat surgery.

The fellowship program offers unique clinical and research experiences in order to meet our goal of training the next generation of leaders in sleep medicine. The clinical training program meets the requirements of the American Board of Medical Specialties for the recently developed Sleep Medicine Board examination.

Brief History of Sleep Medicine at the University of Chicago

The University of Chicago has a most distinguished history in this field. Sleep research began at the University of Chicago when Professor Nathaniel Kleitman established the world's first sleep laboratory in the late 1920s. He was the first scientist to concentrate entirely on sleep. In 1939, he published the first major textbook on sleep, Sleep and Wakefulness, which rapidly became the gold standard of sleep researchers everywhere. Dr. Kleitman and doctoral student Eugene Aserinsky revolutionized sleep research in 1953 when they announced the discovery of rapid eye movement (REM) sleep and its association with dreaming. This finding is usually considered the birth of modern scientific interest in sleep. Later in the decade, Kleitman and one of his students, Dr. William Dement, developed the techniques of all-night sleep recording, using measurements of eye motion and EEGs of brain activity. They used these measurements to chart the sequence of sleep patterns over the course of a night. This changed the established notion that sleep was a single state.The further discovery in 1955 that Narcolepsy had a neurophysiologic abnormality demonstrated by unusual premature REM onset sleep as opposed to the 90 minute delay encountered in normal individuals was a major step in the characterization of this condition. University of Chicago researchers Dr. Allan Rechtschaffen and Gerry Vogel, working with colleagues (including Dr. William Dement), described narcolepsy--the first true sleep disorder--in a landmark paper in 1963. Over the years, Dr. Rechtshaffen went on to become one of the single most respected basic and animal sleep investigators of this field performing experiments in rats that demonstrated the lethal consequences of long-term (two weeks or more) sleep deprivation. In 1968 Rechtshaffen together with Dr. Anthony Kales of UCLA standardized the scoring system for human sleep stages which is currently used today.

The cutting edge research in sleep continues today with the work of Dr. Eve Van Cauter, an authority on the metabolic and cardiovascular impacts of sleep deprivation and obstructive sleep apnea.

Requirements for Admission to the Sleep Medicine Fellowship Program

The fellowship program values diversity and strongly encourages applicants from a wide variety of backgrounds. Early application submission is encouraged to allow adequate time for scheduling interviews. After we receive your completed application including three supporting letters, your file will be reviewed and you will be notified regarding the advisability of an interview. The requirements include:

M.D. or equivalent degree
Successful completion of an ACGME-certified internal medicine, neurology, psychiatry, or pediatrics residency program sponsored by a major university in the United States or Canada
For graduates of medical schools outside the U.S. and Canada, appropriate certification by the USMLE/FLEX
Licensed by the State of Illinois at the beginning of the fellowship

Applicants invited to an interview spend the day with faculty and fellows. Applicants meet with several members of the fellowship program, enjoy lunch and a tour of our clinical and research facilities, and sit in on a conference and a session of polysomnogram interpretation.

Please do not hesitate to contact us if you have any questions about our training program. Inquires concerning the fellowship program should be directed to Dr. Babak Mokhlesi.

Sleep Medicine Fellowship Program Director:
Babak Mokhlesi, M.D., telephone: 773-702-2181
bmokhles@medicine.bsd.uchicago.edu

The application deadline for starting July 1st, 2009 is August 1st, 2008. Interviews will be scheduled throughout the months of August, September, and early October. Please send either by e-mail or regular mail a completed application form, cover letter, CV and three letters of recommendation to:

Sleep Medicine Fellowship Coordinator:
Cindy Gonzales
Sleep Medicine Fellowship Program
Section of Pulmonary and Critical Care Medicine
The University of Chicago
5841 South Maryland Avenue, MC 6092/Room N701
Chicago, IL 60637
Tel: 773-834-8951
Fax: 773-702-4427

Clinical Training in Sleep Medicine Fellowship

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 northwestern Indiana. Clinical activities include:

Pulmonary Sleep Disorders Clinic
Neurology Sleep Disorders Clinic
Pediatric Sleep Disorders Clinic (at the University of Chicago and at Children's Memorial Hospital)
CPAP follow-up Clinic
Inpatient sleep consultations
Adult and pediatric polysomnogram interpretation
MSLT/MWT/actigraphy/sleep log interpretation

