proposal for technical & sleep specialist
Proposal of the
"European guidelines for the certification of the technical and nursing sleep specialist"
The aim of this paper is to introduce a qualification in sleep for technical and nursing staff working in the field of sleep medicine. The certification is a voluntary proof of comprehensive knowledge of sleep medicine.
The qualification is initiated by the Board of the National Sleep Society (NSS). Whenever possible, this qualification should be endorsed by the bodies involved in the educational programme. Applications for certification must be filed to the authority responsible for the educational programme.
The qualification confirms the successful education in the science, practical clinical work and experience in the area of sleep medicine. The practical training for the certificate must have taken place in an accredited Sleep Medicine Centre (SMC).
These guidelines are intended to be a standard. However, it is acknowledged that the NSS may be required to adapt these guidelines to comply with local laws concerning the practice of medical acts by physicians and non-medical professionals.
1. Object
The Certificate intends to show that the named person is able to carry out the organization, logistics, preparation, recording, observation, analysis & evaluation and documentation of Polysomnography and other investigations carried out in the sleep lab. The candidate is responsible for the correct instruction and care of the patients.
2. Definition
The qualification proof certifies the owner that she / he can master
the requirements in the technical and organizational activity of a sleep
lab in independent and certified way.
3. Qualification Procedures
3.1 Prerequisites for attending the examination procedure
Applicants must work full time (equivalent) for a period of 2 years
(full time equivalent) in an accredited SMC.
3.2. Application for admission to the sleep medicine technician examination
To apply, the candidate must show proof to the relevant authority that
the entry requirements described above have been fulfilled.
3.3 Certification Committee
Unless a certification programme is already operational and organized
by university or government officials, the NSS may take responsibility
for this process. For this purpose, it is suggested that the NSS set
up a Certification Committee, consisting of at least 3 members appointed
for 2 years. The application of the candidates is examined by this committee,
with respect to the fulfilment of all requirements. The Certification
Committee is composed of a chairman and at least 2 additional members
(of which at least one should be a sleep technologist), its composition
should reflect the different medical specialisations within sleep medicine.
The Board of the NSS decides who will act as chairman of the Certification
Committee.
The Certification Committee also selects the names of the examiners
and the place for the examination.
3.4 Procedure for examination
The examination consists of a practical-clinical and a theoretical part.
1. Practical-clinical part: adequate knowledge of the use of sleep medicine
diagnostic and therapeutic tools are to be demonstrated.
2. Theoretical part: knowledge should be demonstrated covering all relevant
areas of sleep medicine.
The examination committee, which is appointed by the certification committee,
should consist of at least 3 members (from different laboratories/universities
etc.) who represent the relevant medical specialities.
3.5 Protocol
Written notes of the examination and its outcome signed by the examination
committee are required. The applicant has the right to request a copy.
Two only examination results are possible, pass or fail.
3.6 Repeating the examination procedure
The examination can be repeated twice more (i.e. a total of 3 times)
if a candidate is unsuccessful. The Board of the NSS will decide on
the necessary prerequisites.
3.7 Appeal
A candidate can appeal, to the board of the NSS against the decision
of the Certification Committee or examiners within 4 weeks. However,
the board of the NSS should only exceptionally overrule a decision of
the examiners.
3.8 Certificate
A certificate will be issued by the NSS or the authorized body to
candidates who completed the examination successfully.
3.9 Transitional arrangements
In order to start the certification procedures in those countries
who do not yet have implemented training programmes and examination
sessions, it is recommended that currently active and experienced sleep
professionals can apply for a certification as a sleep nurse or sleep
technologist.
These applicants must be able to show that they performed the procedures
as listed in Appendix 1. They must provide evidence of their theoretical
knowledge.
The Board of the NSS shall decide by simple majority if the application
fulfils the requirements. If so, the certification will be granted.
The transitional period should not be longer than 18 months.
