Search

Introduction: Detailed information regarding sleep medical qualifications in Germany are hard to obtain but would be of particular interest for prospective planning of sleep medical care. The aim of this study was to create an inventory of current sleep medical qualifications in Germany with a focus on sleep-disordered breathing and chronic insomnia. Material and methods: The inventory is mainly based on the health care report of the Federal Republic of Germany, data provided by the Medical Associations of the Federal States (Landesärztekammern) and Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen), the registry of members of the German Sleep Society (DGSM) and its committee for certification and quality assurance. Results: The health care report of the Federal Republic of Germany reports 1255 qualified sleep specialists in Germany in 2018. According to the data of the Medical Associations of the Federal States, 1436 sleep specialists are registered accounting for approx. 0.4% of all practicing physicians. The majority of sleep specialists belongs to the disciplines of internal medicine (66.6%) followed by otorhinolaryngology (12.5%) and neurology (10.7%). The number of physicians with a license for home sleep testing (polygraphy) is considerably higher. According to the registry of members of the DGSM, 700 physicians have achieved the additional qualification of the society called somnologist, which accounts for 0.17% of all practicing physicians. Of all certified sleep laboratories of the DGSM, 70% are led by a pneumologist. To date, 75 therapists have undergone the voluntary training for cognitive behavioral therapy for insomnia offered by the DGSM. Conclusion: The inventory reveals that only a relatively small number of physicians seek further sleep medical training or qualification in Germany, which is in considerable contrast to the high prevalence of, in particular, sleep-related breathing disorders and insomnia. [ABSTRACT FROM AUTHOR]

Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancements in diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) have further expanded the diagnostic possibilities. Drug-induced sleep endoscopy allows for a reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still being discussed. The relevance of positional OSA has received increasing attention - the subgroup of patients in whom sleeping position significantly impacts their disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer offers a new therapeutic option. Further, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum for the treatment of OSA. In regard to the established surgical treatment options, randomized trials with superior methodology have been published, especially for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice. [ABSTRACT FROM AUTHOR]

Copyright of Somnologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The third issue of the International Classification of Sleep Disorders (ICSD-3) was published in 2014. This article describes the differences compared to the second issue on sleep disordered breathing in a more detailed fashion and discusses their significance for clinical practice. For obstructive sleep apnea (OSA) in adults, the clinical conditions that lead to the diagnosis in combination with respiratory events have been expanded with cardiovascular and mental comorbidities. OSA may now be diagnosed more frequently. In children, obstructive hypoventilation is now included in the diagnostic criteria. For the diagnosis of OSA in adults, out-of-center testing is mentioned as an alternative to polysomnography (PSG). This will intensify the current discussion regarding the role of PSG and outpatient recordings in the management of the disease. Sleep-related hypoventilation syndromes and sleep-related hypoxemia are now separate identities and oxygen saturation is no longer a diagnostic criterion for sleep-related hypoventilation. Treatment-emergent central sleep apnea as well as obesity hypoventilation are now included in the ICSD-3, the latter requiring daytime hypoventilation. [ABSTRACT FROM AUTHOR]