Report of the Assembly of National Sleep Societies (on-line conference May 01, 2020)

Due to the burden of Corona pandemic the ANSS-EC was forced to cancel the planned face-to-face Annual 2020 ANSS meeting in Ljubljana (Slovenia). Instead, a virtual 3-hour meeting was held on 1st May 2020. During the on-line meeting the most urgent issues were discussed.

In total, the meeting gathered 38 participants, including presidents or representatives of the national sleep societies of 24 countries: Armenia, Austria, Belgium, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Lithuania, the Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Sweden, Turkey, UK.

After welcoming speech from the ANSS-EC president Barbara G. Stražišar, the on-line meeting started with the talk by the invited speaker Dr. Ludger Gröte on the changes in sleep-related clinical practice in COVID-19 pandemic. Dr. Gröte presented the main statements summarized from the Guidance regarding coronavirus and sleep disorders released by the British Thoracic Society, American Academy of Sleep Medicine, GAVO2 and Swedish Association of Sleep Research and Sleep Medicine. The main positions include: the temporarily cessation of in-lab diagnostic and treatment procedures and more implementation of telemedicine-based services. The discussion on the use of CPAP and NIV during the COVID-19 pandemic is ongoing. Dr. Gröte also presented preliminary results obtained within the ESADA network related to the performance of sleep-related diagnostic and treatment procedures before and after COVID-19 pandemic. Based on the survey performed in 40 European centres, there is almost an 80% reduction in sleep medicine services since the pandemic onset, including more than 4.5-fold drop in performance of the in-lab PSG after the onset of pandemic. Also over 2.5-fold drop in the performance of home PG studies. Also a significant reduction in both in-lab (5 times lower) and home (twice lower) titration studies is observed. Telemedicine services are used only in half of the centres. A number of COVID-19-related recommendations related to healthcare delivery to patients (obstructive sleep apnea and hypoventilation) and their caregivers have been recently published, with the majority produced in the Western and Northern European countries.

Another urgent and related topic is Telemedicine in sleep field. Dr. Johan Verbraecken presented an overview of the different opportunities for telemedicine implementation in somnology, in particular: 1) Tele-diagnostics (long-term monitoring and home PSGs and PGs), 2) Telemonitoring of treatment (CPAP titration and follow-up), 3) Tele-CBT-I, 4) Tele-consultations including teleconferencing (for all sleep disorders). A special attention should be paid to the potential of tele-monitoring in increasing the adherence of patients to treatment and, consequently, the treatment efficacy. Next, Dr. Oana Deleanu presented the main policy aspects and feasibility of telemedicine, as well as the results of the NSS questionnaire on sleep-related telemedicine implementation in different countries (completed by 19 countries). In more than half responded countries there is some kind of legislation regulating telemedicine, and 12 countries have implemented some sleep-related telemedicine services. In general, the survey demonstrated an urgent need for collaborative effort in order to elaborate unified approach and guidance in sleep-related telemedicine in European countries as we are stepping in the Era of Telemedicine.

Few reports considered current ANSS activities. An update on the current state of the NSS based on the results of the traditional questionnaire (completed by 21 NSS) was presented by Dr. Lyudmila Korostovtseva. The analysis showed the need for more collaboration between the NSS, the need of intermediate (e.g. on-line) meetings during the year, as well as the high need for more open discussion and collaboration on the following topics: telemedicine, accreditation, legislation and (unified) reimbursement in sleep field.

Erna Sif Arnardottir presented the update on the work of the “Beyond the AHI” Task Force. A paper “On the rise and fall of the AHI. A historical review and critical appraisal” has been recently accepted in the Journal of Sleep Research.

Dr. Samson Khachatryan presented the update on the ANSS project “Beyond boundaries” aimed at promotion of sleep medicine and sleep research in Europe and beyond EU space, by expanding and harmonizing knowledge, skills and attitudes among sleep professionals. The first pilot step of this project, which included meeting local healthcare and other authorities with role in sleep medicine development, round table discussion with them and a one-day teaching seminar, was completed in Armenia (Yerevan) in October 2019. Following the meeting, a draft of Sleep Medicine Development in Armenia Position Statement Paper was prepared.

The ESRS Board members took active part in the meeting and the discussions. The president of the ESRS, Dr. Walter McNicholas, briefly reported about the ongoing process of preparation for the ESRS biannual Congress in Sevilla (scheduled for the end of September). Due to the COVID-19 pandemic changing scenario, the format of the meeting is still under discussion, the option of a hybrid format (combination of face-to-face and tele-conference) is being currently discussed. The deadline for the abstract submission is extended till 28th May 2020, and the submission of Bid applications for hosting ESRS 2024 is opened till 20th May 2020.

Last but not least was the presentation by Philips representatives (Gregory Frank and Peter Anderer) on “Sleep Staging: Inter-Scorer Agreement Modelled by Artificial Intelligence”. Based on the performed analysis, the approach which implies Somnolyzer sleep staging based on artificial intelligence outperforms the best manual scorer and is a prospective method for sleep staging.

Upon agreement between all the NSS representatives, the elections of the new members of the ANSS-EC were postponed till face-to-face meeting in Sevilla in autumn.