The Evaluation of Sleep Disorders
An essential element of the clinical sleep health educator (CCSH) role is an understanding of modes and rationale for sleep testing based on patient history and complaints. In addition, an understanding of the data derived from the various types of testing and the ability to evaluate that data is crucial. In module two of the AAST Enhanced CCSH Designated Education Program, Jon Atkinson, BS, RPSGT, CCSH, FAAST, discusses the rationale behind sleep testing, both in the laboratory and the home, and highlights the importance of a quality sleep history to ensure the appropriate level of testing and sleep environment is provided. Additionally, Atkinson gives an overview of the American Academy of Sleep Medicine (AASM) Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) indications, recommended protocols and scoring process for each test.
The module also discusses testing results for in-lab polysomnography, MSLT, MWT and positive airway pressure (PAP) titrations, reviewing how to analyze and interpret test and treatment results. The significance of a variety of the standard parameters evaluated with these tests such as apnea hypopnea index (AHI), respiratory disturbance index (RDI), respiratory effort-related arousal (RERA), periodic limb movements in sleep (PLMS), sleep onset REM periods (SOREMPs) and wake after sleep onset (WASO) are presented.
The application and evaluation of data garnered from home sleep apnea testing (HSAT) and other ancillary testing modalities such as actigraphy and pulse oximetry is reviewed. The implications of the future role of biomarkers in sleep medicine are also touched on briefly.
The basics of sleep testing modalities and appropriate review and evaluation of the data gathered assist the CCSH to collaborate with the physician, formulate a follow-up plan and provide accurate and appropriate education for sleep disorders patients. There is also a good deal of basic information provided in this module that would be helpful for the sleep technician preparing for the RPSGT credentialing exam.