Undetected obstructive sleep apnoea (OSA) in the workforce and reduced work productivity in OSA: We need to improve screening to see the whole picture

We read with interest the excellent article by Dr A. Sanna, who has reviewed the contribution of obstructive sleep apnoea (OSA) to occupational accidents and impaired work performance. ¹ Indeed, few studies so far have examined the effect of OSA and its characteristics on work performance. ^2,3 Their results emphasise the need for screening tests among different groups of the workforce to identify subjects with undiagnosed OSA, highlighting the effect of excessive daytime sleepiness. ^2,3

In this context, we have demonstrated that work productivity is inversely correlated with daytime sleepiness, but not with other indices of OSA severity or anthropometric characteristics (e.g. body mass index) in otherwise healthy OSA patients. ³ This was documented by the use of Endicott Work Productivity Scale (EWPS), ³ a 25-item questionnaire estimating the types of behaviour and subjective feelings that are highly likely to reduce productivity and efficiency in work activities. ⁴ Using the same questionnaire, we have more recently presented data indicating that 3 months of continuous positive airway pressure treatment in OSA patients can not only ameliorate excessive daytime sleepiness but also improve work productivity. ⁵

Generally, work productivity, along with work limitation, is considered a comprehensive and useful measure to assess work performance. The impact of OSA on workforce population is now beginning to attract increasing attention. More knowledge is needed in the field of work productivity, working days lost and financial consequences of compromised workforce efficiency. We strongly agree with Dr Sanna in the necessity to detect OSA in the working population. ¹ At the same time, we need to more fully assess the impact of OSA on work characteristics to enable a better view of the whole picture. For this purpose, questionnaires, such as the EWPS, will be appropriate. It also appears that daytime sleepiness, a particularly adverse feature of OSA seen in most but not all patients, ⁶ needs to be meticulously addressed. ²