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Fietze I, Laharnar N, Bargiotas P, Basoglu OK, Dogas Z, Drummond M, Fanfulla F, Gislason T, Gouveris H, Grote L, Hein H, Jennum P, Joppa P, van Kralingen K, Kvamme JA, Lombardi C, Ludka O, Mallin W, Marrone O, McNicholas WT, Mihaicuta S, Montserrat J, Pillar G, Pataka A, Randerath W, Riha RL, Roisman G, Saaresranta T, Schiza SE, Sliwinski P, Svaza J, Steiropoulos P, Tamisier R, Testelmans D, Trakada G, Verbraecken J, Zablockis R, Penzel T. Management of obstructive sleep apnea in Europe - A 10-year follow-up. Sleep Med 2022; 97:64-72. [PMID: 35724441 DOI: 10.1016/j.sleep.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Department of Medicine, The Fourth People' Hospital of Guangyuan City, China; The Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov, First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Panagiotis Bargiotas
- Sleep and Motion Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Zoran Dogas
- Sleep Medicine Center, Department of Neuroscience, University of Split, School of Medicine, Split, Croatia
| | - Marta Drummond
- Sleep and Non-Invasive Ventilation Unit, Hospital São João, Medicine Faculty of Porto University, Porto, Portugal
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Clinical Scientific Institutes Maugeri IRCCS, Pavia, Italy
| | - Thorarinn Gislason
- Medical Faculity, University of Iceland, Reykjavik, Iceland; Landspitali University Hospital, Reykjavik, Iceland
| | - Haralampos Gouveris
- Sleep Medicine Center & Department of Otolaryngology, University Medical Center, Mainz, Germany
| | - Ludger Grote
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Holger Hein
- Sleep Disorders Center, Reinbek/Geesthacht, Germany
| | - Poul Jennum
- Dansk Center for Sovnmedicin, Klinisk neurofysiologisk afdeling, Rigshospitalet, Glostrup, Denmark
| | - Pavol Joppa
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J.Safarik University and L. Pasteur University Hospital, Kosice, Slovakia
| | | | | | - Carolina Lombardi
- Sleep Disorders Center, Dept. Medicine and Surgery, University of Milano-Bicocca & Instituto Auxologico Italiano, IRCCS, Dept. of Cardiology, S. Luca Hospital, Milan, Italy
| | - Ondrej Ludka
- Dep. of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Faculty Medicine, Masaryk University, Brno, Czech Republic
| | - Wolfgang Mallin
- LKH Graz II, Standort Enzenbach, Gratwein - Strassengel, Austria
| | - Oreste Marrone
- CNR Institute for Research and Biomedical Innovation, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Giora Pillar
- Sleep Clinic, Carmel Hospital, Technion Faculty of Medicine, Haifa, Israel
| | - Athanasia Pataka
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessalonika, Greece
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Little France, UK
| | - Gabriel Roisman
- Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Department of Pulmonary Diseases and Clinical Allegology, University of Turku, Turku, Finland
| | - Sophia E Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Pawel Sliwinski
- 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Juris Svaza
- Department of Anaesthesiology and Sleep Laboratory, Riga Stradins University, Riga, Latvia
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Renauld Tamisier
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Georgia Trakada
- Department of Clinical Therapeutics, Division of Pulmonnary Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp and University of Antwerp, Edegem, Belgium
| | - Rolandas Zablockis
- Center of Pulmonology and Allergology, Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany; Saratov State University, Saratov, Russia
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Tasbakan MS, Grote L, Hedner J, Kvamme JA, Verbraecken J, McNicholas WT, Roisman G, Tkacova R, Bonsignore MR, Saaresranta T, Steiropoulos P, Marrone O, Basoglu OK. Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA. J Sleep Res 2021; 30:e13331. [PMID: 33987873 DOI: 10.1111/jsr.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
Patients with obstructive sleep apnea (OSA) are at increased risk of developing metabolic disease such as diabetes. The effects of positive airway pressure on glycemic control are contradictory. We therefore evaluated the change in glycated hemoglobin (HbA1c) in a large cohort of OSA patients after long-term treatment with positive airway pressure. HbA1c levels were assessed in a subsample of the European Sleep Apnea Database [n=1608] at baseline and at long-term follow up with positive airway pressure therapy (mean 378.9±423.0 days). In a regression analysis, treatment response was controlled for important confounders. Overall, HbA1c decreased from 5.98±1.01% to 5.93±0.98% (p=0.001). Patient subgroups with a more pronounced HbA1c response included patients with diabetes (-0.15±1.02, p=0.019), those with severe OSA baseline (-0.10±0.68, p=0.005), those with morbid obesity (-0.20±0.81, p<0.001). The strongest HbA1c reduction was observed in patients with a concomitant weight reduction >5 kilos (-0.38±0.99, p<0.001). In robust regression analysis, severe OSA (p=0.038) and morbid obesity (p=0.005) at baseline, and weight reduction >5 kilos (p<0.001) during follow up were independently associated with a reduction of HbA1c following PAP treatment. In contrast, PAP treatment alone without weight reduction was not associated with significant Hb1Ac reduction. In conclusion, positive airway pressure therapy is associated with HbA1c reduction in patients with severe OSA, in morbidly obese patients. and most obviously in those with significant weight lost during the follow-up. Our study underlines the importance to combine positive airway pressure use with adjustments in lifestyle to substantially modify metabolic complications in OSA.
