and research programs of all the health sciences. Similarly, postgraduate, residency, and fellowship training programs, as well as continuing professional development programs, must include this content. The curriculum should expose students in the fields of medicine and allied health fields to the etiology, pathophysiology, diagnosis, treatment, prevention, and public health burden of sleep loss and sleep disorders. Relevant accrediting bodies and licensing boards ought to define sleep-related curriculum requirements and expectations for knowledge and competency (e.g., Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education, American Board of Medical Specialties, the National League for Nursing, the Commission on Collegiate Nursing Education, and the Council on Education for Public Health). Further, a means for credentialing nonphysicians should be maintained by the American Board of Sleep Medicine, or new mechanisms should be developed by relevant organizations.

TECHNOLOGY DEVELOPMENT AND ACCREDITATION

As awareness increases, greater investment in the development and validation of new and existing diagnostic and therapeutic technologies is required to meet the anticipated demand. Today, the capacity needed to serve the population seeking diagnosis and treatment is inadequate. The wait time for a polysomnogram, the procedure used to diagnose sleep disorders, can be up to 10 weeks. Most American communities do not have adequate health care resources to meet the clinical demand; therefore, millions of individuals suffering from sleep disorders remain undiagnosed and untreated. It has been estimated that sleep apnea alone, a diagnosis that necessitates polysomnography to meet current criteria set out by third-party payers, annually requires at least 2,300 polysomnograms per 100,000 population. However, on average, only 425 polysomnograms per 100,000 population are performed each year in the United States, a level far below the need. In fact, 33 states perform fewer than 500 polysomnograms per 100,000 people annually. This shortfall will exacerbate as awareness of the clinical consequences and public health burden of sleep loss and disorders increases, particularly with the aging of the United States population. Given the cumbersome nature and cost of the diagnosis and treatment of sleep disorders and sleep loss and the resultant inequities with regard to access, in order to ensure future quality care the committee recommends greater investment in the development of new and validation of existing diagnostic and therapeutic technologies.



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