Finally, the absence of accreditation impedes sleep centers moving toward better care for patients (by embracing both diagnosis and treatment, rather than diagnosis alone). The overview to the standards indicates that accredited centers provide a comprehensive approach to patient care (AASM, 2006a). But this broad mission is not reflected in the actual criteria for accreditation. Accrediting criteria emphasize personnel, patient acceptance, facilities, and technical staff. The criteria lack specific emphasis on long-term disease management and improved outcomes provided by patient care. The committee heard testimony that many patients who are evaluated and diagnosed at centers are not systematically tracked in terms of follow-up care—either for treatment or for monitoring adherence with treatment. This testimony is consistent with research revealing that compliance with CPAP is poor (Kribbs et al., 1993; Reeves-Hoche et al., 1994). The committee could not find studies that directly address the extent to which diagnosed patients are not receiving treatment and follow-up care. The committee believes, however, that the accreditation procedure represents a unique opportunity to ensure that sleep centers are primarily focused on improving patient outcomes rather than diagnosis.
Starting in the mid-1990s, the AASM began to accredit sleep fellowship training programs. These are 1-year programs for medical doctors, which may be taken after completion of a residency (e.g., internal medicine, neurology, otolaryngology, psychiatry, or pediatrics or fellowships such as pulmonary medicine). In 2003, the ACGME approved AASM’s application for transferring its fellowship training program to ACGME. AASM had actively sought approval in order to further elevate the standards for training and education. The newly established ACGME accreditation program began in June 2004. Accreditation criteria cover such areas as curriculum, qualifications of faculty, fellow competencies, scholarly activities, duty hours, and evaluation. By 2011, eligibility for board certification in sleep medicine will require attending an ACGME-accredited fellowship program in sleep medicine. Currently there are 24 ACGME-accredited fellowship programs and approximately 50 AASM accredited programs.
Since its inception, the AASM (or its predecessor organization) certified specialists by a specialty examination. By 1991, the AASM formed an independent body to serve that function, the American Board of Sleep Medicine. Certified professionals are known as diplomates in sleep medicine. The number of diplomates rose from 21 in the late 1970s to 3250 in 2005.