Don’t Sleep on It! Does Your
Polysomnography Program Meet
Current Standards?
Tom Smalling, EdD, RRT, RPFT, RPSGT, FAARC
Executive Director
Conflict of Interest
I have no real or perceived conflict of interest
that relates to this presentation. Any use of
brand names is not in any way meant to be
an endorsement of a specific product, but
to merely illustrate a point of emphasis.
AARC Congress 2011
Objectives
Learning objectives for this presentation:
 Identify the entry pathways into the PSG
accreditation system;
 Describe the changes to the CoARC Standards
relevant to the PSG program option;
 Recognize the steps necessary to start a PSG
program option.
AARC Congress 2011
What’s Covered
 Overview of Accredited PSG Programs
 Entry Pathways into the PSG Accreditation System
 Current Status of CoARC Programs
 Changes to CoARC Accreditation Standards
 Curricular Strategies
 Sample program outlines
 Sample instructional units
 How do I get started? Resources
 Question and answers
www.coarc.com
4
Overview of Accredited PSG Programs
Pathways into the PSG Accredited System
Commission on Accreditation for Respiratory Care (CoARC)
1.

Add-on component to respiratory care (base) program;
Committee on Accreditation for Education in
Electroneurodiagnostic Technology (CoA-END)*
2.

Add-on component to END (base) program;
Committee on Accreditation for Polysomnographic
Technologist Education (CoA-PSG)*
3.

Stand-alone program
* CoA-END and CoA-PSG are Committees within the Commission on
Accreditation of Allied Health Education Programs (CAAHEP)
www.coarc.com
5
Overview of Accredited PSG Programs
 Commission on Accreditation for Respiratory Care (CoARC)
 Must be current student or graduate of a CoARC-accredited program to
enroll;
 Graduates receive certificate of completion in addition to degree from RC
program;
 Graduates are eligible to take the Registered Polysomnographic
Technologist Exam (RPSGT) administered by the Board of Registered
Polysomnographic Technologists (BRPT) without additional on-the-job
training (Pathway #3). Other credentialed RTs must complete 6 months FT
OJT experience to become eligible.
 Graduates are eligible to take the Sleep Disorders Specialty Exam (SDS)
administered by the NBRC. Other credentialed CRTs must complete 6
months FT OJT experience to become eligible. RRTs must complete FT 3
months OJT experience.
6
www.coarc.com
Overview of Accredited PSG Programs
 Committee on Accreditation for Education in
Electroneurodiagnostic Technology (CoA-END)
 Must be current student or graduate of a CoA-END-accredited program to
enroll;
 Graduates of the add-on receive certificate of completion and may also
earn a degree from END program (not required);
 Graduates are eligible to take the Registered Polysomnographic
Technologist Exam (RPSGT) administered by the Board of Registered
Polysomnographic Technologists (BRPT) without additional on-the-job
training (Pathway #3).
 Graduates are not eligible to take the NBRC SDS Exam.
www.coarc.com
7
Overview of Accredited PSG Programs
 Committee on Accreditation for Polysomnographic
Technologist Education (CoA-PSG)
 Program enrollment is open to students in post-secondary academic
institutions and accredited sleep centers;
 Graduates receive a certificate of completion and may also earn a degree
from PSG program (not required);
 Graduates are eligible to take the Registered Polysomnographic
Technologist Exam (RPSGT) administered by the Board of Registered
Polysomnographic Technologists (BRPT) without additional on-the-job
training (Pathway #3).
 Graduates are not eligible to take the NBRC SDS Exam.
www.coarc.com
8
Overview of Accredited PSG Programs
Current Numbers/Types of PSG Programs
Commission on Accreditation for Respiratory Care (CoARC)
1.

8 Total (4 Associates; 5 Baccalaureate)
Committee on Accreditation for Education in
Electroneurodiagnostic Technology (CoA-END)*
2.

13 Total (1 Diploma; 6 Certificate; 10 Associate; 1 on-line/distance)
Committee on Accreditation for Polysomnographic
Technologist Education (CoA-PSG)*
3.

