欧洲阻塞性睡眠呼吸暂停多夜检测的当前实践、临床观点与障碍：一项跨ESADA中心的调查

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停的诊断主要依赖单夜睡眠检测，然而呼吸暂停低通气指数（AHI）测量存在的夜间变异性引发了对诊断可靠性的担忧。多夜睡眠检测已被提出以解决这一局限，但其在欧洲睡眠中心的采用情况仍缺乏充分描述。
方法： 一项在线调查纳入了欧洲睡眠呼吸暂停数据库（ESADA）网络内15个国家28个中心的43名临床医生，考察了多夜检测采用的当前实施模式、临床认知与障碍。
结果： 超过80%的受访者认为单夜AHI阈值不够稳健，83%的受访者同意多夜检测可降低误分类风险。然而，目前仅7/28的中心采用多夜方案，诊断路径异质，且全部28个中心中近半数报告称，即使报销得到保证，他们也尚未准备好采用这些方案。所识别的主要障碍为人员配备不足、报销不确定以及缺乏标准化的欧洲或国家指南。临床医生最一致支持在涉及诊断不确定或疑似夜间变异性的情形下进行多夜检测，倾向于选择性而非普遍性方法。区域差异显著：西欧中心表现出最高的实施成熟度，而南欧、中欧和东欧中心面临更大的组织与财务限制。
结论： 在所选定的欧洲睡眠临床医生群体中，多夜睡眠检测的临床价值得到广泛认可，但其实施仍受组织与结构性障碍的限制。这些发现提示，睡眠医学可能正接近这样一个阶段：多夜检测的科学与临床依据获得接受的速度，快于医疗系统能够实施它的速度。

英文摘要

BACKGROUND: Obstructive sleep apnea diagnosis relies predominantly on single-night sleep testing, yet night-to-night variability in apnea-hypopnea index (AHI) measurements raises concerns about diagnostic reliability. Multi-night sleep testing has been proposed to address this limitation, but its adoption across European sleep centers remains poorly characterized.
METHODS: An online survey of 43 clinicians from 28 centers across 15 countries within the European Sleep Apnea Database (ESADA) network examined current implementation patterns, clinical perceptions and barriers to multi-night testing adoption.
RESULTS: Over 80% of respondents considered single-night AHI thresholds insufficiently robust, and 83% agreed that multi-night testing reduces misclassification risk. Nevertheless, only 7/28 centers currently employ multi-night protocols, with heterogenous diagnostic pathways, and nearly half of all 28, reported they would not be ready to adopt them even with guaranteed reimbursement. The principal barriers identified were inadequate staffing, uncertain reimbursement and the absence of standardized European or national guidelines. Clinicians most consistently supported multi-night testing in scenarios involving diagnostic uncertainty or suspected night-to-night variability, favoring a selective rather than universal approach. Regional disparities were notable: Western European centers showed greatest implementation maturity, while Southern, Central, and Eastern European centers faced greater organizational and financial constraints.
CONCLUSIONS: Within the selected group of European sleep clinicians, the clinical value of multi-night sleep testing is broadly recognized, but implementation remains limited by organizational and structural barriers. These findings suggest that sleep medicine may be approaching a stage where the scientific and clinical rationale for multi-night testing is gaining acceptance more rapidly than healthcare systems are able to implement it.