I thank Ms. Colvin and her co-authors for expressing their concerns about the American Academy of Sleep Medicine (AASM) position statement on the clinical use of a home sleep apnea test (HSAT).1,2
I agree with the authors that nurse practitioners (NPs) and physician assistants (PAs) play an important role in the provision of HSAT for patients with suspected obstructive sleep apnea (OSA). As the authors noted, PAs, NPs and other advanced practice registered nurses (APRNs) already provide patient-care services at many accredited sleep facilities.3 The AASM values their involvement as members of the sleep team, and we anticipate that their numbers among the sleep workforce will grow in the years ahead.
Nothing in the position statement is intended to preclude NPs or PAs from practicing according to their state's practice act. The position statement specifies that, “Throughout this statement, the term ‘physician’ refers to a medical provider who is licensed to practice medicine.” While we intentionally made this definition broad enough to be inclusive of medical providers such as NPs and PAs, I acknowledge that we could have worded it more carefully to clarify our intent.
The position statement does emphasize the importance of involving a board-certified sleep medicine physician in the review and interpretation of the raw data from the HSAT device. However, it also recognizes that other aspects of care, such as the face-to-face examination, may be facilitated by medical providers who are not sleep specialists. The AASM acknowledges that additional models for OSA evaluation are needed, and we are focused on developing new pathways that involve other clinicians in OSA assessment and treatment.
We welcome the clinical contributions of NPs and PAs as we continue to work together to improve sleep health and promote high quality, patient-centered care.
Dr. Rosen is the 2017–2018 President of the American Academy of Sleep Medicine.
Rosen IM. Nurse practitioners and physician assistants are important to the sleep team. J Clin Sleep Med. 2018;14(2):295.
Colvin L, Cartwright A, Freedman N, Rogers AE, Vana K. 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]
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]