Managing 24/7

Sleep Apnea - Costs, Risks and Solutions


Working long, nighttime, or irregular shifts has inherent risks, including fatigue-related accidents and an elevated risk of cardiovascular and gastrointestinal disease. Most managers recognize that understanding and addressing the human-factors issues of the 24/7 economy improves employee performance, safety, and health, and can dramatically improve the bottom line of the company. However, a significant but commonly overlooked concern in the extended hours workforce is the high prevalence of the sleep disorder “Obstructive Sleep Apnea Syndrome” (OSA).

What is Obstructive Sleep Apnea (OSA)?

OSA is a condition characterized by the soft tissues around the airway relaxing during sleep to the point of partially or completely obstructing the airway, thus causing a temporary cessation in breathing. The obstructions lead to frequent wake-ups, during which the sufferer gasps for breath. These frequent awakenings result in highly disrupted sleep and chronic exhaustion during waking hours.

Risk Factors and Prevalence

OSA is a common sleep disorder found in approximately 5% of the general work population but is more than twice as prevalent among shiftworkers at 11.6%. This increase may be due to the higher presence of certain risk factors found in the shiftworking population, including smoking, obesity, having a neck size of 17” or greater, the regular use of alcohol or sleeping pills, and moderate sleep deprivation.

The high prevalence of OSA in this population is especially troublesome, considering the safety risks it imposes and the safety-critical nature of many extended hours occupations. Due to interrupted sleep patterns, apnea sufferers experience twice as many traffic accidents per mile and have a threefold risk of occupational accidents. What’s more, general health risks increase, including a near doubling of hypertension risk, a threefold likelihood of congestive heart failure, and a 40% increased risk of depression.

Costs of Unmanaged OSA

Due to these and other risk factors, each undiagnosed case of OSA in the workforce costs an estimated additional $6,000 per year in apnea-related expenses, including increased physician and hospital visits, cardiovascular treatment costs, increased on-the-job injuries, and absenteeism, to name but a few(1). (And this is a conservative estimate, as it does not include costs associated with any downtime from occupational accidents or injuries, overtime costs to cover for absent workers, workers’ compensation costs, and other related expenses.) 

Treatment of OSA

Though apnea is a highly disruptive and risky disorder in its unmanaged state, the costs of accidents and health problems are mitigated when the OSA sufferer receives simple treatment to correct the airway obstruction during sleep. However, in order to receive the simple, non-invasive, corrective treatment, the sufferer needs to know that he or she has OSA in the first place. Up to 95% of people diagnosed with OSA thought that they just had a snoring or fatigue problem, causing sleep specialists to suggest that high-risk groups should be educated and screened.

Challenges of Screening and Treating OSA

However, certain challenges exist in educating, screening, and treating OSA in the shiftwork population.

  • Many existing educational materials about OSA tend to be overly technical and not specifically related to real-life examples.
  • Without a complete confidentiality barrier around OSA education and screening, workers concerned about their OSA risk rarely come forward and risk that their manager will label them as a high-cost, high-risk employee.
  • Accurate and quick screening is another key challenge, as poorly-designed screening questionnaires can cause false positive and negative results, leading to unnecessary and costly visits to the PCP by those who are not at risk, or the failure to diagnose OSA and instead send those OSA back into the population with the condition still unmanaged.
  • Traditionally, OSA diagnosis has been confined to the nearest sleep laboratory, where an “overnight visit” is required—something that is highly inconvenient for the average shiftworker and his or her family.
  • The final challenge is addressing the lack of structured follow-up support for diagnosed OSA sufferers. The standard of follow-up care and attention can be variable, and poor follow-up has been shown to lead to low treatment success rates.

The good news is that OSA is treatable through general measures such as weight loss and smoking cessation, and through the use of a Continuous Positive Airway Pressure (CPAP) device, a simple and comfortable device worn at night that regulates airflow during sleep, preventing nighttime blockages. To learn more about how to screen for sleep apnea risk in your shiftworkers, contact us.

(The above article is excerpted from CIRCADIAN’s white paper, “Reducing the Costs, Risks, and Liabilities of Sleep Apnea,” available here)

1) Kerin K. and Aguirre A. “Reducing the Costs, Risks, and Liabilities of Sleep Apnea” Circadian, 2003.

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