The clash between the American Academy of Sleep Medicine (AASM) and the Board of Registered Polysomnographic Technologists (BRPT) may be 4 months old, but it shows no sign of cooling down.

It’s no secret that tension has been growing between the Board of Registered Polysomnographic Technologists (BRPT) and the American Academy of Sleep Medicine (AASM). Testy written exchanges are posted at www.brpt.org for all to see, starting with the December 17, 2010, letter to Janice East, RPSGT, R. EEG T., president of BRPT.

That letter, which “stunned” East and her colleagues, told of the AASM’s decision to develop a certification exam for sleep technologists, to be administered through the American Board of Sleep Medicine (ABSM). In the letter, the AASM cited concerns with the pass rate for the BRPT’s Registered Polysomnographic Technologist (RPSGT) examination, saying that “a majority of otherwise qualified sleep technologists currently employed at sleep centers are unable to obtain the necessary credentials required to stay in the profession.”

East responded in a strongly worded letter to ABSM President Nathaniel F. Watson, MD, on January 10, 2011. According to East, the BRPT had collaborated with the AASM 10 months earlier to launch the Certified Polysomnographic Technician (CPSGT) examination, which was developed to put a large number of “certified” sleep personnel into the field, and to assist with legislative requirements in states where there was insufficient time for technicians to become RPSGTs. “The CPSGT exam came about in direct response to a request from the AASM,” wrote East. “We invested in excess of $100,000 in the development of a strong certificate-level exam, treating the process with such a sense of urgency that we developed and launched the CPSGT exam within nine months. The CPSGT exam development process included both AASM and AAST input, item review, and exam approval.”

In response to the AASM concern that too few technologists were passing the RPSGT exam, East wrote that the CPSGT exam had yielded a consistent 83% passing rate for 2010. Technicians with limited experience, she wrote, would be put on a tiered progression toward earning the RPSGT credential. The RPSGT pass rate for 2010 was 62%, an improvement over previous years.

At press time, little had changed between the BRPT and the AASM. However, East indicated that the BRPT is now more likely to expand its mission to include education. In the past, the BRPT had administered the exams, with AASM supplying many of the courses to prepare. With those traditional roles no longer in place, that could change.

Below is an recent interview with East to get her opinions on the controversy. As a 2nd-year president of the 32-year-old organization, East spoke candidly about future plans, frustration with the AASM, and the pride of achievement that many technologists feel when passing the RPSGT exam.

Is there room for two sheriffs, so to speak, in the sleep certification/credentialing world?
Janice East, president of the Board of Registered Polysomnographic Technologists (BRPT): Probably not. We thought we were working toward building on our exam and working with the AASM collaboratively to provide the best possible exam and the best preparation.

We would give feedback to the AASM and the American Association of Sleep Technologists (AAST) so they could provide the proper education to prepare for the exams. Then the AAST makes the statement that they are supporting all exams that lead to some type of credentialing for technologists, which is amazing because they are a membership organization, and they are supporting an exam without even knowing what it is.

Why did you write earlier this year that you were “stunned” by the AASM’s certification exam announcement?
When this came up, it was a surprise to us. We had met in September 2010 with the technologists on our board, the entire AAST board, and Jerry Barrett [executive director of the AASM]. We had a long discussion and reviewed our exam processes.

We had what we thought was a good meeting discussing RPSGT recertification, and we shared all of our statistics, which we always do with AASM and AAST. We left that meeting feeling good. About 60 days later, we received a letter from the ABSM president saying that they were going to start their own technologist exam.

Is there any way that this difficult matter can be mended? Have you spoken with the AASM
Nate Watson (Nathaniel Watson, MD, president of the ABSM) gave me his cell phone number, and I did speak with him. I asked specifically if there was any way for us to sit down with the AASM and talk about this. He said no.

We know that pass rates were a matter of contention. What can you tell us about those discussions?
We’ve been in some uncomfortable meetings, and we have been pushed very hard to lower the score required to pass the exam. AASM basically told us to just arbitrarily lower the passing score from whatever it’s set at. We follow best practices in credentialing to develop the exams and they wanted us to randomly change it so more people pass.

What is the ABSM’s main complaint about the RPSGT exam?
Their complaint about our exam is that it’s not really testing what people are doing on the job. However, we performed a job task analysis, and that is the core of creating an exam. We did that analysis in 2009, surveying RPSGTs about their everyday job tasks, rating how important and how frequent these are done.

The job task analysis is standard for any kind of certification exam and it’s used to develop the exam content outline or blueprint. Subject matter experts (SMEs) are used to finalize the exam blueprint, working in conjunction with a psychometrician.

