Walter T. McNicholas

Sleep medicine relies on patient‐reported outcome measures (PROMs) to complement clinical interviews and objective sleep tests. Available sleep questionnaires focus on isolated symptoms or single disorders, limiting their ability to capture the complexity of sleep conditions. Also, many PROMs remain poorly validated. The European Sleep Questionnaire (ESQ) is being developed as a generic transdiagnostic sleep PROM designed to address these limitations. By integrating relevant interview components, it aims to streamline clinical assessment and better reflect real‐world phenotypes across the full spectrum of sleep disorders. The ESQ has been initiated within the EU‐funded Sleep Revolution project and is still being developed through an iterative process. Its design is informed by a comprehensive literature review as well as expert and patient input. The ESQ prototype contains 119 items organized into nine sections and uses Likert‐type scales to assess symptom severity, frequency, and bothersomeness over the past month. It is equipped with an additional module for follow‐up assessment. It is translated into 17 languages and is digitally implemented to support multicenter studies. Initial validation includes cognitive interviews and evaluation of psychometric properties in patients with various sleep disorders. Item refinement and scoring key creation will guide the further development of the ESQ, after which it will be made available for public use. The ESQ aims to support personalized clinical diagnosis and appraisal of treatment results. Future research will extend into other sleep disorders and specific populations, strengthening the ESQ as a comprehensive tool for clinical practice, research, and preventive strategies.

Obstructive sleep apnoea (OSA) is highly prevalent and is associated with significant impairments in quality of life and comorbidity. The most common treatment employed is continuous positive airway pressure (CPAP), especially in moderate and severe cases. The fundamental pathophysiology of the disorder relates to increased collapsibility of the oropharyngeal airway, but the growing recognition that multiple endotypic factors contribute to this collapsibility has opened the possibility of alternative treatment possibilities, especially in less severe cases. In addition to the most important endotype of upper airway narrowing, additional non‐anatomical endotypes include upper airway muscle responsiveness, loop gain, and the arousal threshold. Recent reports have identified mechanisms to identify these endotypes, including those suitable for application in clinical practice. These developments have encouraged a focus on non‐CPAP therapies, including oral appliances, pharmacotherapy, and neurostimulation. Recent reports have identified effective pharmacotherapies directed at each non‐anatomical endotype. While CPAP is likely to remain the most important and widely used therapy for moderate and severe OSA in the foreseeable future, alternative therapies targeting specific endotypes, especially pharmacotherapy, are likely to play an increasing role in less severe cases in the medium term, and in patients who do not comply with CPAP.

Telemedicine as a means of remote patient–physician interaction is gaining popularity in nearly every field, and (respiratory) sleep medicine is no exception. Because obstructive sleep apnoea (OSA) is a chronic condition, and requires a continuous treatment and monitoring of therapy success, telematic communications could be useful to establish diagnostic and therapeutic strategies. This statement summarises the evidence and efficacy of telemedicine options in OSA. An interdisciplinary European Respiratory Society (ERS) task force evaluated the scientific literature based on a systematic search and two-step screening process (title/abstract and full text). Although the task force does not make recommendations for clinical practice, it describes its current practice of telemedicine applications in OSA. The literature shows that telemedicine has been studied in different areas of OSA management, with potential benefits. Telemedicine also served as a major research tool to provide big data related to positive airway pressure therapy. Telemedicine results in similar or improved compliance when compared with traditional face-to-face encounters. Telemedicine-based targeted troubleshooting and support based on individual patient data, and a combination via smartphone apps or coaching websites, are feasible and effective. Expanding evidence suggests that telemedicine is probably cost-effective. However, data do not consistently support staff time savings through telemedicine-based solutions. The potential benefits of telemedicine include improved access to healthcare, and increased adherence to (chronic illness) treatment plans. Benefits should be weighed against the overall costs of telemedicine and risks related to suboptimal compliance.

Background: Obstructive sleep apnoea (OSA) carries an increased risk of motor vehicle accidents, which resulted in the European Commission introducing a legal directive (2014/85/EU) restricting driving in patients with moderate/severe OSA and sleepiness, unless effectively treated. We assessed the implementation of the directive in European Union (EU) member and non-member states. Methods: National sleep societies and/or selected other sleep specialists in EU member states and selected other European countries completed a questionnaire on the local introduction of the EU Directive, or similar, the OSA severity to restrict driving, criteria to resume driving, and the validity period for different driving licences. Results: Data were obtained from 25 out of 27 EU member states and all eight non-member states included, representing a population of ∼770 million. All EU members had introduced the Directive into national regulations, largely unchanged, although some countries applied stricter criteria such as mild OSA and a minimum treatment period before resuming driving. Only five non-member states had driving regulations for OSA. Problems with implementation of regulations were reported in most countries, including inadequate resources to diagnose/treat OSA patients, excessive restrictions regarding disease severity and certification to resume driving, and under-reporting of symptoms by patients fearing the loss of their licence, especially professional drivers. Conclusions: Driving regulations for OSA apply in most European countries, but excessively strict criteria for OSA severity, sleepiness and delayed permission to resume driving are questionable. Further research is needed on whether such regulations result in fewer accidents and on the objective identification of sleepiness.

