Interview with Professor Joaquin Terán Santos, President of the Spanish Sleep Society

Dear Professor Terán Santos, which is the status of the accreditation procedures for sleep medicine experts? Can you explain how the procedure works?

The professional accreditation process in Sleep Medicine was developed in Spain after an agreement of the main Scientific medical societies involved in the Sleep Medicine field: Spanish Respiratory Society (SEPAR), Spanish Neurological Society (SEN), Spanish Psychiatric Society, Spanish ENT Society and Spanish Sleep Society. These societies have constituted the Spanish Accreditation Committee of Sleep Medicine (CEAMS).The accreditation is performed at the same time by all the different societies involved in the diagnosis and treatment of the sleep diseases. The accreditation procedure is performed for a broad spectrum of sleep-disorders and not only  focused on respiratory sleep medicine or pediatric sleep medicine. Despite the fact that physicians with more than 10 years experience in sleep medicine are allowed to directly attend the accreditation process, the procedure has two general requirements. First, 30 European credits are needed for admission into the evaluation process. Second, successful attendance to a 3 days course (12 h/day) where the major sleep diseases, methodologies of sleep evaluation and the different procedures are discussed is required. The course is divided into three parts: theoretical knowledge, case discussion and practical hands-on. Finally, passing an exam with both theoretical and practical sections is required.

Is such an accreditation procedure planned only for physician or also for other professional figures like psychologists, technicians etc?

In this first phase, the process has been developed only for physician and currently is developing the program for the accreditation of psychologists technicians etc. We thought it was important to begin establishing a program for physicians because the Medicine focused on sleep disorders is rapidly evolving and advances in new diagnostic and therapeutic techniques dictate the need for increased professional education and clinical expertise that will ultimately be translated into patient care.

Do you have an accreditation procedure for sleep centers?

We  have in Spain an accreditation process for sleep centers that is also based on the agreement between the aforementioned medical societies and recognizes the existence of different levels

a / Sleep Medicine Centers
a / Sleep-Disordered Breathing Units

Sleep Medicine Centers include those centers with organizational ability, technical and human resources to respond to most healthcare problems on Sleep Medicine. Furthermore, these Centers should have an accredited research and teaching program.

The activity of these centers can be for adults, children or both.

Two levels are set in the category of Sleep-Disordered Breathing Units which usually work through systems of respiratory polygraphy. The first level, sleep-disordered breathing  units for adults and / or children with an organizational structure which include aspects of research and teaching  and the second level, Respiratory Polygraphy units with a fundamentally care activity and  this level require coordination with another unit of greater complexity.

The process is governed by the principles of accreditation of Sleep Medicine centers published by the European Sleep Research Society in 2006 and 2009.
The  Spanish Accreditation Committee of Sleep Medicine (CEAMS)  established , that the different levels of accreditation, do not imply in any way, categories of varying rank, contributing actively to the provision of quality health service and expressing different degrees of complexity for addressing diagnosis and treatment of patients with sleep disorders

The CEAMS considers that this organizational system helps to facilitate diagnosis and treatment of sleep disordered breathing based on:

  • Establish a map of technical resources, facilitating resource management
  • Improve the level of care provision for our patients, ensuring a quality framework
  • Encourage the development of training plans in sleep medicine at different levels of knowledge

Is sleep medicine officially included in academic programs in Spain?

In Spain sleep medicine is not included in the academic programs.

Do you organize accredited sleep medicine courses?

Every year the Spanish Accreditation Committee of Sleep Medicine organizes a accredited course  in sleep disorders with the participation of  50 medical physician of different specialties

Some months before the course, the enrolled physicians receive a list of recent review papers about all sleep diseases and procedures. The distribution of the covered topics is approximately: 12% physiology and pharmacology, 20% evaluation; 30% sleep related respiratory diseases, 10% insomnia and psychiatric disorders, 9% sleep related movement disorders and parasomnias, 8% central hypersomnias, 4% circadian sleep disorders, 4% specific pediatric sleep related issues and 3% sleep in other medical disorders

The program schedule devotes enough time for discussion after each presentation, which is of most importance as it yields a lively discussion based on the experience of the participants. After a short lecture (30 minutes for each topic) the general discussion lasts around 2 h, coordinated by two specially designated experts.

Taking together the 2013 and 2014 courses, a total of 105 candidates have obtained the accreditation. Their background medical specialties were: 57 pulmonologists, 35 clinical neurophysiologists, 6 neurologist, 5 ENT surgeons, 1 psychiatrist and 1 internist.

Are you working in order to succeed in the recognition of sleep medicine as a medical sub-specialty?

In our case, the Spanish Health Authorities are willing to officially recognize this accreditation in the next future as a so called “Specific Competence Area”. In our opinion, the key point to improve sleep medicine by means of an accreditation process is to focus on general and basic knowledge and to establish a common background for the main clinical specialties involved in Sleep Medicine. We think it is necessary to introduce a transitional approval process of different accreditation processes exist in Europe, since these processes are more attached to the different realities in each country.

Is basic research in the sleep field represented in the Spanish Sleep Society activities?

The participation of basic research in the Spanish Sleep Society is a growing reality and this incorporation is very productive in the field of sleep apnea in children and adults as well as in the area of chronobiology.

Thank you Prof. Terán Santos for participating in this interview.

Lino Nobili