39 Total (31 Certificate; 13 Associates; 6 on-line/distance)
www.coarc.com
9
Purpose of Standards
 Outlines the minimum requirements to which an
accredited respiratory care program is accountable.
 Used for the development, evaluation, and self-analysis
of respiratory care programs.
 Provides the basis on which the CoARC confers or
denies program accreditation.
www.coarc.com
Standard I – Program Administration
and Sponsorship
 Institutional Accreditation
 Consortium
 Sponsor Responsibilities
 Program Location
 Substantive Changes
 Affiliate Agreements
www.coarc.com
Standard II – Institutional and Personnel
Resources
 Institutional Resources
 Personnel Resources
 Key Program Personnel
 Program Director
 Director of Clinical Education
 Medical Director
 Instructional Faculty
 Administrative and Support Staff
www.coarc.com
CoARC Policy 6.01 E – Primary PSG Instructor
 There must be a Sleep Disorders Specialist (CRT-SDS or RRT-
SDS) or a Registered Polysomnographic Technologist (RPSGT),
(who is preferably also a Registered Respiratory Therapist),
designated as the primary instructor for that portion of the
program.
 While this individual may be either of the two Key Personnel
noted above, (should s/he meet sleep specialist qualifications),
under those circumstances the program must show that these
additional responsibilities are not adversely affecting the
education of those students enrolled in the base Respiratory
Care program.
www.coarc.com
CoARC Policy 6.01 E – Primary PSG Instructor
 In addition to the CRT-SDS, RRT-SDS, or RPSGT credential, this
individual must possess at least an Associate Degree, and have
at least two (2) years of clinical experience in sleep technology.
 It is recommended that the individual should have at least one
(1) year’s experience in an appropriate teaching position.
www.coarc.com
Standard III – Program Goals,
Outcomes, and Assessment
 Statement of Program Goals
 Assessment of Program Goals
 Assessment of Program Resources
 Student Evaluation
 Assessment of Program Outcomes
 Reporting Program Outcomes
 Clinical Site Evaluation
www.coarc.com
Standard III – Program Goals,
Outcomes, and Assessment
 Standard 3.01 –
…For programs offering the polysomnography option,
the program must have the following additional goal
defining minimum expectations:
“To prepare sleep disorder specialists with
demonstrated competence in the cognitive (knowledge),
psychomotor (skills), and affective (behavior) learning
domains of polysomnography practice as performed by
sleep disorder specialists (SDS).”
www.coarc.com
Standard III – Program Goals,
Outcomes, and Assessment
 Standard 3.03 -
Program goals must be compatible with nationally
accepted standards of roles and functions of registered
respiratory therapists and registered sleep disorders
specialists for programs offering the polysomnography
option.
www.coarc.com
Optional PSG Program Goals
1.
Facilitate the entry of working therapists wishing to
cross-train into this specialty.
2.
Provide graduates with the opportunity to obtain
specialized training and be eligible to take the
national credentialing exam upon completion of
the certificate.
www.coarc.com
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Standard III – Program Goals,
Outcomes, and Assessment
 Standard 3.13 -
The program must, at a minimum, meet the assessment
thresholds established by CoARC for the following
program outcomes, regardless of location and
instructional methodology used: a) Graduate
performance on the national credentialing examination
for entry into practice; b) Programmatic
retention/attrition; c) Graduate satisfaction with
program; d) Employer satisfaction with program; and e)
Job placement.
www.coarc.com
Standard IV– Curriculum
 Minimum Course Content
 Minimum Competencies
 Length of Study
 Equivalency
 Clinical Practice
www.coarc.com
Standard IV– Curriculum
 Standard 4.07 -
…For the polysomnography option, curricular content
must be periodically reviewed and revised to ensure its
consistency with the competencies and duties performed
by sleep disorder specialists in the workforce, as
established by the national credentialing agency through
its periodic job analysis and outlined in its credentialing
examination specifications. These nationally accepted
standards provide the basis for formulating the objectives
and competencies of the program’s curriculum…
www.coarc.com
NBRC Sleep Disorders Specialist (SDS) Examination
Detailed Content Outline Comparison
with Curriculum (Program #
)
I. PRE-TESTING
A. Identification and Care of At-Risk Individuals
1. Recognize signs and symptoms associated with sleep disorders as revealed by history, interview,
or clinical assessment
2. Identify special factors and co-morbid conditions affecting individuals with potential sleep
disorders
3. Interact with members of the health care team
NBRC SDS
Detailed
Content
Outline
Comparison
with
Curriculum
a. communicate findings
b. recommend diagnostic studies
c. recommend therapeutic intervention
B. Study Preparations
1. Review
a. a patient’s history, current medications, questionnaire, and notes
b. the physician’s order for a sleep study
2. Set up
a. equipment to achieve the desired data collection
b. special equipment as indicated
3. Select the appropriate study procedure and corresponding montage e.g. • Polysomnography with
or without PAP titration • Maintenance of Wakefulness Test • Multiple Sleep Latency Test
4. Set high and low filters, and sensitivity settings
5. Evaluate equipment calibrations to ensure accuracy and linearity of amplified signals e.g.
pneumotach, EMG, EEG
6. Confirm adequate audiovisual signals
7. Recommend modifications to the physician’s order when necessary
8. Assess the patient’s current clinical condition
9. Explain testing procedures and potential interventions to the patient
10. Determine the patient’s expectations about the study
11. Recognize special needs associated with a patient’s
a. age
b. psychological status
c. physical status
d. culture
e. language
f. cognitive status
www.coarc.com
12. Identify patient medications that may affect test results
Page 1 of 1
List Course
Number(s)
Curricular Strategies
 Curriculum content and length, and documentation of student