Shift work is a necessity for a society that requires 24/7 services. However, working around the clock can cause a misalignment with our sleep‐wake cycle, resulting in sleepiness, impaired cognition and poor health. Due to the prevalence of shift work within safety‐critical contexts, there is a need to further understand the causes and consequences of non‐typical work on sleep, wellbeing, health and safety, as well as ways to effectively reduce this risk. Furthermore, disorders such as obstructive sleep apnoea, which is the most prevalent medical cause of sleepiness, compound the adverse health and safety consequences of shift work. This article provides an overview of some of the key occupational and sleep health challenges related to shift work: accurate measurement of sleepiness, mitigation, long‐term sustainability and work/life balance. We conclude by proposing four directions for future work in this area to consider, with the overall aim of improving the sleep, health and wellbeing of the shift‐working population.

Obstructive sleep apnoea (OSA) conveys a substantial global public burden due to its high prevalence and causative relationship with cardiometabolic diseases. The current diagnostic reliance on the apnoea/hypopnoea index (AHI) is insufficient to address the complex, multifaceted condition, and a revision of the standard criteria is urgently needed. Together with a better understanding of the clinical, pathophysiological, and sleep diagnostic phenotypic characteristics, this will pave the way to personalised, holistic treatment approaches.

Summary: The European Sleep Research Society (ESRS) is the leading voice for sleep medicine and research in Europe and includes in its mission the objective to promote and develop sleep education. As part of this objective, the Society established a Multidisciplinary Task Force on sleep education, which proposed a workshop on this topic to define the role of ESRS in the future of sleep education in Europe. This includes defining the domains of operation by the ESRS, its most important links and networks, and to recognise areas for development. A concrete goal was to make an action plan with suggestions for eventual Task Forces. Recommendations from the workshop include active collaboration with other Societies and University degree courses in sleep with the objective to position the ESRS as the central focus for sleep education in Europe. Predefined learning objectives and Entrustable Professional Activities were identified as key aspects of future direction. The ESRS Textbook in Sleep Medicine provides a valuable educational resource, and the next edition should expand on the traditional format to include digital material and an integrative platform. The workshop also identified the need to develop a more compact publication to inform non‐sleep specialists, university students, and interested members of the public with basic information on sleep and sleep disorders.

Extract Obstructive sleep apnoea (OSA) is widely recognised as a risk factor for motor vehicle accidents (MVAs) [1, 2] and excessive daytime sleepiness is regarded as the most important contributing factor [3]. Continuous positive airway pressure (CPAP) has been reported to reduce MVA rates in OSA and several studies report that the MVA risk in CPAP-treated OSA patients is reduced to that of an equivalent general population [4, 5]. This evidence has prompted some jurisdictions, such as in Europe and Australia, to introduce driving restrictions for patients with OSA above a certain threshold, unless effectively treated [6]. Other jurisdictions, such as the USA, have not introduced official policies in this regard, although several initiatives involving the haulage (trucking) industry have successfully introduced company policies to prevent driving in symptomatic OSA patients, unless effectively treated [7, 8]. Shareable abstract Effective treatment of OSA reduces driving accident risk https://bit.ly/3zzQUEN

Background: The “Baveno classification” replaced the apnoea–hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances.Method: OSA patients from the European Sleep Apnoea Database (ESADA) were retrospectively allocated into CVD risk groups 1–3 based on the SCORE2 risk prediction model and European Society of Cardiology guidelines. AHI ≥30 events·h⁻¹conferred strong treatment indication. When AHI was −1, symptoms and CVD risk dictated allocation to the weak, intermediate or strong treatment indication group. Changes in Epworth Sleepiness Scale (ESS) score and office systolic blood pressure (SBP) at follow-up (12–24 months) under positive airway pressure (PAP) were assessed.Results: 8625 patients were analysed (29% female; median (interquartile range) age 56 (49–64) years and body mass index 31.9 (28.4–36.3) kg·m⁻²). Treatment indication was weak in 501 (6%), intermediate in 2085 (24%) and strong in 6039 (70%). There was a continuous increase in age, SBP, C-reactive protein and glycosylated haemoglobin from weak to strong (p−1.Conclusion: This analysis provides supporting evidence for the key role of CVD risk assessment and severe breathing disturbances in the identification of OSA patients most likely to benefit from treatment.