• Bronchoscopy
• COPD pharmacology
• non-invasive ventilation
• sleep apnoea
• COPD mechanisms
• asthma
• asthma mechanisms
• COPD exacerbations
• cough/mechanisms/pharmacology
• health economist

Procedures for the diagnosis and therapy of sleep disordered breathing have been well established in healthcare systems for quite some time and effective management of patients with sleep disordered breathing is established in many healthcare settings.1 However, there remain many unanswered questions, not only in relation to pathophysiology, prevalence and management but also in relation to cost of the condition and the cost-effectiveness of treatments. These questions have come into sharper focus with the current economic pressures. Healthcare payers may accept evidence that treatment reduces comorbidities, costs for physician service and drug treatment, lost working days, stays at hospitals and accidents caused by sleepiness but they could legitimately ask a number of other questions. Which patient has to be treated with which treatment and when should it be started? Are there identifiable patients where a more conservative treatment strategy suffices and others where alternative treatment methods are needed? And do these treatments increase life expectancy and quality of life, and reduce healthcare costs? We have to convince the national reimbursement agencies in every country that sleep medicine does provide cost-effective treatment so that they provide us with sufficient resources to effectively diagnose and treat obstructive sleep disordered breathing.

There is good evidence that untreated sleep apnoea is associated with reduced life expectancy2 and high comorbidity. Important comorbid disorders include arterial hypertension, atrial fibrillation, stroke, coronary heart disease, heart failure, diabetes mellitus, atherosclerosis and depression. As a consequence, patients with obstructive sleep disorders consume around 70% more healthcare resources than matched control patients.3 In this issue of Thorax (see page 560), Poul Jennum …