progress must be designed to enable achievement of program
goals and objectives.
 Curricular content must be designed to supplement as well as take
advantage of the comprehensive didactic, laboratory, and clinical
instruction already established in a respiratory care curriculum.
 For instance, while respiratory care program curricula provide
significant instruction on positive airway pressure (PAP) therapy,
respiratory therapy students enrolled in an optional
polysomnography program would learn about the distinct
application of PAP devices within the context of the sleep
laboratory.
www.coarc.com
23
Curricular Strategies
 Learning and clinical resources must be appropriate to the
program’s goals and should be available to students outside of
regular classroom hours.
 Physician input, preferably those who are Board-certified in sleep
medicine, should also be adequate.
 Program competencies should provide the basis for deriving the
objectives and activities constituting the program's curriculum.
 The competencies stated and the curriculum objectives derived
should be consistent with the level of practitioner preparation
delineated in the program's goals, and should encompass the
knowledge, technical expertise and behavior expected of
graduates.
www.coarc.com
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Curricular Strategies
 The curriculum must include an appropriate sequence of
learning experiences consisting of classroom and laboratory
presentations, discussions, demonstrations, and supervised
laboratory and clinical practice that progresses in sequence from
entry-level cognitive, psychomotor, and affective components of
instruction to more advanced levels.
 Clearly written course syllabi which describe learning objectives
and competencies must be developed for each of the didactic,
laboratory, and clinical components.
 Clinical affiliates should conform to professional standards, such
as those established by the AASM, JCAHO, and by other health
care accrediting entities where appropriate.
www.coarc.com
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Curricular Strategies
 The above strategies are not meant to be all-inclusive, but are
attentive and consistent with current accreditation standards
and practices.
 The polysomnography curriculum should be designed in such a
way as to addresses the unique characteristics and constraints
of each respiratory therapy program.
 What works well for a university-based, baccalaureate
respiratory therapy program with 10-week modular curricula,
for example, will not necessarily work for a semester-based,
associate degree community college program.
www.coarc.com
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Sample Program Curriculum
 LAST SEMESTER (YEAR 1)
 OBSERVATIONAL CLINICAL IN A SLEEP LABORATORY
 FIRST SEMESTER (YEAR 2)
 PSG LECTURE I -------------------------- 20 contact hours
PSG LAB I ----------------------------------- 30 contact hours
 PSG CLINICAL I --------------------------- 80 contact hours
 SECOND SEMESTER (YEAR 2)
 PSG LECTURE II -------------------------- 20 contact hours
 PSG LAB II ----------------------------------- 30 contact hours
 PSG CLINICAL II --------------------------- 80 contact hours
TOTAL CONTACT HOURS:
www.coarc.com
260
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Sample Program Curriculum
Professional-Technical
RESP 250
Beginning Polysomnography
2
RESP 251
Intermediate Polysomnography
3
RESP 252
Polygrphy Directed Practice I
3
RESP 253
Neurophysiology of Sleep
2
RESP 254
Intermediate Polysomnography II
3
RESP 255
Intermediate Polysomnography II
3
Professional-Technical: 16
www.coarc.com
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Sample Program Curriculum
First Term
Course Title
Credits
PSG 1000 Polysomnographic Technology I
3
PSG 1000L Polysomnographic Technology Laboratory I
1
PSG 1800L Polysomnographic Technology Clinical Practicum I
1
Total Credits
5
Second Term
Course Title
Credits
PSG 1001 Polysomnographic Technology II
3
PSG 1001L Polysomnographic Technology Laboratory II
1
PSG 1801L Polysomnographic Technology Clinical Practicum II
1
Total Credits
5
Total Certificate Credits
www.coarc.com
10
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Typical Sequence of Instructional Units
 Medical Terminology related to Sleep
 Patient and Laboratory Safety Issues
 Procedures/Documentation for Initiating Sleep Studies
 Electrode Theory/Instrumentation
 Patient Preparation Procedures/International 10-20 System
 Neuroanatomy and Physiology
 Intro to sleep architecture/sleep stages
 Ancillary equipment application
 Signal processing
 Montage selection/Equipment calibration
 Physiologic Calibrations/Lights Out Procedures
 Sleep disorders pathophysiology
www.coarc.com
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Typical Sequence of Instructional Units
 Monitoring procedures
 Sleep microanatomy and architecture
 Sleep pathophysiology
 PSG record staging (R&K/AASM)
 Event recognition (Limb movement; Respiratory; Cardiac; Neuro)
 Sleep Pharmacology
 Sleep Calculations
 Pediatric PSG
 MSLT/MWT
 Data archiving/Report generation
 Therapeutic Interventions (PAP, surgical, non-surgical)
 Sleep lab/center management
 Treatment plans (development/implementation/evaluation)
www.coarc.com
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Standard V– Fair Practices and
Recordkeeping
 Disclosure
 Non-discriminatory Practice
 Safeguards
 Academic Guidance
 Student Identification
 Student Records
 Program Records
www.coarc.com
How do I get started?
CoARC Policy 2.01
 All sponsors must have an accredited base
program. A base program holding continuing
accreditation with no pending progress
reports may expand its offerings by adding a
Polysomnography Specialty, or Satellite (U.S.
or International).
www.coarc.com
Accreditation Policy Change
CoARC Policy Change to go into effect as of
March 2012:
 Polysomnography Program Option referred to
as Sleep Specialist Program Option (SSPO);
 More accurate/appropriate description of the respiratory
therapist’s role in the sleep field;
 Alignment with description used by NBRC.
www.coarc.com
How do I get started?
 Initiation of Accreditation (CoARC Policy 2.03)
 Letter of Intent Application- SSPO