Do you plan on addressing this topic during public speaking engagements?
We always get out to the state societies and anywhere we are invited to speak—including regional and national meetings. Going forward, it is going to be key for us to make sure people understand the role of our credential, how it came about, the value of it, and how it is being used. Awareness of our strengths, and the fact that BRPT has been delivering the RPSGT exam for 32 yrs and is not going anywhere, are important messages.

What concerns you most about the AASM certification exam?
It’s not so much that there is a competing credential. My concern has to do more with the reason that AASM said that they put it together. In the letter we received from Nate Watson, he stated that  “…for a number of years, sleep physicians who are medical directors of sleep centers have expressed concern that certification by the BRPT does not ensure professional readiness.” In all of the meetings we’ve had with the AASM leadership, this concern was never expressed to us. I asked for data supporting this statement in a phone call with Dr. Watson. He did not respond to this inquiry. We don’t have any information about the exam, so it’s hard to comment on the exam itself. Based on the information they shared with us about why they created the exam, it’s a little frustrating.

What kind of information had you been sharing with the AASM and AAST?
We’ve been working with the AASM and AAST for a long time sharing specific information about our exams that showed where people were having problems with the questions, and what education AAST should be able to provide to help people with the exam. One thing you have to remember is that 70% of the people taking the RPSGT exam are coming through pathway #1, which means they are trained on the job.

They have 18 months experience that varies from somebody coming off the street and being shown how to operate the machine, to somebody who’s getting extensive education in a medical center that allows on-the-job training. Our lowest pass rate comes from pathway #1.

Prior to this controversy, how did you view the BRPT’s role?
I always viewed AAST as the education provider, and we were the independent credentialing organization. AASM has stepped into the arena for technical education as well. AASM is a physician membership organization and AAST is a technologist membership association. Both represent the members of their organizations. BRPT is independent of oversight from these groups, but was working collaboratively in areas of mutual interest, such as state licensure issues, improving educational offerings for recertification, and other related activities.

Will you now pursue the educational arena?
Traditionally we stayed out of education, and there are some limitations put on us by our National Commission for Certifying Agencies (NCCA) accreditation. We can’t say ‘You have to take our education modules. You have to complete only our education packets in order to sit for our exam.’ We can, however, provide education. We have not really done that because we viewed that as the role of AAST and AASM.

Moving forward, however, we are investigating avenues for providing more education. We can offer educational opportunities, both for people taking our exam, and for recertification.

Do you believe there will be adequate demand for more educational opportunities?
Yes, but it’s hard for some technologists, especially in rural areas and some countries outside the U.S., to get continuing education. People still tend to think they have to go to conferences, which is not the case. We will offer some webinars for a fee, and some other online pieces at no charge, for recertification.

What do you say to critics who say the RPSGT exam is too difficult?
We have a very strong credential, and it has been around for 32 years. Our message board and a new Facebook page have sparked a vigorous response over concern about the exam—and concern that a new exam is being created. Some people ask:
Why is AASM involved? Is it all about money?

What other types of concerns are you seeing on message boards?
People are concerned about the implications for patient care. You’ve got a physician-driven organization talking about lowering the passing score, and now they are creating another exam. The concern is: What kind of exam is it going to be? Is it going be easy? Sure, there are some people out there who are just happy because it will probably be easier.

If you study, you’ll be able to pass our exam. People just aren’t prepared. We have a 67% pass rate right now for the RPSGT. I asked Nate Watson what pass rate AASM would find acceptable. He did not have an answer, and there is no published literature that addresses that question.

There is a rumor that some RPSGTs are looking to start another sleep technologist membership organization. You see that on some of the blogs and message boards, but I don’t know. I’ve talked to some physicians and technologists as well who have not renewed their membership in AAST or AASM—especially the techs. And some physicians are not renewing for AASM.

Do you believe all of this will lead to a loss of candidates for BRPT?
Our goal is to get information out there. If candidates are going to make a choice about exams, we want them to be educated. We are certainly going to focus on the value of our credential. Unfortunately, we don’t have the financial support that the AASM has. However, we enjoy a wonderful professional standing.

Our NCCA accreditation is key. In the professional credentialing industry, NCCA accreditation represents compliance with best industry standards. It provides strong, independent, third party validation of the RPSGT exam process, which has been instrumental in winning recognition of the RPSGT credential as proof of professional competency in state legislatures, before state medical and licensing boards, and in CMS reimbursement guidelines.

Even though some may complain about it being a difficult exam, they are so proud to have it. You’ll see on the message boards that people don’t want a lower passing score or an easier exam. They’ve worked hard to get where they are, and they are proud of what they have achieved. It’s a fair exam. It is the gold standard in the field of sleep.