Sleep Disorders Clinic
Training in outpatient sleep medicine is a critical component of the fellowship experience at the University of Chicago. Outpatient training is provided during the entire fellowship in a continuity clinic in the Center for Advanced Medicine on the main campus. The Sleep Disorders Clinic consists of Pulmonary, Neurology, and Pediatric experience. We also have an active CPAP follow-up clinic. Each week the fellows attend three half day clinics, one of which is the fellow's continuity clinic. The sleep clinics have over 2,000 patient encounters per year. The fellows see patients in collaboration with a dedicated attending physician. Ample time is provided 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 patients. On average each fellow evaluates 230 new and 322 follow-up adult patients per year. Additionally each fellow evaluates approximately 46 new and 46 follow-up pediatric sleep patients per year.

Adult and pediatric record interpretation
Four half day sessions are dedicated to interpretation of polysomnograms 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, and medical students. The clinical laboratory is equipped with 8 state-of-the art beds. The laboratory is active every day of the week and generates approximately 2200 polysomnograms per year. Each night two to three of the beds are dedicated to pediatric patients from infants to adolescents. In late summer of 2008, the Department of Medicine is planning to open an offsite 6 bed sleep laboratory in downtown Chicago which will increase the capacity of the Sleep Disorders Center and decrease the wait time for our patients. We use the latest version of Nihon Kohden software and we have end-tidal CO2 and capnometry recording capabilities. The University of Chicago Sleep Disorders Center also serves as a beta-test site for Nihon Kohden for software/hardware clinical and research development.

Research in Sleep Medicine
Dr. Van Cauter directs a very active sleep research program with additional six research beds funded by the National Institutes of Health (NIH) evaluating the impact of sleep loss on endocrine and metabolic function and the possible endocrine benefits of improved sleep quality. Currently there are several NIH funded research projects on: impact of a sleep debt in middle-aged and older adults, role of sleep duration in metabolic aging, alterations of circadian timing in sleep and aging, sleep disturbance as a nontraditional risk factor in chronic kidney disease, and sleep, metabolic, and cardiovascular dysfunction in polycystic ovary syndrome and the metabolic impact of CPAP in obstructive sleep apnea.

Clinical and Research Conferences
The Sleep Medicine Fellowship Program is particularly proud of the quality and diversity of the teaching experience, including the many conferences and seminars. Several important conferences are offered as part of the teaching program:

Core Curriculum: weekly one hour conference during the year covering topics such as normal human sleep, basics of polysomnography, sleep physiology, insomnia, sleep-disordered breathing (obstructive, central, periodic breathing, obesity hypoventilation), pediatric sleep disorders (respiratory and non-respiratory), parasomnias, RLS/PLMD’s, pharmacology of sleep, narcolepsy, sleep and other comorbidities (cardiovascular disease, respiratory disorders, endocrine, CNS, and neuromuscular disorders), circadian rhythm disorders, among other topics. The conference is attended by faculty, fellows, residents and students.

Multidisciplinary Conference: weekly one hour conference including presentation of cases by fellows with a goal of developing a formalized approach to clinical problem solving. During these sessions’ polysomnograms or other recorded material are presented as well. The conference is attended by faculty, fellows, residents and students.

Journal Club: monthly one hour conference during which fellows present and discuss in depth important recent articles in Sleep Medicine. The conference is attended by faculty, fellows, residents and students.

Research Conference: monthly one hour conference that highlights the work of clinical and post-doctoral fellows, as well as junior faculty in conjunction with Dr. Van Cauter’s Sleep, Chronobiology and Neuroendocrinology Research Laboratory. . This conference also provides basics on research methodology.

Faculty

Babak Mokhlesi, M.D., M.Sc., Diplomate, ABSM
Director of Sleep Disorders Center; Director of the Sleep Fellowship Program; Assistant Professor of Medicine Section of Pulmonary and Critical Care
Dr. Mokhlesi has studied the prevalence and predictors of hypercapnia in patients with OSA (obesity hypoventilation syndrome) and the impact of adherence with positive airway pressure therapy on hypercapnia in these patients. He is also interested in studying the impact of CPAP therapy on metabolic and cardiovascular outcomes in obstructive sleep apnea.

