Special Section in Sleep MedicineManagement of obstructive sleep apnea in Europe
Introduction
Apart from insomnia, obstructive sleep apnea (OSA) has the highest prevalence in the general population of all sleep disorders, affecting approximately 3–7% of the middle-aged male population and 2–5% of middle-aged women [1], [2]. Despite increased diagnostic and treatment facilities, the majority are still undiagnosed. OSA can manifest at any age, but the prevalence is increasing with age [3]. One study has shown that the incidence of OSA increases over the course of 5 years by 11.1% for men and 4.9% for women, using threshold values of 15 events/h for the apnea–hypopnea index (AHI) [4], [5]. If there is an additional increase in weight then the probability of developing obstructive sleep apnea (OSA) rises. The prevalence is also higher in subpopulations with comorbidities such as stroke, arterial hypertension, heart insufficiency, or diabetes mellitus [6], [7].
The pathophysiology of obstructive sleep apnea syndrome (OSAS) is progressively better understood and clinical picture, comorbidities, and risks better known; OSA severity as expressed by the AHI is also objectively quantifiable and can be successfully treated. The recommended method for diagnosing OSAS is polysomnography [8] but for practical reasons a significant number of patients are diagnosed using portable sleep apnea monitoring [9]. The most effective treatment in moderate to severe OSAS remains positive airway pressure applied during sleep, delivered via nasal or full-face masks.
On account of the high prevalence of OSAS in the general population, the sleep medicine field is confronted by a demanding challenge to provide sufficient resources for the management of this disorder.
The current survey was conducted within the context of the European Cooperation in Science and Technology (COST) Action B26 Group collaboration to determine sleep medicine service delivery with reference to OSA in Europe. Two questionnaires were distributed to determine current clinical diagnostic pathways (which medical personnel is involved, which diagnostic technique is used and how the analysis of recordings is done) in European countries, the reimbursement policies, procedures for the provision of positive airway pressure therapy (how and where the titration is performed and which mode of treatment is supported), and the professional qualifications required.
Section snippets
Methods
A total of 22 countries currently participate in COST Action B26. An English version of two questionnaires was distributed to the 38 representatives of these 22 countries: Austria, Belgium, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Poland, Portugal, Serbia, Slovakia, Spain, Sweden, and the United Kingdom. Israel as a non-EU country participated in this COST action as an associate partner. For each country there are 1–2
Results
Of the 22 countries approached, 20 (36 sleep competent physicians) responded to the questionnaires. The only country that did not respond was Switzerland due to organizational reasons.
Twenty-six of the delegates where pneumologists or linked to pneumology (physician working in the Dept. of Pneumology not being a pulmonologist). The 10 remaining delegates represented other medical specialties such as neurology and clinical neurophysiology.
The results revealed several major differences between
Discussion
The management of OSAS in Europe presents significant variations; but to some degree, with a few exceptions such as UK, it is comparable among countries. Significant differences include reimbursement rules, professional qualifications and procedures for titration of CPAP treatment, and, to a lesser degree, the structure of the referral, diagnostic and management pathways, and the indications for PAP treatment.
In order to satisfactorily meet the increasing demands placed on Sleep Medicine
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2010.10.003.
Acknowledgements
This survey took place within the context of the COST Action B26 Group (COST = European Cooperation in Science and Technology), hosted by the European Union to increase the awareness of OSAS. We take this opportunity to express our thanks to the European Union for its support, and to the sleep specialist delegates for their participation in this survey.
References (27)
- et al.
Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing
J Am Coll Cardiol
(2008) - et al.
Simple interventions improve re-attendance when treating the sleep apnoea syndrome
Sleep Med
(2006) - et al.
Management of sleep apnea: concordance between nonreference and reference centers
Chest
(2007) - et al.
Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women
Sleep
(1997) - et al.
Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing
Eur Respir J
(2009) - et al.
Predictors of sleep-disordered breathing in community dwelling adults: the Sleep Heart Health Study
Arch Intern Med
(2002) - et al.
Longitudinal study of moderate weight change and sleep-disordered breathing
JAMA
(2000) - et al.
Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study
Arch Intern Med
(2005) - et al.
Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities
Eur Respir J
(2007) - et al.
Practice parameters for the indications for polysomnography and related procedures: an update for 2005
Sleep
(2005)