INFO BOX
In 1979 the Board of Registered Polysomnographic Technologists (BRPT), a committee of the Association of Polysomnographic Technologists (which later changed its name to the American Association of Sleep Technologists [AAST]), administered the first registry examination at the New York State University Sleep Disorders Laboratory in Stony Brook. Since that time, more than 17,000 technologists have obtained an RPSGT credential. The RPSGT exam is accredited by the National Commission for Certifying Agencies (NCCA).

SOURCE: SleepScholar.com

Reports of sleeping air traffic controllers highlight a long-known and often ignored hazard: Workers on night shifts can have trouble concentrating and even staying awake.

“Government officials haven’t recognized that people routinely fall asleep at night when they’re doing shift work,” said Dr. Charles Czeisler, chief of sleep medicine at Brigham and Women’s Hospital in Boston.

Czeisler said studies show that 30 percent to 50 percent of night-shift workers report falling asleep at least once a week while on the job.

So the notion that this has happened only a few times among the thousands of controllers “is preposterous,” he said in a telephone interview.

In a sign of growing awareness of the problem, the Federal Aviation Administration said Saturday it was changing air traffic controllers’ work schedules most likely to cause fatigue. The announcement comes after the agency disclosed another incident in which a controller fell asleep while on duty early Saturday morning at a busy Miami regional facility. According to a preliminary review, there was no impact to flight operations, the FAA said.

Czeisler said the potential danger isn’t limited to air traffic controllers, but can apply to truck and bus drivers, airline pilots and those in the maritime industry. Who else? Factory workers, police, firefighters, emergency workers, nurses and doctors, cooks, hotel employees, people in the media and others on night or changing shifts.

“We live in a very sleep-deprived society where many people are burning the candle at both ends,” Czeisler said. He said that a half-century ago, just 2 percent of people slept six hours or less per night; today it’s 28 percent.

Dr. William Fishbein, a neuroscientist at the City University of New York, said that when people work odd shifts “it mucks up their biological rhythms.”

Hormones are synchronized with the wake-sleep cycle. When people change shifts, the brain never knows when it’s supposed to be asleep, so this affects how people function.

People who change shifts every few days are going to have all kinds of problems related to memory and learning, Fishbein said. This kind of schedule especially affects what he called relational memories, which involve the ability to understand how one thing is related to another.

In addition to drowsiness and inability to concentrate, people working night shifts are more subject to chronic intestinal and heart diseases and have been shown to have a higher incidence of some forms of cancer. The World Health Organization has classified shift work as a probable carcinogen.

“We have 500 cable channels, we take work home with us on our Blackberrys and computers, both work and entertainment options are available 24 hours a day seven days a week and there is much more and brighter light exposure in our homes in evenings, which affects hormones involved in sleep, Czeisler said.

“And we are still trying to get up with the chickens because our work hours are starting earlier and earlier,” he said.

Today, controllers are at the center of the firestorm, with recent reports that several planes couldn’t contact airport towers for assistance in landing. Members of Congress are responding to a worried public, controllers have been suspended and the head of the government’s air traffic control system has resigned.

President Barack Obama told ABC News that controllers must stay alert and do their jobs.

One old solution back in the news is allowing night workers to nap.

“There should be sanctioned on-shift napping. That’s the way to handle night shift work,” said Gregory Belenky, a sleep expert at Washington State University in Spokane.

A NASA study suggested that pilots on long-distance flights would perform much better if given a chance to take a scheduled nap, as long the rest was planned and the both pilots didn’t sleep at the same time.

“But even though that’s been known for decades, it’s never been allowed because we prefer to pretend that these things are not happening,” instead of managing the problem, Czeisler said. “We have a bury-our-head-in-the-sand attitude.”

Controllers are often scheduled for a week of midnight shifts followed by a week of morning shifts and then a week on swing shifts. This pattern, sleep scientists say, interrupts the body’s natural sleep cycles.

Many of the Federal Aviation Administration’s 15,700 controllers work schedules that allow no realistic opportunity for rest. Their record for errors on the job has grown sharply over the past several years.

FAA rules prohibit sleeping on the job, even during breaks. Employees who violate them can be fired. But controllers told The Associated Press that napping at night where one controller works two jobs while the other sleeps, and then they swap, is an open secret within the agency.

Czeisler also is urging screening of truck drivers for sleep apnea, a breathing problem they can be prone to because many are obese. He estimates that as many as 250,000 people in the U.S. doze off while driving every day, mostly in the daytime.

Studies have shown that a sleep-deprived driver is as impaired as someone with enough alcohol in his blood to be considered a drunken driver.

Even a drunk has some reflexes. “If you fall asleep, your performance is much worse,” he said.

