Current practice, clinical perspectives and barriers to multi-night testing for obstructive sleep apnea in Europe: a survey across ESADA centers.

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.