The impact of obstructive sleep apnea and daytime sleepiness on work limitation

Sep 11, 2007Sleep medicine

How Obstructive Sleep Apnea and Daytime Sleepiness Are Linked to Work Limitations

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Abstract

Among 428 patients with obstructive sleep apnea, those with higher sleepiness scores showed significantly greater work limitations.

No significant relationship was found between OSA severity and work limitations in the overall group.
Blue-collar workers with mild OSA experienced 23.1% time management limitations compared to 43.8% in those with severe OSA.
Patients with an Epworth Sleepiness Scale (ESS) score of 5 had much less work limitation than those with a score of 18 in time management (19.7% vs. 38.6%), mental-interpersonal relationships (15.5% vs. 36.0%), and work output (16.8% vs. 36.0%).
In a follow-up of 49 patients, those using continuous positive airway pressure (CPAP) reported significant improvements in time management (26% vs. 9%), mental-interpersonal relationships (16% vs. 11.0%), and work output (18% vs. 10%).
Subjective sleepiness is associated with decreased work productivity in individuals referred for sleep-disordered breathing.

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BACKGROUND: Many patients with obstructive sleep apnea (OSA) participate in the work force. However, the impact of OSA and sleepiness on work performance is unclear.

METHODS: To address this issue, we administered the Epworth Sleepiness Scale (ESS), the Work Limitations Questionnaire (WLQ), and an occupational survey to patients undergoing full-night polysomnography for the investigation of sleep-disordered breathing. Of 498 patients enrolled in the study, 428 (86.0%) completed the questionnaires. Their mean age+/-standard deviation (SD) was 49+/-12 years, mean body mass index (BMI) was 31+/-7 kg/m(2) mean apnea hypopnea index (AHI) was 21+/-22 events/h, and mean ESS score was 10+/-5. Subjects worked a mean of 39+/-18 h per week. The first 100 patients to complete the survey were followed up at two years.

RESULTS: In the group as a whole, there was no significant relationship between severity of OSA and the four dimensions of work limitation. However, in blue-collar workers, significant differences were detected between patients with mild OSA (AHI 5-15/h) and those with severe OSA (AHI>30/h) with respect to time management (limited 23.1% of the time vs. 43.8%, p=0.05) and mental/personnel interactions (17.9% vs. 33.0%, p=0.05). In contrast, there were strong associations between subjective sleepiness (as assessed by the ESS) and three of the four scales of work limitation. That is, patients with an ESS of 5 had much less work limitation compared to those with an ESS 18 in terms of time management (19.7% vs. 38.6 %, p<0.001), mental-interpersonal relationships (15.5% vs. 36.0%, p<0.001) and work output (16.8% vs. 36.0%; p<0.001). Of the group followed up, 49 returned surveys and 33 who were using continuous positive airway pressure (CPAP) showed significant improvements between the initial and second follow-up in time management (26% vs. 9%, p=0.0005), mental-interpersonal relationships (16% vs. 11.0%, p=0.014) and work output (18% vs. 10%; p<0.009).

CONCLUSION: We have demonstrated a clear relationship between excessive sleepiness and decreased work productivity in a population referred for suspected sleep-disordered breathing. Screening for sleepiness and sleep-disordered breathing in the workplace has the potential to identify a reversible cause of low work productivity.

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The impact of obstructive sleep apnea and daytime sleepiness on work limitation

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