Concerning the Sleep Curriculum in a Pulmonary Training Program

It is curious that topics of sleep and respiratory disorders of sleep still have an undefined role in pulmonary training programs. Since the first statement about the need for training in pulmonary programs, knowledge of the physiology and pathophysiology of disorders of respiratory control and of the upper airways (nose, pharynx, and larynx) has been acknowledged as a part of pulmonary training. For example, questions concerning the presentation or pathophysiology of diaphragmatic paralysis, hypoventilation syndromes, and stridor are reported to be part of ABIM (American Board of Internal Medicine) subspecialty examinations. Currently, questions about breathing disturbances of sleep are an expected part of the board examination. Currently, more than 30 years after the first report by a U.S. pulmonologist defining sleep-disordered breathing and more than 40 years after descriptions of changes in arterial blood gases in chronic obstructive pulmonary disease (COPD) as a function of sleep, both the American Thoracic Society and the American College of Chest Physicians devote organizational resources and significant programmed and open presentation time at annual meetings for sleep apnea and related disorders, including state-of-the-art and year-in-review presentations. So.where is the problem in articulating a role for sleep in pulmonary training programs? Of many potential barriers, one may be the lack of articulation of a strategy and curriculum.

The following is a summary of my view of the evolution of statements regarding sleep and the attempt to articulate a strategy for incorporating sleep physiology and pathophysiology into a pulmonary training program. I have asked for much advice on this topic, but the views expressed are my own.