Polysomnography as a Distinct Profession

APT POSITION PAPER: POLYSOMNOGRAPHIC TECHNOLOGY A DISTINCT PROFESSION

Polysomnographic Technology is a multidisciplinary allied health occupation that has emerged as the unique profession for performing the technical evaluation of the broad range of sleep disorders. Polysomnography is a complex evaluation used as a quantitative polysomnographic (PSG) measurement of multiple physiological parameters during sleep.

A polysomnographic technologist, polysomnographic technician or polysomnographic trainee attends PSG evaluations provided by sleep laboratory facilities. PSG evaluation is necessary because physiological functions change during the sleeping state and many disorders are specifically induced by sleep. The growth in the field has been exponential as evidenced by the record numbers of technicians taking the Board of Registered Polysomnographic Technologists (BRPT) Comprehensive Registry Exam (CRE).

The APT has acknowledged the need for a formal educational format for the field and invested its full resources to developing a standardized curriculum based on the BRPT exam matrix to fill this need. The Professional Development Committee (PDC) was established to develop the educational materials. In April, 2003, the Commission on Accreditation of Allied Health Education Programs (CAAHEP) has approved the formation of a Committee on Accreditation of Polysomnography (CoAPSG) to recommend educational programs in polysomnography for accreditation.

Historically, as the medical specialty emerges so does the associated allied health profession. The development of modern Sleep Medicine began to see significant expansion with research completed in the early 1950s with the discovery of rapid eye movement (REM) sleep. Since that time, more than eighty specific disorders of sleep and arousal are identified in the AASM nosology. A PSG evaluation is one of the tools used by physicians that can result in a specific diagnosis of a sleep disorder that might otherwise be missed. The most common reasons for an individual to be referred to the sleep disorders facility for evaluation

include:

(1) episodes of sleep at inappropriate times;

(2) difficulty sleeping during scheduled sleep periods;

(3) difficulty staying awake during scheduled wake periods;

(4) atypical behavioral events during sleep;

(5) to document the effectiveness of various therapeutic

interventions utilized for the management of the documented sleep disorder.

A PSG evaluation is necessary because physiological functions change during the sleeping state and many disorders are specifically induced by sleep. Likewise, a PSG evaluation allows events occurring in a variety of physiological systems to be observed simultaneously. Much of its diagnostic utility depends on the ability to correlate specific changes or abnormalities of one physiological parameter with specific conditions defined by another parameter or parameters. Consequently, it is a significantly more powerful and complex tool than could be provided by individual and independent measurements of each variable.

The PSG evaluation requires a complete PSG to document:

(1) the underlying sleep disorder, i.e. sleep apnea or PLMs;

(2) the success of treatment of sleep apnea, i.e. Nasal CPAP titration;

(3) sleep stage and respiratory disturbance parameters.

In accordance with the APT Standards of Care of the Sleep/Wake Professional, polysomnographic technologists, polysomnographic technicians and polysomnographic trainees follow standards of care which are the foundation for clinical/technical decision making. These standards embody all the significant activities taken by these professionals in provision of patient sensitive care. The PSG recording montage should consist of the measurement of the defined parameters which include electro-occulography (EOG), electroencephalography (EEG), electromyography (EMG) of the chin and anterior tibialis muscle, snoring, electrocardiography (ECG), nasal/oral airflow, chest and abdominal

breathing effort, body position, and oxygen saturation. Monitoring these parameters allows the polysomnographic technologist, polysomnographic technician and polysomnographic trainee to determine and initiate appropriate treatment modalities/interventions per facility protocol. Thus, this profession has unique diagnostic tools and therapeutic interventions which require expertise in this unique specialty of Sleep Medicine.

Polysomnographic Technology is a distinct profession that has evolved to address an array of highly prevalent sleep disorders which are profoundly influenced by the sleep - wake cycle across the spectrum of age, gender and organ systems. A substantial body of knowledge exists that specifically relates to those disorders of the sleep - wake cycle. One of the indicators of this growth of knowledge and interest is seen in the dramatic increase in the number of medical journals publishing papers in the areas of sleep medicine and sleep science. The APT continues its strong connection to the American Academy of Sleep Medicine and leadership of the APT works closely with the Associated Professional Sleep Societies to schedule and develop the programming for ease and convenience of those sleep professionals to attend sessions in both meetings and share in the displays of new technological advances and services.

Adopted by the Association of Polysomnographic Technologists June 3, 2003

Association of Polysomnographic Technologists

One Westbrook Corporate Center • Suite 920 • Westchester, IL 60154

Phone 708-492-0796 • Fax 708-273-9344

aptaction@aptweb.org