Interview: Professor Walter McNicholas

Professor Walter McNicholas, Director of the Pulmonary and Sleep Disorders Unit at University College Dublin and former President of the European Respiratory Society, discusses his work in the field of sleep-disordered breathing and gives an overview of the Sleep and Breathing conference he is co-chairing and at which ELF Chair Dan Smyth is presenting.

Could you tell us about your area of work?

I lead a multidisciplinary clinical and research team that forms a major section of the Department of Respiratory Medicine in St. Vincent’s University Hospital, Dublin, and University College Dublin. In addition to providing inpatient and outpatient care to people with a broad range of lung conditions, we provide a National Referral Service for people with respiratory sleep disorders, particularly obstructive sleep apnoea (OSA).

Our sleep service has an international reputation in clinical and basic research covering many areas including treatment and outcomes and the link between sleep disorders and other conditions. We are also closely involved in the evaluation of monitoring devices for sleep disorders.

How did your interest in this field develop?

During the late 1970s, when I was a Clinical Fellow in Respiratory Medicine at the University of Toronto, Canada, I sought interesting opportunities to develop a speciality and pursue a future clinical and academic career. OSA was only recently recognised as a significant condition at that time, and one of the leading experts in that topic, Dr Eliot Phillipson, had recently developed clinical and research departments at the University. I was fortunate that Dr Phillipson agreed to hire me as a Research Fellow, and my interest in sleep and breathing conditions has continued ever since. OSA was thought to be relatively rare in those years, and I used to joke that sleep apnoea was an interesting condition to research but that I probably wouldn’t see many patients. How wrong I was in that opinion, since we now recognise the condition to be one of the most prevalent in clinical practice, with thousands of people with OSA now attending our service.

You are one of the Chairs of this year’s ERS-ESRS Sleep and Breathing conference. Could you give a quick overview of the conference and what it aims to cover?

Building on the success of the previous Sleep and Breathing conferences in Prague (2011) and Berlin (2013), the Barcelona conference will continue to fill in the knowledge gaps relating to this common clinical problem. The 2015 conference will bring in key leaders and experts to provide a comprehensive update and to further relevant education and professional development.

The conference is jointly organised by the European Sleep Research Society (ESRS) and the European Respiratory Society (ERS). It is the only meeting offering an integrated approach to the investigation and treatment of sleep disorders, and will provide a state-of-the-art review of latest developments that should benefit all practitioners in the area of respiratory sleep medicine.

My colleagues in the Organising and Programme Committees have worked hard over the past 2 years to develop a stimulating and informative programme, and I sincerely hope that all participants will enjoy the conference.

What types of research will be covered at the conference, and how will this benefit people who live with sleep disordered breathing?

The conference will cover the latest research in the diagnosis and treatment of sleep and breathing disorders, particularly monitoring. There is increasing focus on moving the management of OSA out of the sleep laboratory, and recent developments in telemedicine will be discussed in this context. These developments should facilitate the diagnosis and treatment of more people with this debilitating condition, and should help simplify their long-term follow-up.

Sessions will be devoted to the interactions of sleep disordered breathing with heart disease and diabetes and will emphasise the importance of recognising OSA in people with other conditions, as failure to do so can cause major issues for them. The beneficial effects of successful therapy of OSA on heart and brain disorders such as heart attack, heart failure, and stroke will be discussed.

The conference will also cover sleep-related aspects of chronic lung conditions such as COPD and will also explore the interactions between OSA and fat tissue in the development of other conditions. A particular focus on sleep apnoea across the age spectrum from children to the elderly will also form part of the proceedings.

One session will be devoted to the issue of sleepiness while driving, which is a very topical issue in the context of the new EU Directive on driving that applies to patients with OSA. The ELF Chair, Dan Smyth, will speak on the patients’ perspective in this session.

What do you enjoy most about your work?

I greatly enjoy the diverse nature of my work, which ranges from patient care to clinical and basic research in addition to teaching undergraduate and postgraduate medical students in my hospital and university. My continuing involvement in society leadership, presently as Clinical Vice-President of the ESRS, offers a particularly stimulating environment and brings me into contact with other experts in sleep and breathing throughout Europe and the rest of the world.

What is the proudest moment of your career so far?

My proudest moment was when I was elected President of ERS in 2002. As the first President of ERS, or indeed of any other major international respiratory society, with a main interest in respiratory sleep disorders, I felt that my election represented a coming of age for this subspecialty. The subsequent development of the Sleep and Breathing Conferences by ERS and ESRS adds further proof to the commitment of the Society to this topic.

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