Note: AAST members will receive a discount to these programs. Visit the links for ‘more information’ to find out more on the course and discover how you can register today.

Basics of Sleep Management

March 3 2012 – The course will focus on the skills required to successful manage a sleep center, including: accreditation, equipment, staffing, budgeting, marketing, and more.

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Introduction to Sleep Technology:  An A-Step Course

March 5-15 - This course is a 90+ hour comprehensive program for sleep technicians new to the field.

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Intermediate Sleep Center Management Series

April 21 & 22 – This two-day series to provide a multi-session overview of the claims submission process, including information about appealing denials.

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Accomplished Goals

Since 2009, Sleeptechs has established itself as the only international recruitment agency for sleep technology professionals. Now in 2011, in just two short years, our name is recognized and respected in the Australian market. In addition, this year we have established contracts with several new Australian employers and have increased our campaign to find the very best sleep technicians and technologist to fill open position. In fact, we are still recruiting and have available positions now. If you have not already – “Sign Up” now.

Finally, Sleeptechs has setup two social media campaigns (including our Facebook page and Twitter account) and significantly increased our database of technicians. And don’t forget – we have listed our job openings and have an easy method to search for North American job openings – just visit the Job Search page.

What’s Up Next

Our vision has always been to improve the qualifications and experience of sleep technology professionals. We do this by offering exclusive job opportunities in the global market place that bring unmatched professional development.

Here is a short list of what’s up next for Sleeptechs in 2012:

• Establish domestic employment contracts with employers in the USA
• Establish additional foreign contracts in Europe and Middle East
• Utilize social media sites for ‘Career Talk’ and other professional support
• Encourage ‘position statements’ and ‘article’s on our Blog – “Write for Us”
• Increase both domestic and international technician database

What are your plans for professional and career development?

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The results from this study demonstrated that there were no significant differences in cortical arousals nor in other summary statistics. In addition, the inter- and intra- scorer reliability data remained unchanged. The authors concluded that a lack of significant changes in sleep state distribution and arousal scoring calls into question the need to include additional EEG derivations during clinical PSG.

Read the Abstract

Study Objective: To examine the impact of using American Academy of Sleep Medicine (AASM) recommended EEG derivations (F4/M1, C4/M1, O2/M1) vs. a single derivation (C4/M1) in polysomnography (PSG) on the measurement of sleep and cortical arousals, including inter- and intra-observer variability.

Design: Prospective, non-blinded, randomized comparison.

Setting: Three Australian tertiary-care hospital clinical sleep laboratories.

Patients or Participants: 30 PSGs from consecutive patients investigated for obstructive sleep apnea (OSA) during December 2007 and January 2008.

Interventions: N/A

Measurements and Results: 
To examine the impact of EEG derivations on PSG summary statistics, 3 scorers from different Australian clinical sleep laboratories each scored separate sets of 10 PSGs twice, once using 3 EEG derivations and once using 1 EEG derivation. To examine the impact on inter- and intra-scorer reliability, all 3 scorers scored a subset of 10 PSGs 4 times, twice using each method. All PSGs were de-identified and scored in random order according to the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Using 3 referential EEG derivations during PSG, as recommended in the AASM manual, instead of a single central EEG derivation, as originally suggested by Rechtschaffen and Kales (1968), resulted in a mean ± SE decrease in N1 sleep of 9.6 ± 3.9 min (P = 0.018) and an increase in N3 sleep of 10.6 ± 2.8 min (P = 0.001). No significant differences were observed for any other sleep or arousal scoring summary statistics; nor were any differences observed in inter-scorer or intra-scorer reliability for scoring sleep or cortical arousals.

Conclusion: This study provides information for those changing practice to comply with the 2007 AASM recommendations for EEG placement in PSG, for those using portable devices that are unable to comply with the recommendations due to limited channel options, and for the development of future standards for PSG scoring and recording. As the use of multiple EEG derivations only led to small changes in the distribution of derived sleep stages and no significant differences in scoring reliability, this study calls into question the need to use multiple EEG derivations in clinical PSG as suggested in the AASM manual.

