In Europe, obstructive sleep apnea (OSA) diagnostics and treatments are occurring more in outpatient care settings, with home sleep apnea testing (HSAT) and telemedicine becoming more prevalent in the care of patients with OSA since 2010. During this same time period, sleep specialists with more formal educational qualifications have increased in European sleep centers, according to study findings published recently in Sleep Medicine.
Researchers in Europe sought to investigate OSA administration over time through a 10-year follow-up of a 2010 questionnaire-based study of European sleep centers. The previous study assessed titration procedures, sleep specialist qualifications, and differences in reimbursement.
In the updated survey, researchers also investigated how management of OSA had changed over the past decade due to the increasing demand for treatment and the availability of new technologies, such as those based on telemedicine. Investigators for the current study administered an updated version of the 2010 questionnaire to 36 sleep centers in 26 European countries (including all 21 countries participating in the previous survey).
The researchers found that in contrast to 2010, when most OSA diagnostic exams were primarily performed by specialized physicians in most centers (86%), the current survey indicated that sleep specialists now perform diagnostic exams in 69% of centers. With respect to qualifications, researchers for the recent survey found that the percentage of countries with a general sleep physician qualification rose from 52% to 65% and that the percentage of centers with sleep-certified physicians rose from 36% to 79% (P =.043). Researchers also found an increase in sleep-certified technicians (from 20% to 60%; P =.035) and in sleep-certified nursing professionals (from 14% to 50%: P >.05).
The survey also identified a trend towards auto-titrating positive airway pressure treatment (in hospital 73%; at home 62%) and HSAT, which increased from 76% in 2010 to 89% in the current survey results. Use of polysomnography as the lone diagnostic practice decreased from 24% to 12%.
Although telemedicine was not part of the 2010 survey, the current survey found it is now widely used in diagnostics (8%), treatment (50%), and follow-up (73%). Insurance reimbursement coverage increased for HSAT from 62% to 73% of costs and from 62% to 77% for follow-up services.
Researchers concluded that, “In the past decade, formal qualification of sleep center personnel increased, OSA diagnostic and treatment procedures shifted towards a more automatic approach, and telemedicine became more prominent.” Home sleep apnea testing has increased compared with in-hospital testing and sleep recording analysis relies more on automated algorithms.
Fietze I, Laharnar N, Bargiotas P, et al. Management of obstructive sleep apnea in Europe – A 10-year follow-up. Sleep Med. Published online June 9, 2022. doi:10.1016/j.sleep.2022.06.001