Recently, there have been some pretty strong words from the AARC regarding sleep legislation that the AARC claims would “rescind the scope of practice of RTs.” RT talks to Donna Arand, PhD, director of the Board of Registered Polysomnographic Technologists (BRPT), about these concerns and why RTs are well qualified to become polysomnographers.

RT: The field of sleep medicine has grown dramatically over the last few years; how do the respiratory and sleep communities complement each other?

Donna Arand: The most common sleep disorder seen at sleep centers is sleep apnea, and the standard treatment is PAP therapy. The gold standard for determining effective pressure is to titrate PAP during polysomnography. The combination of PAP titration during polysomnography requires knowledge of sleep recordings, the respiratory system, and PAP equipment. This is where the fields of sleep medicine and respiratory care complement each other. Each provides essential components for determining effective treatment for sleep-related breathing problems, and it is the combination that assures high-quality patient outcomes.

RT: What makes those involved in respiratory care good candidates to become involved with polysomnography?

Arand: The educational background and experience of those in respiratory care provide an exceptional basis for learning polysomnography. It enhances understanding of the interrelationship between polysomnographic parameters, including airflow, chest movement, ECG, and oxygen saturation, and the role of PAP in altering these.

Additionally, in patients who have compromised pulmonary or cardiorespiratory systems due to medical disorders such as COPD, CHF, or Cheyne Stokes, knowledge in respiratory care is useful in assessing the need for additional interventions. Such complicated titration cases may require supplemental oxygen or a change in the type of PAP therapy being administered, such as changing from CPAP to bi-level or ASV. Finally, the value of a respiratory background for polysomnography is also apparent on the RPSGT exam, since licensed respiratory therapists are among the groups with the highest pass rate.

RT: What is the incentive for someone who is already involved in sleep medicine and polysomnography to sit for the RPSGT exam?

Arand: Individuals who are currently involved in sleep medicine and polysomnography should definitely pursue credentialing in the field. The RPSGT certification is the gold standard in the field, and there are currently a number of state legislatures and third-party payors that require that RPSGTs perform sleep studies This trend is likely to continue and expand. Additionally, American Academy of Sleep Medicine (AASM) accreditation requires at least one RPSGT to be on the full-time staff at sleep centers; and some centers are requiring that all technicians become registered within a specified time frame, such as 2 years from hire. With these increasing regulations and requirements, it would be prudent for anyone involved in polysomnography to obtain the RPSGT credential as soon as possible. Currently, there are numerous pathways that one can use to qualify to sit for the RPSGT exam. The different pathways make it easier for individuals from various sleep backgrounds to sit for the exam. With the current focus on standardized training and education in the health care field, however, future requirements to sit for certification exams may become more stringent, and multiple pathways could be eliminated. So there will be no better time than the present to pursue the RPSGT certification.

Donna Arand, PhD

RT: What does the future of the sleep industry look like? Why should those in respiratory care be interested in becoming registered in polysomnography?

Arand: All indications are that the field of sleep medicine will continue to grow. There are an estimated 70 million people in the United States who have chronic or intermittent sleep problems, and most are undiagnosed. Additionally, the number of technologists taking the RPSGT exam has increased significantly over the last 5 years. With the increased public awareness of sleep disorders and the importance of sleep for maintaining health, the need for sleep technologists and testing will continue to increase. New technologies will evolve, and in-home testing may play a part in sleep centers’ cost-containment strategies and provide greater access for patients. A shift in emphasis to high-quality outcomes will also result in changes in the practice of sleep medicine and especially the role of technologists. Technologists will likely expand their duties to include patient education, monitoring CPAP compliance, and managing diverse testing and treatment programs. All of these factors will no doubt increase demand in sleep centers for individuals registered in both respiratory care and sleep because of their ability to quickly correct many of the issues that reduce CPAP compliance and thereby improve outcomes. With demand increasing and such individuals in short supply, salaries will be competitive and job opportunities abundant. All of these factors make it ideal for respiratory therapists to become registered sleep technologists.

RT: In the summer of 2009, the AARC issued a letter stating that current legislation addressing sleep disorder diagnosis and treatment threatens to legally rescind part of the scope of practice of respiratory therapy:

It is our firm conviction that any requirement for further testing, credentialing or licensing of the respiratory therapist in the services deemed polysomnography is not warranted. We support state regulation of appropriately educated, competency-tested and credentialed polysomnographic personnel so long as it does not in any way adversely impact the scope of practice and/or licensure status of the respiratory therapist.

What is the position of the BRPT on this?

Arand: The idea that the sleep community or the BRPT is trying to limit the scope of practice of respiratory therapists is completely false. Nothing the sleep community has done was an attempt to limit the scope of practice of respiratory therapists. The position of the sleep community is simply that titration of PAP during polysomnography also requires knowledge of polysomnography. This is certainly something that respiratory therapists can learn and the sleep community encourages them to pursue. The fact is polysomnography is an interdisciplinary field that touches on a number of areas of medicine. It has components of cardiology, neurology, and respiratory. These components do not stand alone, but they are evaluated simultaneously in terms of their interrelationship. This is what makes polysomnography a unique specialty. Expertise in one of the areas involved is certainly beneficial, but it is not enough to encompass all of polysomnography. The titration of PAP during polysomnography is one task; it is not a profession. The sleep community’s message is just that specialized training is needed to perform polysomnography and titrate PAP simultaneously.