Citation: Ruehland WR; O’Donoghue FJ; Pierce RJ; Thornton AT; Singh P; Copland JM; Stevens B; Rochford PD. The 2007 AASM recommendations for EEG electrode placement in polysomnography: impact on sleep and cortical arousal scoring. SLEEP 2011;34(1):73-81.

• Article assessed  24 July 2011 via PubMed Central
• Public link – click here

Keywords:
Electroencephalography, polysomnography, sleep scoring, cortical arousal scoring, sleep architecture, obstructive sleep apnea, sleep disordered breathing, inter-scorer reliability, intra-scorer reliability, kappa

Tell us what you think

Is there a significant benefit from including additional EEG derivations when performing routine in-laboratory PSG? Does your opinion change when you consider the utility of in-home PSG (i.e. screening devices)? Once again – what about those sleep labs located in rural areas – should the EEG placement and setup be different to facilitate additional PSGs in these remote locations?

Leave comments below or consider writing your ‘Perspective’ and submitting it for publication here on Sleeptechs.  Contact Us now.

The Registered Sleep Technologist (RST) credential from the American Board of Sleep Medicine (ABSM) in March 2012 will represent the first time since 1979 that two credentialing bodies are available for sleep technology professionals. The original credential, the Registered Polysomnographic Technologist (RPSGT) was introduced by the American Board of Registered Polysomnographic Technologist (BRPT), the education and examination board of the Association of Polysomnographic Technologists (APT).  This article presents my personal viewpoints on whether or not two sleep technology credentials can co-exist.

Perspective

I’ve read a lot of grossly misinformed statements about the ABSM and their intentions. Until taking the time to research the concerns of those opposing the new credential, I had not made up my own mind on the matter of whether I would make an application for the RST. I feel it is important to present key facts rather than hearsay about the RST credential. Below is a summary of my findings.

Some believe, or are of the opinion that the RST exam is intended to be easier for skilled and trained technologists to pass. However, according to the ABSM, topics the BRPT fails to include in it’s RPSGT exam, such as Multiple Sleep Latency Testing (MSLT) questions and pediatric questions lead to a less prepared work force. If anything, the BRPT increased their pass rates in 2010 and 2011 by removing difficult content such as MSLT and pediatric questions. The ABSM states, “The primary goal of the American Board of Sleep Medicine is to offer a certification examination for sleep technologists based on a blueprint reflective of the day-to-day professional responsibilities of sleep technologists in the sleep center setting and instruction received from available didactic programs. We believe this methodology fairly and responsibly evaluates professional competence (1).” It seems very clear that the newly offered RST exam will be aimed to coincide with the curriculums of the Committee on Accreditation for Polysomnographic Technologist Education (CoA PSG) programs. However, until the first testing window for the RST exam in November 2011, and until which time a copy of that exam is released, all opinions on the ease of the test are poorly informed assumptions.

Another public opinion of the RST exam is that of “greed”. Among the various forums and discussion areas for sleep techs, some say that the doctors (i.e, ABSM Board Members) are doing this to raise their profits because Medicare cut the reimbursement. Actually, reimbursements were put on hold, not cut. On December 8th 2010 legislative processes decided to postpone the medicare cuts (2). While some continue to rant about how it will eventually happen, I remind you this threat has been looming for years, and has yet to come to pass. This is a common fear and tease game seen on the national level of politics and government. So these accusations of greed are unfair, and meant to undermine any true intentions had by the ABSM.

Finally, to argue that two allied health credentials could not run in parallel is largely biased. I admit, finding the truth of the matter was not easy, and also a lucky accident. Recently, I discovered that nurse practitioners can choose from two different credentialing bodies. While that might not be quite as similar to our profession as some would like, there is a better example. Electrodiagnostic technologists are very similar to our own profession; I would dare to call it a sister profession. They function in their jobs, education, and credentialing very similarly to the sleep technology profession. Therefore, we have the great fortune of comparing our current predicament to one that happened to them only two years back.