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Affiliation(s)
| | - Ludger Grote
- Sleep Disorders Center, Center for Sleep and Wake Disorders, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jan Hedner
- Sleep Disorders Center, Center for Sleep and Wake Disorders, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Walter T McNicholas
- Department of Respiratory Medicine, School of Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Gabriel Roisman
- Sleep Disorders Centre, Hospital Antoine-Beclere, Clamart, France
| | - Ruzena Tkacova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia
| | | | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and Sleep Research Centre, University of Turku, Turku, Finland
| | - Paschalis Steiropoulos
- Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Oreste Marrone
- National Research Council, Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
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Gunduz C, Basoglu OK, Kvamme JA, Verbraecken J, Anttalainen U, Marrone O, Steiropoulos P, Roisman G, Joppa P, Hein H, Trakada G, Hedner J, Grote L, Steiropoulos P, Verbraecken J, Petiet E, Trakada G, Montserrat J, Fietze I, Penzel T, Ondrej L, Rodenstein D, Masa J, Bouloukaki I, Schiza S, Kent B, McNicholas W, Ryan S, Riha R, Kvamme J, Hein H, Schulz R, Grote L, Hedner J, Zou D, Pépin J, Levy P, Bailly S, Lavie L, Lavie P, Basoglu O, Tasbakan M, Varoneckas G, Joppa P, Tkacova R, Staats R, Barbé F, Lombardi C, Parati G, Drummond M, van Zeller M, Bonsignore M, Marrone O, Petitjean M, Roisman G, Pretl M, Vitols A, Dogas Z, Galic T, Pataka A, Anttalainen U, Saaresranta T, Plywaczewski R, Sliwinski P, Bielicki P. Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA). Sleep Med 2020; 75:201-209. [DOI: 10.1016/j.sleep.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
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Tasbakan MS, Grote L, Hedner J, Kvamme JA, Verbraecken J, Mcnicholas WM, Roisman G, Tkacova R, Bonsignore M, Saaresranta T, Steiropoulos P, Basoglu OK. Positive Airway Pressure Treatment Reduces Glycated Hemoglobin (HbA1c) Levels in Obstructive Sleep Apnea Patients: Longitudinal Data from the Esada. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Saaresranta T, Hedner J, Bonsignore MR, Riha RL, McNicholas WT, Penzel T, Anttalainen U, Kvamme JA, Pretl M, Sliwinski P, Verbraecken J, Grote L. Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients. PLoS One 2016; 11:e0163439. [PMID: 27701416 PMCID: PMC5049787 DOI: 10.1371/journal.pone.0163439] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established. METHODS A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype. RESULTS The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity. CONCLUSIONS Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.
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Affiliation(s)
- Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
- * E-mail:
| | - Jan Hedner
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Maria R. Bonsignore
- Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
- CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
| | - Renata L. Riha
- Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Walter T. McNicholas
- Department of Respiratory and Sleep Medicine, St. Vincent´s University Hospital, Dublin, Ireland
- Conway Research Institute, University College Dublin, Dublin, Ireland
| | - Thomas Penzel
- Schlafmedizinisches Zentrum, Charité –Universitätsmedizin Berlin, Berlin, Germany
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ulla Anttalainen
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland
| | | | - Martin Pretl
- Centre for Sleep and Waking Disorders, Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Inspamed, Neurology and Sleep Laboratory, Prague, Czech Republic
| | - Pawel Sliwinski
- Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
| | - Ludger Grote
- Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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