For many years, the National Board for Respiratory Care Inc (NBRC) has developed specialty examinations in defined areas of respiratory care that allow credentialed respiratory therapists to demonstrate their additional competence in specialized areas of practice. Several years ago, the NBRC initiated its five-step examination development process to consider construction of an examination for respiratory therapists specializing in sleep disorders testing and therapeutic intervention. This new specialty examination is slated to be available to candidates in early 2009.

Theodore Oslick, MD Gary A. Smith

The NBRC does not arbitrarily decide to offer such specialty examinations; in fact, consideration of new examinations always begins with a request issued by one of the NBRC’s sponsoring organizations, the American College of Chest Physicians (ACCP), the American Association for Respiratory Care (AARC), the American Thoracic Society (ATS), or the American Society of Anesthesiologists (ASA). In the case of the forthcoming sleep specialty examination, the request originated with the AARC’s board of medical advisors and was later approved by the AARC board of directors and forwarded to the NBRC for its evaluation and consideration.

The genesis for the new specialty examination for respiratory therapists performing sleep disorders testing and therapeutic intervention can be directly linked to the bylaws changes enacted by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the joint curriculum for sleep technologists developed by the AARC, the American Academy of Sleep Medicine (AASM), the American Association of Sleep Technologists (AAST), the Board of Registered Polysomnographic Technologists (BRPT), the Electroneurodiagnostics Committee on Accreditation (ENDCoA), and the Committee on Accreditation for Respiratory Care (CoARC). CAAHEP enacted bylaws changes to recognize that there are at least three acceptable entrance routes to the professional discipline of sleep disorders testing: respiratory therapy education, END education, and education via programs accredited by the newly established Committee on Accreditation of Polysomnographic Technology.


The NBRC’s procedures for development of examinations consist of a five-step process:

1) Completion of a viability study with a favorable conclusion that development of the proposed examination is desirable and feasible. This process was completed with participation of many related organizations, including the ACCP, ATS, AASM, AAST, AARC, NBRC, BRPT, CoARC, NAMDRC, and representatives from state licensure agencies. Although the decision to recommend that the NBRC move to the next step in the examination development process was not unanimous, the overwhelming number of participants representing various communities of interest voted favorably on this issue.

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2) Conduction of a national personnel survey to determine if a sufficiently large population of potentially credentialed practitioners exists to support the new specialty credential.

3) Completion of a national job analysis study to ensure identification of specific job duties performed by the population of specialty practitioners and the uniformity of tasks performed by practitioners nationwide.

4) Development of test specifications that provide a blueprint for construction of multiple, parallel forms of the specialty examination, as well as acquisition of potential test questions for the specialty examination.

5) Validation of the new specialty examination to ensure statistical evidence between practitioners’ examination scores and the tasks assessed on the examination exists.


The national job analysis has been completed, and test specifications are currently being developed from the task ratings obtained in the national research. The test blueprint will be approved in January 2008, and acquisition of test questions will begin shortly thereafter.

The NBRC plans to employ a hierarchical structure when incorporating a sleep specialty examination with other respiratory therapy credentialing examinations. That is to say, tasks previously tested on one of the credentialing examinations will not be retested on another examination, unless that task is tested at a higher cognitive level. Thus, it should be emphasized that respiratory therapy competencies previously assessed on the CRT and/or RRT examinations will not be tested again on the sleep specialty examination. The sleep specialty examination will focus specifically on those tasks performed by respiratory therapists during sleep disorders testing and therapeutic intervention. Thus, candidates for the respiratory therapist sleep specialty examination can expect a test that is somewhat shorter than the current 200-item BRPT examination.

The NBRC will conduct an item writing workshop to generate items for the sleep specialty examination on March 1 and 2, 2008. Then, the examination committee will review, revise, and edit the questions; following this extensive review of potential questions, multiple forms of the sleep specialty examination for respiratory therapists will be assembled.

The Task List Outline for the proposed specialty examination included five major categories regarding the role of the respiratory therapist performing sleep disorders testing and therapeutic intervention: pretesting, sleep disorders testing, study analysis, administrative functions, and treatment plan.

The group of job experts who authored tasks for the national job analysis survey derived a definition of the role of a respiratory therapist specializing in sleep disorders testing and therapeutic intervention. The consensus definition incorporated in the survey for evaluation of the criticality of each specific task on the survey was:

“A respiratory therapist specializing in sleep disorders testing and therapeutic intervention has an NBRC respiratory therapy credential and experience or education in the discipline of sleep medicine. A specialist identifies and cares for individuals at risk for sleep disorders, prepares the equipment and patient for a sleep study, maintains signal integrity during a study, recognizes sleep disorders during a study and applies appropriate therapy, documents study details and performs appropriate procedures at the study conclusion, initiates review of patient information and the study record, scores sleep stages and events, and documents statistics associated with observations in the record, participates in administrative functions, including equipment maintenance, quality control, data management, and policy and procedure development, and participates in the development, implementation, and evaluation of treatment plan for patients with sleep disorders.”

A passing point study will be completed by job experts after the first examination forms are developed. This objective process will determine how many questions a respiratory therapist must answer correctly to earn the specialty credential, and all future forms of the examination will match the base form of the test in overall difficulty. The passing point setting process ensures that all individuals who are awarded the specialty credential have demonstrated the same level of competence, regardless of which form of the test a practitioner attempted.


Candidates for the specialty examination will be required to hold an NBRC respiratory therapy credential and have appropriate education and experience in the discipline of sleep medicine. Credentialed respiratory therapists who have completed a sleep add-on curriculum offered by a respiratory therapy program accredited by the CAAHEP will most certainly be eligible for the sleep specialty examination.

The NBRC’s sleep specialty examination is not designed to specifically compete with or replace the current credentialing program for sleep technologists offered by the BRPT. An NBRC sleep specialty credential was never intended to replace the RPSGT.

Theodore Oslick, MD, is NBRC president. Gary A. Smith, is NBRC CEO and executive director. Please direct questions to .