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.

2nd Department of Respiratory Medicine Institute of Tuberculosis and Lung Diseases Warsaw Poland

Center of Pulmonology and Allergology Clinic of Chest Diseases Immunology and Allergology Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Centre for Sleep and Wake Disorders Sahlgrenska Academy Gothenburg University Gothenburg Sweden

CNR Institute for Research and Biomedical Innovation Palermo Italy

Dansk Center for Sovnmedicin Klinisk neurofysiologisk afdeling Rigshospitalet Glostrup Denmark

Dep of Internal Medicine Geriatrics and Practical Medicine University Hospital Brno and Faculty Medicine Masaryk University Brno Czech Republic

Department of Anaesthesiology and Sleep Laboratory Riga Stradins University Riga Latvia

Department of Chest Diseases Ege University Faculty of Medicine Izmir Turkey

Department of Clinical Therapeutics Division of Pulmonnary Medicine National and Kapodistrian University of Athens School of Medicine Athens Greece

Department of Respiratory and Sleep Medicine St Vincent's Hospital Group University College Dublin Dublin Ireland

Department of Respiratory Medicine and Tuberculosis Faculty of Medicine P J Safarik University and L Pasteur University Hospital Kosice Slovakia

Department of Sleep Medicine Royal Infirmary Edinburgh Little France UK

Division of Medicine Department of Pulmonary Diseases Turku University Hospital and Department of Pulmonary Diseases and Clinical Allegology University of Turku Turku Finland

Grenoble Alpes University Inserm CHU Grenoble Alpes Grenoble France

Hospital Clinico Respiratorio Barcelona Spain

Institute of Pneumology at the University of Cologne Bethanien Hospital Solingen Germany

Interdisciplinary Center of Sleep Medicine Charité Universitätsmedizin Berlin Germany

Interdisciplinary Center of Sleep Medicine Charité Universitätsmedizin Berlin Germany; Department of Medicine The 4th People' Hospital of Guangyuan City China; The Federal State Autonomous Educational Institution of Higher Education 1 M Sechenov 1st Moscow State Medical University of the Ministry of Health of the Russian Federation Moscow Russia

Interdisciplinary Center of Sleep Medicine Charité Universitätsmedizin Berlin Germany; Saratov State University Saratov Russia

LKH Graz 2 Standort Enzenbach Gratwein Strassengel Austria

Medical Faculity University of Iceland Reykjavik Iceland; Landspitali University Hospital Reykjavik Iceland

Multidisciplinary Sleep Disorders Centre University Hospital Antwerp and University of Antwerp Edegem Belgium

Respiratory Failure Unit Aristotle University of Thessaloniki G Papanikolaou Hospital Thessalonika Greece

Respiratory Function and Sleep Unit Clinical Scientific Institutes Maugeri IRCCS Pavia Italy

SEIN Sleep Wake Centre Heemstede the Netherlands

Sleep and Motion Laboratory Medical School University of Cyprus Nicosia Cyprus

Sleep and Non Invasive Ventilation Unit Hospital São João Medicine Faculty of Porto University Porto Portugal

Sleep Clinic Carmel Hospital Technion Faculty of Medicine Haifa Israel

Sleep Disorders Center Antoine Beclere Hospital Clamart France

Sleep Disorders Center Dept Medicine and Surgery University of Milano Bicocca and Instituto Auxologico Italiano IRCCS Dept of Cardiology S Luca Hospital Milan Italy

Sleep Disorders Center Reinbek Geesthacht Germany

Sleep Disorders Centre University Hospital Gasthuisberg Leuven Belgium

Sleep Disorders Unit Department of Respiratory Medicine Medical School University of Crete Crete Greece

Sleep Laboratory ENT Department Førde Central Hospital Førde Norway

Sleep Medicine Center and Department of Otolaryngology University Medical Center Mainz Germany

Sleep Medicine Center Department of Neuroscience University of Split School of Medicine Split Croatia

Sleep Unit Department of Pneumonology Medical School Democritus University of Thrace Alexandroupolis Greece

Victor Babes University of Medicine and Pharmacy Timisoara Romania

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