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Sleep related breathing disorders (SRBD) impair quality of live, morbidity and mortality of affected patients seriously. Moreover, due to their high prevalence, they have a huge impact on health care systems and national economics. The members of the German Respiratory Society, the German Society of Sleep Research and Sleep Medicine, the Association of Pneumological Clinics and the Association of Pneumologists focus strongly on the diagnosis and treatment of SRBD in their daily work. Prevailing developments in the provision of patients with SRBD, have strong impact on the quality of diagnosis and treatment, on the supply of devices, on the follow-up care and on the role and duties of the physician. Therefore, the societies estimate it essential, to publish this common position paper based on the evaluation and discussion of the scientific literature, the clinical practice and a consensus process of an expert group which is published in more detail (Randerath, Somnologie, DOI 10.1007/s11818-013-0649-2; Pneumologie 2/2014). [ABSTRACT FROM AUTHOR]

The present paper describes standardised operating procedures (SOP) within clinical sleep medicine. As such, it is a continuation of the previously published European Guidelines for the Accreditation of Sleep Medicine Centres (SMC) and European Guidelines for the Certification of Professionals in Sleep Medicine, aimed at creating standards of practice in European sleep medicine. It is also part of a broader action plan of the European Sleep Research Society (ESRS). In an updated section, the cost-effectiveness of sleep medicine and its relevance for resource allocation of general health care is emphasized. The following section of this paper is the translation of the guideline of the ESRS into German language: Fischer J, Dogas Z, Bassetti CL et al. (2012) Standard procedures for adults in accredited sleep medicine centres in Europe. J Sleep Res 2012; 21:357-368. In the current paper, the SOPs in sleep medicine centres regarding the diagnostic and therapeutic management of patients evaluated at SMC, accredited according to the European Guidelines, are primarily based on prevailing evidence-based medicine principles. In addition, parts of the SOPs are based on a formalized consensus procedure applied by a group of Sleep Medicine Experts from the European National Sleep Societies (ANSS). For the workload of the professionals in different SOPs, consensus was also achieved. The final recommendations for SOPs are categorized either as 'standard practice', 'procedure that could be useful', 'procedure that is not useful' or 'procedure with insufficient information available'. The SOPs described here include both subjective and objective testing, as well as recommendations for follow-up visits and for ensuring patient-safety in sleep medicine. The overall goal of the current SOPs is the further development of excellence in practice and quality assurance of sleep medicine in Europe. [ABSTRACT FROM AUTHOR]

Many patients with the obstructive sleep apnoea syndrome (OSAS) look tier alternative conservative or surgical therapies to avoid treatment with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients, lots of methods are offered that promise a definitive cure or relevant improvement of OSAS. The "Apnoea" working group of the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine (EBM). This paper presents the results of the task force. The authors performed a literature search until 31 December 2005 (Medline and hand search of relevant papers). The studies were evaluated according the recommendations of the "Oxford Centre for Evidence-based Medicine Levels of Evidence". The data were unsatisfactory for most of the methods. Sufficient data were available for intraoral appliances (IOA) and maxillomandibular osteotomy (MMO). IOAs can reduce mild to moderate respiratory disturbances; MMOs are efficient in the short- and long-term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to EBM criteria. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases over the years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multilevel surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy, although more data from prospective controlled studies are needed. There is no evidence for any other treatment options studied in this paper. [ABSTRACT FROM AUTHOR]

Patients with excessive daytime sleepiness are impaired in all work-related and social areas of their lives. Expert opinions are recommended for pension proceedings, regarding driving licenses, and for work restrictions in the workplace. Experts have to consider all differential diagnoses of sleep disorders. Polysomnography is imperative in this process. Several neuropsychological tests are available to confirm sleepiness and attention deficits. Prior to final medical assessment, optimal treatment should be pursued. In the current German regulation of driver licenses (Fahrerlaubnisverordnung, FeV), an untreated sleep disorder with daytime sleepiness is judged as a reason for inability to drive. The importance of daytime sleepiness in other occupations should be assessed according to the needs at the workplace. Before the patients respond to an appropriate therapy, they are often temporarily unable to work. The patient should be informed of the appraisal with regard to career choice and workplace design. The expert, thus, has the responsibility of performing an interdisciplinary differential diagnosis of pathological sleepiness and monitoring treatment success using appropriate test methods. In the present paper the legal guidelines in Germany and available test methods are presented. [ABSTRACT FROM AUTHOR]