Source: Associated Press

Since the Federal Motor Carrier Safety Administration came into existence in 2000, there have been considerable changes and requirements imposed on trucking, with Congress providing the agency with a long list of regulations to implement. Significantly, one issue—driver fatigue—is being tackled from three different angles:

View Federal Motor Carrier Safety Administration Spotlight on Sleep Apnea

• In response to congressional mandates, there have been two instances of hours-of-service regulations issued since 2003 and a third regulation is under way, due for release in July.

• The National Transportation Safety Board has issued a series of recommendations to FMCSA for changes to existing rules touching on driver fatigue while calling for new regulations. One example has been to screen truck drivers for obstructive sleep apnea (OSA) as part of an overall fatigue-management program. So pervasive is the OSA problem that the NTSB has issued similar warnings to the aviation, maritime and rail industries for their employees.

• Most significantly, FMCSA’s new Compliance, Safety, Accountability program, or CSA, attempts to expand the scope of regulatory oversight of motor carriers and drivers. The program will add tools to the conscientious safety manager’s toolbox and identify trends in driver behavior—including fatigue—before they cause crashes.

And yet, while drivers and motor carriers await the new hours-of-service rule, momentum for broader fatigue management among the most safety-conscious motor carriers is building without government mandates.

Much debate surrounds the hours-of-service rule and its effect on driver health, but reducing the hours a driver can work or drive will not remedy the health problems caused by obstructive sleep apnea. In fact, the effort expended on HOS changes is likely to produce fewer safety benefits than the industry could capture simply by aggressively addressing the health of today’s commercial drivers through targeted treatment of OSA.

OSA deprives a driver of deep sleep because the airway in the back of his throat is obstructed for 10 seconds or more. Reduced oxygen wakes the sleeper just enough to start breathing again but not enough to remember the action. And this can happen more than 50 times per hour. The result is a driver who is almost as fatigued in the morning as when he retired for the night — and doesn’t know why.

Estimates vary, but based on one 2006 study used by the FMCSA Medical Review Board, which provides the agency with recommendations regarding medical requirements for commercial vehicle drivers, suggests that between 24% and 41.9% of all commercial drivers could qualify for OSA screening.

The MRB recommended in January 2008 that FMCSA make substantial changes to the current guidelines pertaining to OSA.

OSA testing and treatment options are varied. Traditional testing can require two or more overnight stays in a sleep clinic to test for OSA and determine if the patient will benefit from sleeping with a special mask that keeps the airway open with a continuous flow of air.

Truck drivers, however, need to be diagnosed and treated expeditiously because fleet owners require healthy and treated drivers available for daily duty. For these companies, ambulatory testing of drivers holds tremendous promise because it can be done while a driver sleeps at home, in a hotel or even in his cab’s sleeper berth.

Savvy industry executives realize that drivers are essential to their business and treating OSA where needed is an investment in those drivers, their families and the company’s viability. Data clearly show that with effective management of OSA, individuals experience improved quality of life and fewer catastrophic illnesses and diseases.

Motor carriers have a unique opportunity to address potential safety liabilities within their companies by establishing OSA programs. When this has been accomplished, they will be rewarded with healthier, happier and more productive employees with fewer health claims as well as reduced crash numbers and workplace injuries.

Source:  Transport Topics News

(This means more qualified physicians will become Board Certified).

The American Board of Anesthesiology (ABA) announced that the American Board of Medical Specialties (ABMS) has approved the ABA’s application for sponsorship of subspecialty certification in sleep medicine. The 2011 ABMS sleep medicine certification exam will be the final opportunity for physicians to apply under the Practice Pathway; after this exam, all first-time applicants must have completed a formal sleep medicine fellowship program. The exam will be offered Nov. 10, 2011, by these six member boards of the ABMS:

American Board of Anesthesiology (ABA) 
American Board of Family Medicine (ABFM) 
American Board of Internal Medicine (ABIM) 
American Board of Otolaryngology (ABOto) 
American Board of Pediatrics (ABP) 
American Board of Psychiatry and Neurology (ABPN)

The following shows the registration dates that are currently available from each board:

ABA 
Normal Registration Dates: April 1 – June 1 
Late Registration Dates: —

ABFM 
Normal Registration Dates: March 3 – May 2 
Late Registration Dates: May 3 – Aug. 1

ABIM 
Normal Registration Dates: March 1 – May 1 
Late Registration Dates: May 2 – June 1

ABOto 
Normal Registration Dates: Feb. 2 – May 1 
Late Registration Dates: —

ABP
Normal Registration Dates: Feb. 1 – March 31 
Late Registration Dates: April 1 – May 2

ABPN 
Normal Registration Dates: Jan. 7 – April 1 
Late Registration Dates: April 2 – May 1

All dates and deadlines are subject to change. Physicians must submit an application through the board in which they hold their primary certification. Please consult the website of the appropriate board for more details.

View details at assmnet.org