The BRPT supports the development of schools of polysomnography, add-on tracks in other health care programs, and numerous educational programs to provide that knowledge. Likewise, the BRPT believes it is important to develop national boards and examinations to recognize competency in the sleep field, just as in other areas of health care. Acknowledgment of such boards by state licensing agencies and other regulatory agencies helps ensure the quality of care being provided.

RT: How does someone in the respiratory care industry go about becoming an RPSGT?

Arand: There are a number of pathways, each with different requirements, that can qualify an individual to become a RPSGT, and those in respiratory care would likely pursue Pathway #2 (Table). This pathway is for individuals with other allied health credentials and requires only 6 months of paid clinical experience, wherein at least 21 hours per week, per calendar year, of on-the-job duties performed are polysomnography direct patient recording and/or scoring. Candidates must hold one of the following credentials: RN, LPN, RRT, CRT, R. EEG T., R. EP T., CNIM, PA, PhD, MD, DO, DC, EMT-P, DDS, RT, RT (R), RT (CT), RT (BD).

Table. BRPT Exam Pathways and Eligibility Requirements at a Glance

CPSGT Pathway

Clinical Experience

A-STEP or CAAHEP Requirements

Secondary Education

BCSL/CPR Certification

BRPT Standards of Conduct

There is only one pathway to earning the CPSGT Certificate

Candidates must provide verification of three months of full time experience in polysomnography, defined as 36 hours per week over three months, or a cumulative total of at least 432 hours. Experience is defined as direct patient recording and/or scoring.

Candidates must submit proof of completion of these 9 AASM A-STEP self-study online modules, upon which the exam is based:

  • Introductory Topics
  • Performing PSG 1: Theory
  • Performing PSG 1: Preparation and Setup
  • Arousals, Artifacts and Arrhythmias
  • Patient Assessment
  • Sleep Related Breathing Disorders
  • Positive Airway Pressure & Oxygen Therapy for Sleep Related Breathing Disorders (PAP only)
  • Scoring of Sleep Stages
  • Performing PSG 2: Recording and Monitoring

Candidates must include proof of completing secondary education. Acceptable forms of proof are copies of transcripts or diplomas from high school, GED or equivalent, or college or university education.

Must hold certification in Basic Cardiac Life Support (BCLS) or the equivalent

(international only) that remains current at the time of testing. These programs must include a hands-on practical training evaluation segment and you must provide documentation that shows demonstration of skills.

Candidates must follow the BRPT Standards of Conduct and Policies and Procedures.

RPSGT Pathway #2

6 months of PSG experience (credentialed health professionals)
Candidates must hold one of the following credentials: RN, LPN, RRT, CRT, R. EEG T., R. EP T., CNIM, PA, PhD, MD, DO, DC, EMT-P, DDS, RT, RT (R), RT (CT), RD (BD)

Candidates must complete a minimum of 6 months of paid clinical experience where at least 21 hours per week per calendar year of on-the-job duties performed are polysomnography direct patient recording and/or scoring. Duties must be within a 3-year period prior to the exam.

Note: An additional requirement to graduate from a CAAHEP program previously set to go into effect July 2012 has been suspended.

No proof required with submission of application

Candidates must hold certification in Basic Cardiac Life Support (BCLS) or the equivalent (international only) that remains current at the time of testing.

These programs must include a hands-on practical training evaluation segment, and you must provide documentation that shows demonstration of skills.

Candidates must follow the BRPT Standards of Conduct and Policies and Procedures.

Copyright BRPT. Adapted with permission.

RT: The BRPT is offering a new certification exam, the CPSGT. Who should consider taking this exam and what will it mean to be a “certified polysomnographic technician”?

Arand: Individuals who are just beginning to work in the field of sleep should consider taking the CPSGT exam (Table), especially if they plan to make this their career. This entry-level certification requires 3 months of experience, and it is valid only for 3 years, which allows time for the individual to prepare for the RPSGT exam. The CPSGT is not renewable and cannot be extended. It is not required to sit for the RPSGT exam. This certification indicates that the individual has demonstrated very basic knowledge about performing sleep studies, which is reassuring to their sleep patients and employers. Those living in areas where national certification is required for all sleep technicians may find that this will meet mandated requirements while they obtain the experience needed to sit for the RPSGT exam.

Editor’s Note
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RT: How does the process for each credential/certification work?

Arand: The process is quite simple. The applications and requirements are available online at the BRPT Web site Applicants must meet the requirements for taking the desired exam. For the RPSGT exam, there are a number of eligible pathways with different requirements, so an individual just needs to qualify with one of the pathway options. The individual completes the application and submits it to the BRPT office with the required supporting materials and fee. The BRPT office will review the application and notify the candidate about their acceptance for the exam or additional issues that still need to be addressed. Individuals will subsequently receive information regarding their assigned date, time, and location of the testing facility. Individuals passing the exam are required to obtain continuing education credits to maintain their certifications.

Donna Arand, PhD, is clinical director of the Sleep Disorders Center at Kettering Hospital in Dayton, Ohio. She is also an associate research professor of neurology at the Wright State University Boonshoft School of Medicine. Arand has served on the Board of Directors of the American Academy of Sleep Medicine (AASM), and she is former chair of the AASM accreditation committee. In addition to serving as a director of the BRPT, she is the president of the American Insomnia Association and a site visitor for the AASM.

Katie Griffith is former associate editor for RT.