During the past decade, hospital inpatient screening for sleep apnea and the launch of the Certification in Clinical Sleep Health (CCSH) credential has given rise to an even more expanded role for technologists. Grassroots efforts among sleep centers and respiratory departments have shown hospital administrators just how much undiagnosed sleep apnea truly impacts hospital length of stay, daily costs, and readmission rates. Enter the “sleep navigator” role.

A sleep navigator is typically a tech with a CCSH credential who is utilized for the purpose of screening, educating, and assisting hospitalists and other physicians with ordering sleep testing as part of discharge planning. Hundreds of thousands of apnea patients (most undiagnosed) are admitted and readmitted each year to America’s hospitals. In many cases patient readmissions are the result of, or exacerbated by, an underlying sleep disorder that has remained undetected and untreated. Inpatient screening programs appear straightforward, but implementation is a rockier road than most expect.³ Past articles and conference presentations of such programs cite initial roadblocks with administrations, nursing, information technology, and even hospitalist groups. Once the metrics begin to turn on readmissions, costs and lengths of stay, then impressions change and support often follows.

One such example is from a hospital system in Atlanta, Ga, led by T. “Massey” Arrington, RPSGT, MBA, RST, CCSH. Arrington, executive director of Wellstar Sleep Centers, said, “The greatest hurdle we had to overcome was time. We spent six months trialing this at one hospital. Finding team members with the CCSH credential was another hurdle, but that is improving as there are now more CCSH credentialed candidates in the market. Convincing senior leadership to support us was actually the easy part, once we presented them with our trial findings and identified the significant impact our inpatient screening was going to have on reducing readmissions. I would argue my biggest champions for the original idea to screen every single patient admitted were my medical director, Hitendra Patel, and our chief nursing officer, Jill Case-Wirth. Dr Peter C. Gay from Mayo also encouraged us after he learned of our unique approach.”⁴

Over its lifetime, the field of sleep medicine has moved from a diagnostic to more of an outcomes-based subspecialty. The role the PSG technologist plays and will play in supporting improved outcomes requires refined and improved competencies, increased formal education, and development of new work models. The best way to prepare is to distinguish yourself by a combination of:

• In and out of lab testing experience;
• Certification;
• Add-on certifications;
• Formal education; and
• Independent study.

I know my graduate degree has meant the difference in jobs that went to me versus other candidates at least four times in the last 30 years. Physicians and other licensed health professionals are taught early on that education is a career-long endeavor, and we should treat it the same way.

Final Thoughts

For much of this decade, it is this author’s opinion that we all can expect even higher acuity of in-lab patients, an increased utilization and role of respiratory-assist devices, greater access to self-administered apnea testing, and the need for improved interdisciplinary workflows among the total care team (including providers, durable medical equipment companies, hospitals, and independent sleep centers). Remember if you’re doing the same old thing and your competition is improving, then like it or not, you’re falling behind—sage advice for sleep programs and the evolving role of the PSG technologist.

Robert Lindsey, MS, RPSGT, is the director of Sleep Medicine and Neurophysiology at DCH Health System in Tuscaloosa, Ala, and has been on the Sleep Review editorial advisory board since 2004. He began his sleep career as a polysomnographic tech at CHI Memorial Healthcare in Chattanooga, Tenn, in 1991.

References

1. Sullivan CE. Nasal positive airway pressure and sleep apnea. Reflections on an experimental method that became a therapy. Am J Respir Crit Care Med. 2018 Sep 1;198(5):581-7.

2. Kryger M. Interview by author. 10 May 2021.

3. Arrington T, Gladden K.  “The sleep navigator, defining world class sleep medicine delivery.” Virtual SLEEP 2020.

4. Arrington T. Interview by author. 13 Jul 2021.

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