Jean-Paul Spire, M.D., Diplomate, ABSM
Professor of Neurology Department of Neurology
Dr. Spire is an expert in the care of pediatric sleep disorders and in the diagnosis and treatment of the organic sleep disorders, namely narcolepsy and sleep apnea. His research interests include: true spatial reconstructive imaging of multi-modalities with PET, MRI, functional topography of the brain, and three-dimensional evoked potential studies. Dr. Spire has co-authored two textbooks; one on pediatric sleep disorders and a recent one based on actual cases of patients evaluated and managed at the Sleep Disorders Centers of the Children's Memorial Hospital and the University of Chicago Hospitals.

Michael H. Kohrman, M.D., Diplomate, ABSM
Associate Professor of Pediatrics and Neurology Department of Pediatrics
Dr. Kohrman is an expert in the care of children with neurological problems, especially sleep disorders, epilepsy, and seizures. He is trained as both a neurologist and a pediatrician. He is a member of the Hospitals' Pediatric Epilepsy Center team and director of the Pediatric Clinical Neurophysiology Lab. Dr. Kohrman's research interests are related to childhood sleep disorders and epilepsy, and their interactions.

Esra Tasali, M.D., Diplomate, ABSM
Assistant Professor of Medicine Section of Pulmonary and Critical Care
Dr.Tasali is a funded NIH investigator interested in studying the links between sleep and metabolic, endocrine and cardiovascular functions. Dr.Tasali’s current research focuses on the role of sleep disturbances in the development of metabolic and endocrine abnormalities including type 2 diabetes, obesity and metabolic syndrome

John Jacobsen, M.D., PhD, Diplomate, ABSM
Assistant Professor of Neurology Department of Neurology
Dr. John Jacobsen is an expert in the neurophysiology of sleep and neuromuscular transmission. He is active in teaching EEG and EMG to resident physicians. Dr. Jacobsen recently co-edited a textbook based on actual cases of patients evaluated and managed at the sleep disorders centers of the Children's Memorial Hospital and the University of Chicago Hospitals.

Helene Rubeiz, M.D., Diplomate, ABSM
Assistant Professor of Neurology Department of Neurology
Dr. Rubeiz's main interests are general clinical neurology, in particular, neuromuscular diseases and sleep disorders. She enjoys seeing patients in clinic and supervising residents.

Eve Van Cauter, PhD.
Professor of Medicine Section of Endocrinology, Diabetes, and Metabolism
Director of the Sleep, Chronobiology and Neuroendocrinology Research Laboratory
Dr. Van Cauter’s major interests are the role of sleep in the regulation of hormonal rhythms and the characterization of the abnormal sleep patterns found in a variety of conditions, including aging. She uses analyses of temporal patterns of hormonal secretion to study the functional significance of sleep and circadian rhythmicity on endocrine function in normal and pathological conditions. In recent years, Dr. Van Cauter has also led a major research program evaluating the impact of sleep loss on endocrine and metabolic function and the possible endocrine benefits of improved sleep quality in older adults.

Fuad Baroody, M.D.
Associate Professor of Surgery and Pediatrics; Director, Pediatric Otolaryngology
Dr. Fuad Baroody is an expert pediatric head and neck surgeon--specializing in obstructive sleep apnea, allergic rhinitis, sinusitis, and other pediatric disorders including recurrent ear infections and airway narrowing. Dr. Baroody has written more than 70 peer reviewed scientific articles and 15 book chapters on allergic diseases.

