On behalf of the Board of Directors and the Technology Presidential Committee of the American Academy of Sleep Medicine (AASM), we appreciate the feedback from Solveig Magnusdottir, MD, MBA, in response to the AASM position statement on consumer sleep technology and our previous letter to the editor.1–3 We agree that although consumer sleep technology has the potential to improve our ability to increase awareness of and track sleep disorders through multi-night testing in the home environment, scientific validation is necessary for consumer sleep technology to have a significant role in clinical practice.
We also agree with Dr. Magnusdottir's statement that, “AASM has a leadership obligation to facilitate increased public awareness of sleep disorders and to support improved integration of sleep health into medical care in a responsible manner. To establish common ground, AASM needs to embrace innovation in sleep medicine.” We will briefly describe how AASM already has taken steps to fulfill this obligation.
Regarding the facilitation of increased public awareness of sleep disorders, in 2018 the AASM concluded a 5-year cooperative agreement with the Centers for Disease Control and Prevention (CDC) for the administration of the National Healthy Sleep Awareness Project, involving collaboration with the Sleep Research Society (SRS) and other partners. This initiative produced two consensus statements that sparked, and continue to stoke, media coverage about the importance of a healthy sleep duration.4,5 The project also generated multiple public awareness campaigns on important topics such as drowsy driving, obstructive sleep apnea (OSA), and insufficient sleep among teens. This partnership of the AASM and SRS continues with a group of experts from both societies tasked with the evaluation of recommendations regarding shift work.
Currently the AASM continues to invest in an ongoing public relations campaign to raise awareness that healthy sleep is essential for health and well-being, untreated sleep disorders are common and detrimental to health, and patient-centered care is available from board-certified sleep medicine physicians and the sleep team of health care providers at accredited sleep centers. Anyone who has been involved in sleep medicine for more than a few years should recognize that we are living in the golden age of sleep awareness. Using Google search data since 2004 as a gauge, Figure 1 shows that public interest in sleep is currently at its peak. Although the AASM has contributed to this success, this achievement is a credit to everyone in our field—including individual AASM members, accredited sleep facilities, sleep-related patient organizations, sleep therapy manufacturers, and advocates such as Arianna Huffington, who received the 2018 Mark O. Hatfield Public Policy or Advocacy Award from the AASM.
Sleep topic, interest over time in the United States: 2004 to 2019.
Numbers represent search interest relative to the highest point on the chart for the given region and time. A value of 100 is the peak popularity for the term. A value of 50 means that the term is half as popular. Source: Google Trends. Accessed Feb. 16, 2019. Available from: https://trends.google.com.
Sleep topic, interest over time in the United States: 2004 to 2019.
The AASM also is committed to the integration of sleep health into medical care, and we recognize that primary care providers play an important role in detecting and managing sleep disorders. However, we face two considerable challenges. First, education on normal sleep and sleep disorders is severely lacking in most medical school curricula.6 For decades, the AASM and other stakeholders have sought to improve sleep education in medical schools through a variety of task forces, workshops, and other strategies.7–11 However, increasing the amount of time committed to sleep instruction requires decreasing time from other topics of study, and medical educators have been and continue to be reluctant to make this trade. Second, primary care physicians are being stretched to their limits by large patient panels, complex chronic diseases, and administrative requirements such as prior authorization and electronic health records (EHRs) management.12 Many simply do not have the bandwidth to take on significant responsibility for identifying and managing sleep disorders.
These were some of the topics that we discussed during the Sleep-Disordered Breathing Collaboration Summit, which the AASM hosted in November 2018. Thirty-five representatives from 14 medical societies, nurse practitioner associations, and patient advocacy groups met to discuss strategies to improve the diagnosis and treatment of OSA. The goal of the summit was to discuss how the sleep field could expand access to care by involving primary care physicians, advanced practice providers, and other medical specialists in a team-based approach to address the sleep apnea crisis. Although attendees expressed broad support for this idea, it became clear that there is not a one-size-fits-all approach that will work across specialties and practice settings. More details about the summit will be provided in a forthcoming report.
