Sleep medicine--time for a change.

The growing awareness of obstructive sleep apnea and its profound impact on patients' quality of life and health has resulted in an unprecedented growth in sleep medicine in the last 2 decades. The present paper argues that, based on recently accumulated knowledge about the pathophysiology of cardiovascular morbidity in sleep apnea, the practice of sleep medicine must be changed in order to improve patients' care. The diagnosis of sleep apnea should be performed when patients are aged 25 to 30 years, far younger than the approximately 50 years of age, which is when most patients usually receive a diagnosis now, and programs of regular follow-up visits to assess patients' condition and compliance with treatment should be incorporated into the everyday practice of sleep specialists. Because of the wide gap between the number of sleep specialists and sleep clinics and the prevalence of sleep apnea in the general population, an alliance between sleep medicine and family practitioners is necessary to ensure such changes. A proposal for such an alliance is presented.