Management of obstructive sleep apnea in Europe - A 10-year follow-up.

OBJECTIVE: In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of OSA management over time. METHODS: The 2010 questionnaire including questions on sleep diagnostic, reimbursement, treatment, and certification was updated with questions on telemedicine and distributed to European Sleep Centers to reflect European OSA management practice. RESULTS: 26 countries (36 sleep centers) participated, representing 20 ESADA and 6 non-ESADA countries. All 21 countries from the 2010 survey participated. In 2010, OSA diagnostic procedures were performed mainly by specialized physicians (86%), whereas now mainly by certified sleep specialists and specialized physicians (69%). Treatment and titration procedures are currently quite homogenous, with a strong trend towards more Autotitrating Positive Airway Pressure treatment (in hospital 73%, at home 62%). From 2010 to 2020, home sleep apnea testing use increased (76%-89%) and polysomnography as sole diagnostic procedure decreased (24%-12%). Availability of a sleep specialist qualification increased (52%-65%) as well as the number of certified polysomnography scorers (certified physicians: 36%-79%; certified technicians: 20%-62%). Telemedicine, not surveyed in 2010, is now in 2020 used in diagnostics (8%), treatment (50%), and follow-up (73%). CONCLUSION: 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.

Upper airway sagittal dimensions in obstructive sleep apnea (OSA) patients and severity of the disease.

OBJECTIVES. To estimate the soft tissue determined individual features of the upper airway sagittal size which may predispose the patient to snoring and OSA and to find whether there is any relationship between the patient's body-mass index (BMI) and the severity of OSA. MATERIAL AND METHODS. 58 consecutive patients with a mean age of 33.4 years were surgically treated for snoring and OSA. Before the operation they were subject to the following: physical examination, a sleep study to determine the severity of sleep disturbed breathing (SDB); the body mass index (BMI) was calculated, lateral cephalometry (LC) was recorded. RESULTS. Snoring was found in 25 patients, OSA I (mild) - 15, OSA II (moderate) - 9, OSA III (severe) - in 9 patients. Among patients with obesity, the most widespread types of sleep disorders were OSA II and OSA III. (p=0.029). There were differences in the mean values of the BMI between the group of snorers and the group with OSA II (p=0.007), between snorers and OSA III (p=0.006). Differences in upper airway cephalometric mean values between groups were found, the thickness of the uvula (SPT) between snorers and OSA III (p=0.001), between the OSA I and OSA III groups (p=0.032), and between the OSA II and OSA III groups (p=0.075). CONCLUSION. Our study found narrowing in the anterior-posterior dimension of the airway at all levels, correlating with the severity of OSA as well as the BMI. The narrowest place was found in the oropharynx with an extension to the hypopharynx.