Finally, the AASM clearly embraces innovation in sleep medicine and appreciates how rapid changes are affecting daily clinical sleep practices. That is why we developed a position paper for the use of telemedicine in 2015 and launched the AASM SleepTM telemedicine system in 2016.13,14 AASM leadership recognized that telemedicine is going to become a mainstream feature of clinical practice in the United States and made a commitment to help our members stay on the forefront of health care delivery. Similarly, the AASM appointed a Technology Presidential Committee and an Artificial Intelligence in Sleep Medicine Subcommittee to help our members understand the rapid innovation occurring in the field. Soon an artificial intelligence position statement will be published, and AASM members will have access to an online database with assessments describing the appropriate roles and limitations of specific consumer sleep technology devices. The AASM also recently participated in an SRS-organized workshop evaluating the potential role of consumer sleep technology both for longitudinal research and clinical practice. Although technological innovators within the sleep space often tout the new and interesting data from their devices, it remains clear to the AASM that open scientific validation of that data in a reasonable patient-based context remains the gold standard for integration with the clinical care of patients with sleep disorders.
At its most recent quarterly meeting, held in January 2019 in San Francisco, the AASM Board of Directors hosted presentations about sleep innovation from representatives of Fitbit and Verily, which along with Google is a subsidiary of Alphabet Inc. Several AASM leaders also met with Fitbit leadership at its nearby headquarters, and Fitbit agreed to send a representative to give a presentation at the AASM Sleep Medicine Disruptors course, which was livestreamed from the MATTER health incubator in downtown Chicago on March 29, 2019. We recognize that the field of sleep medicine is primed for change due to technology, and the AASM is focused on equipping our members to embrace this innovation to improve access to high-quality, patient-centered care. We appreciate Dr. Magnusdottir's letter and strive to partner with our members, industry representatives, sleep researchers, and medical colleagues to continue to advance the field of sleep medicine.
The authors report no conflicts of interest. Dr. Kirsch is the 2018-2019 president of the AASM. Dr. Khosla is the 2018-2019 chair of the AASM Technology Presidential Committee.
Kirsch DB, Khosla S. Public awareness, medical integration, and innovation in sleep medicine. J Clin Sleep Med. 2019;15(5):799–801.
Magnusdottir S. The importance of evidence-based medicine and clinical guidelines: meaningful and clinically actionable information cannot be compromised for the convenience of consumer sleep data. J Clin Sleep Med. 2019;15(5):795–796
Khosla S, Deak MC, Gault D, et al. Consumer sleep technology: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(5):877–880. [PubMed Central][PubMed]
Khosla S, Deak MC, Gault D, et al. Consumer sleep technologies: how to balance the promises of new technology with evidence-based medicine and clinical guidelines. J Clin Sleep Med. 2019;15(1):163–165. [PubMed Central][PubMed]
Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015;11(6):591–592. [PubMed Central][PubMed]
Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–786. [PubMed Central][PubMed]
Mindell JA, Bartle A, Wahab NA, et al. Sleep education in medical school curriculum: a glimpse across countries. Sleep Med. 2011;12(9):928–931. [PubMed]
Orr WC, Stahl ML, Dement WC, Reddington D. Physician education in sleep disorders. J Med Educ. 1980;55(4):367–369. [PubMed]
Dement WC. The Medical School Curriculum Consensus Workshop: consensus document. Sleep. 1988;11(6):566–570. [PubMed]
Rosen RC, Rosekind M, Rosevear C, Cole WE, Dement WC. Physician education in sleep and sleep disorders: a national survey of U.S. medical schools. Sleep. 1993;16(3):249–254. [PubMed]
Zozula R, Bodow M, Yatcilla D, Cody R, Rosen RC. Development of a brief, self-administered instrument for assessing sleep knowledge in medical education: “the ASKME Survey”. Sleep. 2001;24(2):227–233. [PubMed]
Strohl KP, Veasey S, Harding S, et al. Competency-based goals for sleep and chronobiology in undergraduate medical education. Sleep. 2003;26(3):333–336. [PubMed]
Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. A time-motion study of primary care physicians' work in the electronic health record era. Fam Med. 2018;50(2):91–99. [PubMed]
Singh J, Badr MS, Diebert W, et al. American Academy of Sleep Medicine (AASM) position paper for the use of telemedicine for the diagnosis and treatment of sleep disorders. J Clin Sleep Med. 2015;11(10):1187–1198. [PubMed Central][PubMed]
Watson NF. Expanding patient access to quality sleep health care through telemedicine. J Clin Sleep Med. 2016;12(2):155–156. [PubMed Central][PubMed]