Sleep Technician Training and Credentialing: An Update

BY DR. BARBARA PHILLIPS, MSPH, FCCP
Co-Chair, ACCP Sleep Institute

The technologists who work in sleep centers are essential for the safety of our patients and for the quality and validity of the data that we use to make clinical decisions. As the field of sleep medicine has matured, training and credentialing of these clinicians has evolved.

One of the topics of discussion emerging from this evolution has been whether the work of polysomnography data collection and sleep apnea treatment falls under the scope of respiratory care.

This plays out from time to time at the level of state legislatures and licensing bodies, where several states have passed legislation requiring additional training, certification, and credentialing of already-licensed respiratory therapists in order for those therapists to work as sleep lab technicians. In some cases, language is inserted that specifically states that an individual must have passed the Board of Registered Polysomnography Technology (BPRT) examination or the A-STEP program in order to work in a sleep center.

Chest physicians may be asked to comment on or to support legislation regulating licensure or scope of practice of sleep lab technicians, including respiratory therapists. In evaluating such proposed legislation, it may be helpful to review the ACCP’s position on this issue, published in 2007 (www.chestnet.org/practice/advocacy/positionPapers/07archives.php, accessed 11/5/09).

The paper states: “Currently, the Commission on Accreditation of Allied Health Education Programs (CAAHEP), the nationally recognized accreditation body for educational programs for various allied health professionals, provides unbiased oversight of the educational process for polysomnographic technologists. Licensure for polysomnographic personnel must require attendance at an education and training program accredited by CAAHEP through one of its member Committees on Accreditation, namely CoAPSG (polysomnography), CoARC (respiratory care), or CoAEND (electroneurodiagnostic technology). Educational programs, such as the AASM-A-STEP (American Academy of Sleep Medicine – Accredited Sleep Technology Program), were designed as stop-gap measures to maintain a workforce flow in regions where CAAHEP accreditation programs are not readily available. This type of program is a temporary measure and should not become a primary path to testing for credentialing.

Competency testing for the credentialing of individuals performing polysomnography ensures the knowledge level of technologists entering the field. The National Commission for Certifying Agencies (NCCA) is the accreditation body of the National Organization for Competency Assurance (NOCA) and establishes standards for credentialing agencies. Acceptable credentials must be those granted through validated examinations administered by NCCA-accredited credentialing organizations, such as the Board of Registered Polysomnographic Technologists (BRPT), the National Board for Respiratory Care (NBRC), or an equivalent entity. Additional certification beyond those of the relevant allied health disciplines must not be required.”

The ACCP’s position is that all personnel working in sleep centers should be well-trained and qualified to perform high quality work that best serves the needs of the patient. The College recognizes that there is a variety of pathways to become a well-qualified sleep technologist and that respiratory therapists should not be excluded if they have proper training and are able to pass a recognized certifying examination. With that background, it is also useful to understand the characteristics of the CoARC (Committee on Accreditation for Respiratory Care) training program for respiratory therapists with the AASM A-STEP program.

CoARC’s current standards are at www.coarc.com/standards.htm, and state (line 179) that polysomnography is part of the scope of respiratory care.

To be licensed, a respiratory therapist must have completed, at a minimum, an associate degree education program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) in collaboration with the Committee on Accreditation for Respiratory Care (CoARC), as well as having obtained a professional respiratory therapist credential from the National Board for Respiratory Care (NBRC) upon passing of a competency examination for respiratory therapists administered by the NBRC. Training in respiratory therapy includes some education in sleep disorders, testing, and treatment. Respiratory therapists are qualified to become sleep technologists with additional training and experience.

The A-STEP program is sponsored by the AASM as a temporary measure to help increase the supply of qualified sleep technologists. The program consists of an 80-hour, on-the-job training course, with an additional 14 online modules (45 to 90 min per module) to be taken while working in a sleep facility. Although the program has not received CAAHEP accreditation, the program is serving a useful function in providing needed education to sleep technologists.

With regard to formal credentialing, chest physicians need to know that there is now an alternative to the Registered Polysomnographic Technologist (RPSGT) certifying exam for respiratory therapists. The new credential is called the Sleep Disorders Specialist (SDS), and it is offered through the NBRC.

A comparison of content emphasized by the SDS and RPSGT examinations also is instructive. Most of the competencies overlap and are covered by the two examinations. Both examinations include a set of competencies that cover skills before a sleep study begins. Competencies described for the RPGST examination start with the physician’s order and do not necessarily involve skills in recognizing patients at risk for sleep disorders.

Comparing the relative emphasis of competency domains was a bit complicated. The matrix (Table) illustrates the comparison.

Comparison of RPSGT and SDS Examinations

Source: Dr. Barbara Phillips, MSPH, FCCP

The biggest difference is that the RPSGT emphasizes competencies related to performance of sleep studies more than the SDS examination. The SDS examination gives more emphasis to pretesting information, administration of the sleep center, and support of patient treatments for sleep disorders.

Both examinations use what is called a single compensatory passing point. Scores from item responses across domains described in the matrix below are aggregated into one broad score respectively reflecting competence. In other words, candidates do not have to separately pass each domain. In fact, they can enjoy some degree of benefit by compensating for weak areas by doing better in other domains.

The ACCP’s position statement on sleep lab technician licensure states: “The ACCP only supports non-exclusionary legislation that requires rigorous, unbiased, and independent training, accreditation, and credentialing, conforming to accepted national standards.”

This is useful guidance when we are asked to evaluate or support legislation relating to sleep technician licensure.