Board of Medicine

Policy Statement on Diagnostic Testing and Treatment of Sleep-Related Breathing Disorders

Adopted by the Iowa Boards for Medicine, Nursing and Respiratory Care on March 13, 2008. Revised policy adopted by the three boards on April 2, 2009

This policy statement is not a legally binding opinion of the board, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders, or contested case decisions.

Diagnostic testing and treatment of sleep-related disorders are rapidly expanding in Iowa. Diagnostic testing includes polysomnography, which involves monitoring of relevant normal and abnormal physiological activity during sleep. Therapeutics for sleep-related disorders may include the use of oxygen, continuous positive airway pressure, bi-level positive airway pressure and non-invasive positive pressure ventilation. The Iowa Boards of Respiratory Care, Medicine and Nursing are concerned by instances where diagnostic testing and treatment for sleep-related disorders are being provided by individuals with limited experience and training in facilities ill-equipped to handle associated problems. Inadequately trained personnel may not have necessary skills to assure testing and treatment are being performed correctly. A false positive result may lead to treatment that is unnecessary and costly. A false negative result may lead to a patient not receiving needed treatment. Ultimately, false positive and false negative results may cause patient harm. Patients with sleep-related disorders often have other serious medical conditions. A critical part of a practitioner’s role in assessing a patient with a sleep-related disorder is to evaluate the patient’s overall physical condition to understand the patient’s response to diagnostic testing and treatment. To ensure protection of the citizens of Iowa, it is critical that facilities and personnel involved in the diagnostic testing and treatment of sleep-related disorders satisfy certain minimum standards of education and training.

Researchers have identified at least 80 sleep-related disorders that are obstructive, neurological or mixed in origin. To achieve meaningful data for diagnosis and treatment, a practitioner providing diagnostic testing must have significant skill and training. Respiratory care practitioners, registered nurses, licensed practical nurses and physicians (“M.D.s” and “D.O.s”) have an educational foundation upon which to add the skills required to effectively treat individuals with sleep-related disorders.

The Iowa Boards of Respiratory Care, Medicine and Nursing consider licensed respiratory care practitioners, nurses, or other health care professionals licensed by the state of Iowa and registered polysomnographic technologists and registered electronencephalographic technologists who have specific training and competency testing in these topics, qualified to perform diagnostic testing and treatment of sleep-related disorders. All personnel performing diagnostic testing and treatment of sleep-related disorders should do so under the direction of an Iowa licensed physician who holds a sleep specialty credential and who is actively involved in the facility where the testing and treatment are being provided.

Diagnostic testing and treatment of sleep-related disorders should be conducted under appropriate conditions in an integrated facility. While parts of the facility are not required to be in the same location, the parts of the facility should be unified and presented to the public under a singular identity.

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