Advisory Committee support;
Letters of support from affiliates;
Establishes maximum enrollment.
$250 application fee
 Action by CoARC Board (Approval/Denial of Intent)
 Enrollment of students for the first class must occur within
six (6) months of the date of the Approval of Intent.
www.coarc.com
How do I get started?
 Initiation of Accreditation (CoARC Policy 2.03)
 Submit a CoARC Accreditation Services Application;
 Sleep Specialist Initial Accreditation Self Study Report (ISSRSleep) – submitted within 3 months after enrollment of first
class;
 $500 self-study fee;
 On-Site Review – conducted within 3-5 months after ISSR;
 Action by CoARC (Initial Accreditation or Withhold of Initial
Accreditation);

Initial Accreditation for 5 years
 $500 annual fee.
www.coarc.com
How do I get started?
 Perform a needs assessment;


Interest from the community; Assess your resources;
Find a qualified primary PSG instructor/facility;
 Obtain support/feedback from administration, advisory
committee, and medical director; co-medical director?
 Go to www.coarc.com, download and review the Letter
of intent application and self study;
 Network with colleagues.
www.coarc.com
37
What resources are at my disposal???
 www.coarc.com
 Application for Accreditation Services
 Policies and Standards
 List of currently accredited PSG-add on programs
 www.aarc.org
 Specialty sections in sleep & education (sleep@aarc.org)
 www.nbrc.org
 SDS exam content and administration; state practice acts
 www.brpt.org
 RPSGT exam content and administration
www.coarc.com
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CoARC Executive Office
For any questions, contact the Executive Office at:
1248 Harwood Road
Bedford, TX 76021
(817) 283-2835
tom@coarc.com
www.coarc.com
Questions and Answers
www.coarc.com