Interview with the President of the French Society for Sleep Research and Sleep Medicine (SFRMS), Prof. Isabelle Arnulf

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

The French Sleep Society has organized alone since 1985 and in cooperation with the Chest Society since 2008 a national inter-university diploma of Sleep Medicine (DIU, Diplome interuniversitaire le Sommeil et sa pathologie), which is made up of 22 universities. It represents 96 hours of courses and 3 weeks of training in a recognized sleep center. It is a difficult diploma, passed by 50-60% of the students, and open only to MDs. In 2014-2015, there were 180 students registered in the course. This number increases every year, and we have to limit available places because of a lack of locations to train them in sleep labs. The program is organized by a national pedagogic committee (double coordination by Nicole Meslier for the Chest Society and Christelle Monaca for the Sleep society). Teachers come from all over France to teach in Paris, with half of the courses being in e-learning. There is still a local diploma in Lyon-Grenoble, with 30 registered students per year, but it is not validated by the Sleep Society.

Such an accreditation procedure is planned only for physicians or also for other professional figures like psychologists, technicians etc.?

Well, the DIU is a medical diploma. Psychologists and PhDs can attend the course and receive a certificate if they succeed, but not a diploma because they cannot examine patients and pass the part of the final examinations devoted to medical diagnosis and treatment of sleep disorders. Sleep technologists (nurses and radio-technologists) follow a university diploma of sleep technology, organized by Paris 5 university, with around 25-30 attendants per year.

Do you also have an accreditation procedure for sleep centers?

Yes, we do, for now more than 20 years. We accredit centers with a multidisciplinary approach to sleep medicine. The procedure closely follows the ESRS recommendations, with at least a physician having the DIU diploma, plus a minimal number of polysomnographies and MSLT/MWT activities (e.g., minimum 50 MSLT/y), a large information file to complete and a visit by 2 experts mandated by the Society on the site. Around 50 centers are accredited by the SFRMS, and their name is available for physicians and patients on the SFRMS site, by region. “Old” centers are revisited and re-accredited too.

Do you have accreditation procedures for centers with different characteristics (multidisciplinary, respiratory specific, pediatrics etc)?

No, we don’t, and there is certainly room for improvement here. So far, we only accredit multidisciplinary centers, not respiratory specific centers. There has been a request from clinicians to identify expert centers in child sleep medicine, but we encountered difficulties in evaluating this expertise.

Is sleep medicine officially included in academic programs?

No, it is not. It is still part of the various organs’ specialty. There is a chapter on sleep apnea in the pulmonology program, a chapter on sleepiness/narcolepsy in the neurology program and a chapter on insomnia in the psychiatry program.

Do you organize accredited sleep medicine courses?

Yes, we do so during a full day just before our national congress, and one or two other days in the year. We noticed that there was many non-university “stand alone” sleep medicine courses organized by private systems (imagine the pressure of CPAP companies and providers upon finding new prescribers, when sleep apnea can be a real financial business …). As a sleep society, we tried to unify these offers of courses in 2014-15 by creating a common site on sleep medicine courses (www.sommeil-formation.org), a program committee, and three recommendation levels from the society (organized, accredited, or just supported by the society) to guarantee a high level medical content. It seems to work!

Are you working toward achieving the recognition of sleep medicine as a medical sub-specialty?

Yes, we tried hard during several years, president after president, and this is the first time that we are on the way to get this sleep sub-specialty, with support from the Health ministry and from the University ministry, thanks to the next reform of medical studies aimed at transversal trainings. The law will be published in September, 2015. If it works, France will be the third country to have the sleep sub-specialty, after Germany and Bulgaria. When 3 European countries have a sub-specialty, it applies to all EU countries! Six primary medical specialties (neurology, psychiatry, pulmonology, ENT, cardiology and occupational medicine) have agreed together to build a sub-specialty consisting of two levels: one obtained within the primary medical specialty (e.g., Level 1 for pulmonologists will include the respiratory sleep disorders and be completed within the pulmonology frame, with ECTs plus training in cardiorespiratory and polysomnography aimed at diagnosing sleep apnea and hypoventilation. Those who have completed this will be entitled to prescribe ventilations and dental orthoses; Level 1 for psychiatrists will be focused on insomnia and circadian sleep disorders, with ECTs plus training to use sleep diary and actigraphy, as well as how to perform CBT); and the second, multidisciplinary level, in which the student will complete all the missing sleep disorders diagnoses and treatments, as well as technics (videoPSG, investigation of vigilance,..) with a full time semester in a sleep center. We expect numerous students for Level 1, to face the need for treating the highly frequent sleep disorders (insomnia by sleep psychiatrists, restless legs syndrome by sleep neurologists, sleep apnea by sleep pulmonologists), and around 20 new students per year in Level 2, to lead the multidisciplinary (mostly in-hospital) sleep centers and organize clinical research and courses.

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

Sure it is, thanks to several excellent basic research groups in the Society: Pierre Hervé Luppi and Jian Sen Lin are active members of the scientific committee, which organizes the congress. Note that the society was initially, as was ESRS, a research society. It has evolved within the last 30 years into a mixed clinical and research society (hence the name changed). SFRMS supports basic research by funding many master and PhD students in the basic research lab, giving travel grants to attend the congress and present their abstract, and via a Young Researchers Group meeting every year in the national Sleep Congress. Despite these supports, it was still difficult to grasp that basic sleep researchers would send posters and abstracts to the national meeting (only 2 or 3 did, vs. 120 abstracts from clinical research), because they found it more relevant for them to attend the neuroscience meeting. This year, for the first time, the Society is organizing a specific “basic research track” with the basic researchers (highlighted by a little microscope on the program) in the Congress, in addition to the three previous concomitant tracks (respiration, neurology/psychiatry and human sleep physiology), so that a basic researcher can attend only basic research symposia and conferences during the whole congress. I hope it will make it more attractive for them.

Thank you, Professor Isabelle Arnulf, for participating in this interview.

Lino Nobili