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Volume 14 No. 02
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Accepted Papers

Letters to the Editor

Nurse Practitioners and Physician Assistants Are Qualified to Perform Home Sleep Apnea Test Clinical Evaluations

Loretta J. Colvin, ACNP-BC1; Ann Cartwright, PA-C2; Neil Freedman, MD3; Ann E. Rogers, PhD, RN, FAASM4; Kimberly D. Vana, DNP, FNP-BC, FNP-C5
1Maryville University, St. Louis, Missouri; 2National Jewish Health, Denver, Colorado; 3NorthShore University Health System, Evanston, Illinois; 4Emory University, Atlanta, Georgia; 5Peoria, Arizona

The American Academy of Sleep Medicine's position statement on the clinical use of a home sleep apnea test addresses board-certified sleep physician (BCSP) evaluation of obstructive sleep apnea (OSA). However, it does not include nurse practitioners (NPs) or physician assistants (PAs).1 Given concerns about BCSP shortages,2 it is important to highlight additional models for OSA evaluation.

A 2012 survey of sleep centers reported 40% utilized NPs or PAs with these providers performing clinical evaluation and management of OSA.3 National data trends suggest this will increase. In the United States advanced practice registered nurse (APRN) and PA employment is projected to increase by approximately 30% between 2014 and 2024, compared to a 7% physician growth.4 Graduate education programs prepare them to obtain medical histories, perform examinations, order testing, and treat medical conditions.3 State licensure determines minimum education, training, certification and standards required for clinical practice.3

In the United States, studies comparing NPs or PAs to BCSPs are not available; however, studies comparing BCSPs to non-certified physicians favor the BCSPs.5 Alternatively, studies performed outside the United States have demonstrated similar outcomes when comparing sleep specialists to sleep-trained nurses or primary care physicians.6,7 Outside sleep centers, studies comparing clinical outcomes of APRNs to physicians report equivalent outcomes,8 with no PA comparison studies available.

NPs and PAs are qualified to obtain medical histories, perform face-to-face examinations and determine home sleep apnea test appropriateness in sleep centers within the laws of his/her state. Through an error in omission, the American Academy of Sleep Medicine risks suggesting otherwise, contradicting current standard of practice within sleep centers and NP/PA scope of practice. It is premature for the American Academy of Sleep Medicine to limit this role to BCSPs without evidence supporting the exclusion of NPs and PAs.


The views expressed in this letter are the authors' own and do not necessarily represent the views of their institutions or employers. The authors have seen and approved this manuscript before submission. The authors report no conflicts of interest.


Colvin LJ, Cartwright A, Freedman N, Rogers AE, Vana KD. Nurse practitioners and physician assistants are qualified to perform home sleep apnea test clinical evaluations. J Clin Sleep Med. 2018;14(2):293.



Rosen IM, Kirsch DB, Chervin RD, et al. Clinical use of a home sleep apnea test: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2017;13(10):1205–1207. [PubMed Central][PubMed]


Watson NF, Rosen IM, Chervin RD, et al. The past is prologue: the future of sleep medicine. J Clin Sleep Med. 2017;13(1):127–135. [PubMed Central][PubMed]


Colvin LJ, Cartwright A, Collop NA, et al. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med. 2014;10(5):581–587. [PubMed Central][PubMed]


Occupational Outlook Handbook. United States Department of Labor, Bureau of Labor Statistics website. 2016-17 Edition. Accessed October 20, 2017.


Parthasarathy S, Subramanian S, Quan SF. A multicenter prospective comparative effectiveness study of the effect of physician certification and center accreditation on patient-centered outcomes in obstructive sleep apnea. J Clin Sleep Med. 2014;10(3):243–249. [PubMed Central][PubMed]


Chai-Coetzer CL, Antic NA, Rowland LS, et al. Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life. JAMA. 2013;309(10):997–1004. [PubMed]


Antic NA, Buchan C, Esterman A, et al. A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. Am J Respir Crit Care Med. 2009;179(6):501–508. [PubMed]


Stanik-Hutt J, Newhouse R, White KM, et al. The quality and effectiveness of care provided by nurse practitioners. J Nurse Pract. 2013;9(8):492–500