background There has recently been concern about the future of sleep medicine in response to the “disruptive technology” of home sleep testing (HST) and its embrace by the medical insurance industry in the USA. 1,2 A reader might surmise that the ficontract by an insurance carrier in Massachusetts to mandate HST as a fistep in apnea diagnosis was the shot heard around the world that would change sleep medicine forever. The original shot heard around the world referred to the fiskirmish of the American Revolution (incidentally only about 30 miles from the headquarters of the insurance carrier in Massachusetts) was simply a step in a process that had its genesis long before. Similarly, the genesis of this shot affecting sleep medicine was long ago, and the reader must recognize that this is a shot heard around America, not the around the World. There have been many “disruptive” technologies and treatments in medicine, and in general they have improved patient outcomes. We can now prevent poliomyelitis and many childhood viral diseases; we can cure most bacterial, mycobacterial, and fungal infections; we seldom require surgery to treat diseases caused by gastric acid hypersecretion; we use “noninvasive” surgery using laparoscopic and thoracoscopic techniques to treat many patients who a generation ago would have required large incisions, dissections and excisions, and prolonged hospital admissions. We can now determine the presence of cancer in many cases using PET/MRI imaging. disruptions in Sleep medicine Sleep medicine is a young fiand there have already been several disruptions. In the fi eld of sleep apnea some of the disruptions have been technical, while others were based on new knowledge. There have already been several shots heard around the world of sleep. Some of the shots have been quiet, while some have very loud. Such shots might include the following: the description of CPAP 3 ; the fi rst description of data acquisition for respiratory variables during sleep by a microcomputer 4 ; the notion that respiratory sleep data can be obtained outside the laboratory 5 ; the publication of data suggesting that apnea patients have more automobile accidents 6 and increased mortality 7 ; the implementation of an integrated home sleep testing system 8 ; the monitoring of CPAP compliance 9 ; and the realization that sleep apnea is a very common problem. 10