For countries with existing training programmes and examination sessions,
transformation of these by the NSS into the presently proposed certification
system is possible if they comply with the requirements mentioned above.
Appendix 1. Index of preceding practical experience
The candidate will be required to provide a written statement from the head of their SMC stating correct performance of the following
1. Correct performance of full polysomnography (PSG) recordings in 300 patients.
2. Independent reading of 300 PSGs according to R&K, including scoring of arousals, respiratory events, PLM and recognition of other sleep events like bruxism, parasomnia etc.
3. Independent performance of a full MSLT/MWT procedure in 30 patients
4. Depending on the specialisation of the applicant they should in addition provide evidence of sufficient practical experience of the techniques relevant to their field e.g. CPAP titration, cognitive behavioural therapy (CBT), actigraphy, psychomotor testing of vigilance etc.
5. Basic knowledge of cardiopulmonary resuscitation (CPR).
Appendix 2. Index of theoretical knowledge
The candidate must demonstrate knowledge of the following sleep medicine contents.
2.1 EEG and physiological bases of sleep
Candidates should demonstrate basic knowledge of:
· physiological and age-related variations of sleep/vigilance
during the day, examination and evaluation of vigilance disturbances,
physiological variations, age related variations.
· EEG activity during sleep, staging of sleep.
2.2 Chronobiological aspects of sleep
The candidate should have basic knowledge concerning:
· Circadian rhythm and its influence on temperature and heart/circulatory
and hormone activity.
· Tiredness and sleepiness during the day.
· Methods for recording daytime dependent variations of sleepiness
and efficiency.
· Diagnostic procedure of circadian variation and physiological
variables.
· Sleep disturbances due to disrupted sleep-wake rhythm and their
classification and differential diagnoses.
· Therapeutic non-medical management of circadian rhythm disorders
and pharmacological therapy.
2.3 Diagnostic procedures for identification and assessment of sleep disturbances.
The candidate should have basic knowledge of:
· Outpatient diagnostic procedures for insomnia
· Sleep related respiratory disturbances.
· Sleep related circulatory disturbances.
· Outpatient methods for identifying and assessing disturbances
of vigilance
· Knowledge of established and validated questionnaires for assessing
sleep disturbances.
· Diagnostic procedures including :
- PSG.
- Rating scales and neuropsychological tests.
- MSLT and MWT.
- Cardio-respiratory polygraphy.
· The applicant should have extensive knowledge about the methodology,
recording, artefact recognition and evaluation of the polysomnographic
investigation.
2.4 (Differential) diagnosis of sleep disorders as listed in ICSD-2
The candidate should have basic knowledge of:
· Differential diagnosis and classification of sleep disturbances,
daytime sleepiness and tiredness. In particular, the candidate has to
be able to recognise the symptoms, differential diagnosis and prognosis
of the following disorders and must be able to independently draw up
therapeutic programs.
- Insomnia.
- Sleep apnea syndromes and other sleep-related breathing disorders
- Hypersomnia and disturbances with daytime sleepiness.
- Narcolepsy.
- Parasomnias.
- Sleep disturbances in: psychiatric, neurological, internal, cardio-respiratory,
skeletal, abuse of drugs, alcohol, medication, paediatric disorders,
medication side effects and circadian rhythm disturbances.
2.5 Therapy of sleep disturbances
The candidate should have basic knowledge of indication, methods and
application of:
· Sleep hygiene.
· Cognitive behavioural therapy and other psychotherapeutic procedures
for sleep disturbances.
· Influence of medication on normal sleep.
· Drug therapy for sleep disorders.
· nasal CPAP and other aspects of non-invasive ventilation
· surgery
· dental appliances
2.6 Organisations of a sleep lab
The applicant should have basic knowledge of organisational structure and process of a sleep lab, including personnel, technical and logistical prerequisites for running a sleep-lab (cf. European Guidelines for the Accreditation of Sleep Medicine Centres)