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.
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