Obstructive Sleep Apnea (OSA):common medical disorder (4% men, 2% women) characterized by recurrent collapse of the upper airway at night leads to:

a) nocturnal hypoxemia,

b) sleep fragmentation, and in consequence

c) daytime sleepiness

Risk factors: male gender, obesity and increased age. Snoring is a major hint to possible OSA. Snoring is caused by vibration of soft tissues in throat during sleep              

What we know:In patients with OSA the incidence of fatal cardiovascular events (e.g. heart attack, stroke) are significantly higher than patients without OSA. Furthermore, patients with OSA are high risk for having traffic collisions.  

Treatment appears effective in mitigating these increased risks.  

Sleep Deprivation 

Background: In the laboratory setting, short-term sleep restriction leads to a variety of adverse physiologic sequellae, including deterioration in glucose control, Increased blood pressure, sympathetic activation, increased CRP, reduction in appetite suppressing hormones.  

Individuals who report sleeping 6 or less hours per night have an increased risk of adverse consequences including weight gain, diabetes and heart attacks.  

Sleep=Consequence

These data suggest that sleep restriction may have long-term health consequences.

The discussion about the allocation of resources in health care starts with budget numbers, which represent: physicians, nurses, equipment, buildings, supplies, drugs

We know that:

These resources are limited and expensive.  There are a multitude of demands for these resources.  Because there are a multitude of demands and limited resources, not all demands can be fully satisfied. How do we then decide where to allocate the resources?  Resource allocation decisions must account for:

• need,
• costs, and
• impact of the intervention.

Therefore, when seeking resources for a given program, need must be defined, costs must be estimated and expected benefits provided must be measured. 

How do we measure the expected benefits:

1) There is more than impact on health status;

2) Measurement is in relation to the objectives of the organization;

3) Typically, a multi-criteria analysis- objectives are translated into evaluation criteria. 

In the day-to-day management of health care resources, allocation decisions are mostly based on historical patterns: the entire system is not subject to ongoing review. HOWEVER there are constant efforts to improve efficiency and fairness, i.e. significant decisions have to be made; Resources will go to the options that bring the given organization closest to its objectives, considering needs, costs and expected benefits.