Elsevier

Sleep Medicine Reviews

Volume 16, Issue 5, October 2012, Pages 455-462
Sleep Medicine Reviews

Clinical review
Impact of sleep apnea on economics

https://doi.org/10.1016/j.smrv.2011.10.001Get rights and content

Summary

Obstructive sleep apnea syndrome (OSA) alters sleep quality and is associated with sleepiness and decreased cognitive functioning. It has therefore always been recognized as a major public health issue with potential societal consequences: accidents, increased morbidity, and cognitive deficits impairing work efficiency. The number of patients diagnosed and treated for OSA has increased drastically in the last few years.1 In response to this epidemic, health authorities have encouraged studies investigating how patients cope with OSA and also its diagnosis, comparing ambulatory to hospital-based polysomnography. Based on epidemiological knowledge, this review aims to carefully describe the possible links between sleep apnea and public health concerns along with identifying the certitudes and missing data concerning the consequences of sleep apnea on accidents, work, economics and health-related quality of life.

Introduction

Although half a century ago obstructive sleep apnea (OSA) was mostly unknown and undiagnosed, the last few decades has seen OSA become a central problem in the pathogenesis of major public health issues such as cardiovascular diseases, accidents and metabolic syndromes.*1, 2, 3, 4, 5 The discovery of continuous positive air pressure (CPAP) treatment 30 years ago, drove doctors and public health authorities to dramatically increase patients’ care, in the hope of preventing comorbidities which could possibly be associated with OSA.

Due to the important expenses devoted to sleep apnea care, health authorities of many countries have attempted to encourage economic evaluations and public health studies to better understand the utility of diagnosing and treating OSA. From its identification, OSA was immediately recognized as a potential public health issue, associated with societal consequences: accidents, comorbidities and cognitive impairment.5, 6

This article not only aims to describe possible links between sleep apnea and public health concerns but also to identify certitudes and missing data concerning the consequences sleep apnea may have on work economics and health-related quality of life (HrQoL).

Section snippets

Epidemiology: the magnitude of sleep apnea, screening the disorder and seeking help

This section’s aim is not to describe the epidemiology of sleep apnea but only to put the prevalence of OSA, its socio-demographics and access to care in a universal and economical perspective. Independently of the nationality or socio-economical characteristics of patients, sleep apnea has common features around the planet which have to lead to similar care (Table 1).

Seeking help for sleep apnea and access to the treatments

Despite growing knowledge of sleep apnea, numerous studies stress that many patients remain undiagnosed. According to Pang and Terris,19 93% of women and 82% of men with moderate to severe OSA may still be undiagnosed. The gold standard for diagnosing OSA is still attending an overnight level I polysomnogram. Due to limited resources, including the number of recording beds, high costs, long waiting lists and laboratory requirements, many authors have explored the use of clinical predictors or

Absenteeism, work limitation and other work characteristics

Sleep apnea patients may have multiple comorbidities which can contribute to disability, absenteeism and work productivity loss. Interestingly, despite major interest on the socioeconomic impact of sleep apnea, there is to our knowledge, only one study published concerning sleep apnea and absenteeism. Sjötsen et al.28 established the total number of lost workdays caused by sleep apnea. The cohort was chosen through access to a register-linked case–control study of Finnish public sector

Sleep apnea and accidents

The impact of sleep apnea on car accidents is a crucial public health issue. Public authorities and the media are deeply aware of the risk of sleepiness at the wheel during the night and of the effects of sleep debt and sleep pathologies (sleep apnea, hypersomnia) on accidents.

Direct costs of OSA

The studies devoted to the direct costs of OSA have mainly focussed on the cost of diagnosis (polysomnograpy versus ambulatory) and the cost/benefit of using CPAP.

Regarding the diagnosis of OSA, Whittle et al. were among the first to produce a cost-analysis study with the aim of recommending home sleep studies versus laboratory polysomnography. Comparing a group of 150 subjects “at home” to 75 patients “in the laboratory”,43 they calculated that home sleep studies gave a faster delay of

The specific impact of OSA on quality of life

About 15 years ago, Smith and Shneerson used the short form 36 health survey questionnaire (SF-36) to test the impact of sleep disruption in 223 patients with OSA before and 6 months after treatment (CPAP).56 Subjects with OSA requiring treatment scored lower on all dimensions of the SF-36 (p < 0.05) than the general population. The differences were most important for vitality (24%) and social functioning (27.9%). After six months of treatment with CPAP there was an improvement in all scores and

Final comments

OSA affects the daily lives of millions of people around the world. The economic impact of this most prevalent sleep disorder on the collectivity seems enormous. There is also increasing evidence linking OSA to several severe public health major concerns: obesity, diabetes, depression, cardio-vascular diseases and accidents. Beside the patients themselves, their family and work relatives may also be deeply concerned by the consequences of snoring and OSA in their own lives.

Practice points

  • The

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