The American Association of Electrodiagnostic Technologists (AAET), was the sole credentialing body for the profession. The AAET was founded in 1974 to register nerve conduction study (NCS) technologists, although back then they were called electrodiagnostic technologists. The AAET is a technologist driven credentialing group, much akin to our BRPT. In 2010, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), an organization of physicians which employ NCS technologists, offered to absorb the AAET into their organization. The AAET explained to it’s members that, “TheAANEM proposal requires the AAET to ‘dissolve and transfer its assets, including the examination, to theAANEM (3).” With the offer, the AANEM agreed to grandfather in current NCS techs registered by AAET, and to include current AAET board and council members in the AANEM standing committees. However, the AAET refused this gracious offer. In response to the refusal, the AANEM launched their own credentialing exam. The physicians from the American Board of Electrodiagnostic Medicine (ABEM) designed a separate credentialing exam, with a “grandfather” option, that was in direct competition with the professional technologist developed exam. “The ABEM is creating a written and practical examination for NCS technologists. We believe the examination will soon be recognized as the premiere certification for NCS technologists.”(4) Does this sound familiar? Of course it does. This is exactly what is happening to the sleep technology profession as we speak. Based on their numbers, it appears one third of the NCStechs took the grandfather option extended to them. Luckily we have the AAET conflict with the AANEMto learn what effects a second credentialing option will have on the profession. Although it’s still early for them and the effects are yet to be seen, I hope we learn something from their results soon.

So is the RST trying to replace the RPSGT credential for which many of us worked so hard to achieve? At this time, logical deduction points to the coexistence of two credentials, not the elimination of one. While their may be some initial bias to hire or not hire the new RST credential holders, ultimately they should coexist. The amount of lobbying and work we are talking about to remove the RPSGT from CMS guidelines and state laws is not reasonable. It is unrealistic to believe that the RPSGT will be replaced, no matter what quotes are attributed to the AASM/ABSM situation. Moreover, to determine which pathway is more challenging when considering to sit for each exam is still being fiercely debated. This may be due to the fact that there are various opinions on which means of training and education lead to the best qualified technologists. Whichever educational temple you pray to, it is incorrect to state that little effort will be required to sit for the new RST exam. Indeed, many people who have spoken on the matter may not have actually reviewed the pathways that lead to sitting for the ABSM credentialing exam. You can make up your own mind on the appropriate difficulty levels of the various pathways. These pathways for the ABSM and BRPT can be found online at: http://absm.org/resources/sleeptechregapp.pdf and http://www.brpt.org/default.asp?contentID=85 respectively.

Summary

I find most concerns all root back to the same fear, a drop in pay. All unfounded fears aside, can two credentials co-exist? They can and they will. Should two credentials co-exist? You bet they should, and this will likely benefit the technologists of the sleep medicine world. We come out on top thanks to the structure of free market capitalism. The introduction of the RST will likely be the stimulus for change needed to incite the long awaited improvements in credentialing called for by techs, managers, and doctors around the world. Both the ABSM and BRPT are important and necessary in their own right. At the very least, they will have to work more diligently to please us and keep our best interests in mind, or else we will pay our money to a different credentialing body!

Editor: Christopher P. Herrera, PhD, RPSGT

References:

1. AASM Special Update Tuesday, January 25, 2011 found at AASMnet.org
2. Medicare Reimbursement Cuts May Be Delayed – By: Jessica Grogan MDNews.com
3. Letter to the AAET membership, May 4, 2010, AAET Board of Directors. http://www.aaet.info/content/detail.cfm?coid=289
4. American Board of Electrodiagnostic Medicine, http://www.abemexam.org/Technologist/CNCT.aspx

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