CCSH Exam Blueprint

Clinical Sleep Health Examination

An advanced credentialing examination for healthcare providers who work directly with sleep medicine patients, families and practitioners to coordinate and manage patient care, improve outcomes, educate patients and the community, and advocate for the importance of good sleep.

CCSH Exam Blueprint Effective 08/01/2019:

The Certification in Clinical Sleep Health examination consists of 100 multiple choice items. Of these, 75 items count toward the candidates’ scores and 25 are pretest items that are not scored.

The Successful Candidate Will Have Knowledge Of:

The Successful Candidate Will Have Knowledge Of: Sleep physiology, respiratory/cardiac/neurophysiology, sleep disorders and diagnostic criteria, sleep related comorbidities, intervention/treatment/therapy modalities, clinical guidelines, adherence techniques, testing options, sleep and related test results, human growth and development, cultural competency, behavioral health models, health literacy, written care plans, learning theories, outcomes data and measures, verbal and written communication skills, medical terminology, patient assessment techniques, chart review and documentation, medications, over-the-counter products and supplements, substance abuse, patient confidentiality, ethics, emergency procedures, safety, infection control, basic knowledge of computers, math skills/calculations.

DOMAIN 1: Sleep Fundamentals (30%; 22 items)

TASK A: Describe normal sleep architecture and factors contributing to variations in normal sleep (7-9%; 5-7 items)

1. Quantity and quality
2. Age (e.g., pediatric, geriatric, infant, adolescent, adult)
3. Gender
4. Environment and culture

TASK B: Identify and recognize the pathophysiology, epidemiology, and clinical presentation of abnormal sleep (9-12%; 7-9 items)

1. Identify terminology currently used to classify common sleep disorders and symptoms
2. Recognize the clinical presentation of sleep disorders
   • Sleep disordered breathing
   • Insomnia
   • Circadian rhythm disorders
   • Other sleep disorders
3. Describe the incidence and prevalence of sleep disorders
4. Differentiate between acute and chronic sleep disturbances
5. Describe the short and long-term effects of sleep disruption, deprivation, and restriction

TASK C: Correlate abnormal sleep symptoms with underlying pathophysiology (9-12%; 7-9 items)

1. Cardiopulmonary disorders (e.g., COPD, CHF, A-Fib)
2. Neurological and neuromuscular disorders
3. Metabolic disorders
4. Mental health disorders (e.g., depression, anxiety, substance abuse)
5. Chronic pain
6. Other medical conditions

DOMAIN 2: Clinical Evaluation and Management (45%; 35 items)

TASK A: Correlate and document sleep and medical history (7-9%; 5-7 items)

1. Assess the impact of sleep on quality of life
2. Recognize health baseline and changes
   • Clinical presentation (e.g., body habitus, alertness)
   • Vital signs (e.g., height, weight, neck circumference, BMI)
   • Recent hospitalization, surgeries, or newly diagnosed conditions
3. Evaluate signs and symptoms of disease progression, exacerbation, and improvement
4. Document actions, observations, and orders
5. Evaluate the impact of medications (e.g., prescription, OTC, supplements)

TASK B: Identify co-morbid conditions and impact on patient (9-12%; 7-9 items)

1. Recognize how sleep disorders affect comorbid conditions
2. Recognize how comorbid conditions affect sleep
3. Recognize the impact of chronic conditions on quality of life

TASK C: Utilize measurement tools and explain results in collaboration with a provider (11-13%; 8-10 items)

1. Administer questionnaires (e.g., Epworth Sleepiness Scale, Berlin Questionnaires, Stop Bang, sleep diary, FOSQ); analyze and interpret results
2. Discuss testing indications and results
   • In-lab PSG, Split, Titrations
   • HSAT
   • MSLT/MWT
   • Actigraphy
   • Other procedures (e.g., PAP Nap, Pulse Oximetry)

TASK D: Evaluate treatment and/or therapy (15-17%; 11-13 items)

1. Monitor and evaluate adherence and efficacy
2. Identify and remove/reduce barriers to success
3. Evaluate and address side-effects
4. Describe therapeutic options
   • Sleep disordered breathing therapies (e.g., PAP and related devices, oral appliance therapy, positional therapy, surgical options)
   • Cognitive behavioral therapy
   • Light therapy
   • Chronotherapy
   • Pharmacotherapy
5. Develop individualized patient care plans
   • Chronic disease model (e.g., morbid obesity, metabolic syndrome)
   • Following clinical practice guidelines

DOMAIN 3: Communication and Education (20%; 15 items)

TASK A: Provide education to patients, families, health care professionals, and community (11-13%; 8-10 items)

1. Encourage, respond to, and expand upon questions
2. Recognize and incorporate the importance of diversity of the learner
   • Lifestyle
   • Environment
   • Cultural differences
   • Communication barriers (e.g., language, disabilities)
3. Evaluate readiness to learn at appropriate level for age, development, and role
4. Adapt interactions to learning styles
5. Assess health literacy level and educate accordingly

TASK B: Encourage and promote patient self-assessment and self-management (7-9%; 5-7 items)

1. Evaluate readiness to change behavior
2. Provide tools to ensure patient success
3. Encourage proper sleep hygiene

DOMAIN 4: Program Administration (5%; 3 items)

TASK A: Develop multidisciplinary approach (0-2%; 0-2 items)

1. Develop and expand collaborative sleep programs
   • Inpatient/Peri-operative screening
   • Occupational health/wellness
   • Outpatient (e.g., dental, cardiology, and primary care)
   • Other (e.g., A.W.A.K.E., PAP clinics, group visits)

TASK B: Manage performance improvement and quality (0-2%; 0-2 items)

1. Audit charts
2. Track and report outcomes
3. Implement process improvement

TASK C: Promote sleep and wellness as a public health issue (0-2%; 0-2 items)

1. Raise awareness of the importance of healthy sleep through community outreach
2. Influence public policy

Job Analysis Summary

Job task analyses (often referred to as role delineation studies, practice analyses, audits of practice, task analyses or job analyses) are used to validate certification examinations and provide a basis for defending the appropriateness of the examination content (Kane, 1997). By assessing what sleep technologists do in their practice, this JTA ensures that the content specifications for the CCSH examination are current and relevant. Content validity in a certification examination provides evidence that the roles addressed in the examination reflect actual practices necessary for successful performance.

The DCO for the CCSH exam serves as the basis for a valid and fair assessment of competency in the field of clinical sleep health. A Job Task Analysis (JTA) was conducted in 2018. The existing version of the CCSH Detailed Content Outline (DCO) was reviewed and revised by a representative panel of 12 incumbent practitioners. A group of Subject Matter Experts (SMEs) attended the meeting and defined the tasks and the important knowledge, skills, and abilities (KSAs) that should be assessed in the examination. The final outcome of the meeting is an updated DCO for the CCSH exam that is directly tied to the job tasks in the field and reflects current practice.