Jeffrey C. Hall, Michael Rosbash, and Michael W. Young in 2017 for their discovery and molecular characterization of clock genes, which led to an understanding of the circadian expression of every existing cellular function. Despite this, medicine has been slow to incorporate sleep as a tool for optimizing patient care. In 2022, the American Heart Association has finally taken the lead in declaring sleep's critical importance in cardiovascular health by changing "Life's Simple 7" to "Life's Essential 8", adding sleep as a modifiable risk factor for CV disease. Is this too little too late? The CDC declared SWD in the US as a major public health crisis in 2014, and at that time, it was estimated that 1 in 5 adults had a SWD. Now, about 33-50% of adults and youth are affected by a SWD, with a cost of almost $100 billion dollars a year to US health care and a growing impact on medical complexity and outcomes. What is the path forward? Abandon the idea of diagnosing SWD as comorbidity and adopt its use as a modifiable biomarker of health. Duration, quality and timing of sleep are quintessential to providing individualized insights for risk stratification and management. The following clinical scenarios highlight the implementation of this radical strategy across the lifespan. WHAT IS THE TAKE HOME POINT? Healthcare business strategy needs to look beyond the current model of sleep medicine delivery in order to reduce health care expenditure, improve predictive modeling across disease states and achieve optimal outcomes for patients. Synchronous and asynchronous use of digital tools, remote patient monitoring and home diagnostics including subjective and objective parameters of sleep to provide longitudinal data will better predict personalized risk stratification, enhance patient engagement and activation and reduce time to intervention when needed, as illustrated through the clinical cases provided. Healthcare business strategy needs to look beyond the current model of sleep medicine delivery in order to reduce health care expenditure, improve predictive modeling across disease states and achieve optimal outcomes for patients9 OCTOBER 2024
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