Recent Publications by the Faculty

Khan M, Mokhlesi B. Nail gun narcoleptic. Lancet. In Press.
Lee WY, Mokhlesi B. Diagnosis and management of obesity hypoventilation syndrome in the intensive care unit. Crit Care Clin. In Press.
Tasali E., Mokhlesi B., Van Cauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. In Press
Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. In Press
Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest 2007; 132:1322-36
Mokhlesi B. Positive airway pressure titration in obesity hypoventilation syndrome: CPAP or bi-level PAP? Chest 2007; 131:1624-6
Ip M, Mokhlesi B. Sleep and glucose intolerance/diabetes mellitus. Sleep Med Clin 2007; 2:19-29.
Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea.
Sleep Breath. 2007; 11:117-124.
Van Cauter E, Holmback U, Knutson K, Leproult R, Miller A, Nedeltcheva A, Pannain S, Penev P, Tasali E, Spiegel K. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Horm Res. 2007;67 Suppl 1:2-9. Epub 2007 Feb 15.
Mokhlesi B., Tulaimat A., Evans AT., Wang Y., Hassaballa HA., Itani A, Herdegen JJ., Stepanski EJ. Impact of adherence with positive airway pressure therapy on hypercapnia in obstructive sleep apnea. J Clin Sleep Med 2006; 2:57-62
Hassaballa HA., Tulaimat A., Herdegen JJ., Mokhlesi B. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath 2005; 9:176-180.
Mokhlesi B. “Sleep and cardiovascular disorders”. In: Sleep Medicine Secrets: Stevens DR (Ed). 1st Edition. Hanley & Belfus. Philadelphia. 2004: pp 141-148
Tulaimat A., Mokhlesi B. “Human sleep”. In: Secrets in Sleep Medicine: Stevens DR (Ed). 1st Edition. Hanley & Belfus. Philadelphia. 2004: pp 15-22
Latta F, Leproult R, Tasali E, Hofmann E, Van Cauter E. Sex differences in delta and alpha EEG activities in healthy older adults. Sleep. 2005 Dec 1;28(12):1525-34.
Latta F, Leproult R, Tasali E, Hofmann E, L'Hermite-Baleriaux M, Copinschi G, Van Cauter E. Sex differences in nocturnal growth hormone and prolactin secretion in healthy older adults: relationships with sleep EEG variables. Sleep. 2005 Dec 1;28(12):1519-24.
Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol. 2005 Nov;99(5):2008-19.
Tasali E, Van Cauter E, Ehrmann DA. Relationships between sleep disordered breathing and glucose metabolism in polycystic ovary syndrome. J Clin Endocrinol Metab. 2006 Jan;91(1):36-42.
Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846-50.
Tasali E, Van Cauter E. Sleep-disordered breathing and the current epidemic of obesity: consequence or contributing factor? Am J Respir Crit Care Med. 2002 Mar 1;165(5):562-3.
Luc ME, Gupta A, Birnberg JM, Reddick D, Kohrman MH. Characterization of symptoms of sleep disorders in children with headache. Pediatr Neurol. 2006 Jan;34(1):7-12.
Su S, Baroody FM, Kohrman M, Suskind D. A comparison of polysomnography and a portable home sleep study in the diagnosis of obstructive sleep apnea syndrome.
Otolaryngol Head Neck Surg. 2004 Dec;131(6):844-50
Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Kramer R, Casey KR, Coleman J Jr; Clinical Practice Review Committee; American Academy of Sleep Medicine. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications. Sleep. 2003 Dec 15;26(8):1060-5
Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R; Clinical Practice Review Committee, American Academy of Sleep Medicine. Nonprescription treatments of snoring or obstructive sleep apnea: an evaluation of products with limited scientific evidence. Sleep. 2003 Aug 1;26(5):619-24.
Giglio P, Undevia N, Spire JP. Case 2: an irresistible urge to sleep. MedGenMed. 2004 Aug 31;6(3):45.
Undevia N, Giglio P, Spire JP. Case files from the University of Chicago's Sleep Disorders Center. Case 1: a gigantic fatigue. MedGenMed. 2004 Apr 2;6(2):50.
Reder AT, Mednick AS, Brown P, Spire JP, Van Cauter E, Wollmann RL, Cervenakova L, Goldfarb LG, Garay A, Ovsiew F, et al. Clinical and genetic studies of fatal familial insomnia. Neurology. 1995 Jun;45(6):1068-75
Pediatric Sleep Medicine (Textbook) edited by Stephen H. Sheldon, Jean-Paul Spire, and Howard B. Levy. W.B. Saunders Company (February 1992)
Diagnosis in Sleep Medicine: A Case Based Approach (Hardcover Textbook) edited by John Jacobsen, Stephen Sheldon, Jean-Paul Spire. Blackwell Futura (December 20, 2006)