Untreated obstructive sleep apnea (OSA) among working-age adults was associated with significantly reduced workforce productivity in both the US and the UK, primarily due to absenteeism and decreased work performance, a new analysis showed.

Using representative population samples, investigators estimated that roughly 1 in 5 adults in both countries experience symptoms consistent with OSA. Although continuous positive airway pressure (CPAP) therapy is highly effective, adherence remains low, which contributes to reduced work productivity and increased economic costs. 

Results of the analysis showed that as OSA prevalence increased, gross domestic product (GDP) losses rose in a near-linear fashion.

“Our findings show that at the individual level, productivity losses from untreated OSA exceed the annual cost of CPAP therapy in both countries,” lead investigator Umar Rehman, PhD, Division of Surgery and Interventional Science, University College London, told Medscape Medical News. 

“This highlights a clear economic and clinical opportunity: investing in earlier identification, easier access to diagnostic services, and structured follow-up to support adherence could yield large benefits for both individuals and society.”

The study was published online on February 24 in Thorax.

Underdiagnosed, Undertreated

OSA diagnosis and treatment rates remain low in many countries. In the US and UK, an estimated 80%-85% of affected individuals go undiagnosed, seriously curtailing opportunities for timely intervention. 

Untreated OSA has been linked to cardiovascular disease, diabetes, and cognitive decline, as well as excessive daytime sleepiness, which can impair work performance and increase injury risk.

Although CPAP therapy is highly effective in reducing apnea severity, adherence remains a major challenge. Prior studies show that more than half of patients discontinue treatment over time. 

To estimate the prevalence and societal impact of OSA among working-age adults, the investigators analyzed symptom data from representative samples drawn from the 2021 national censuses in both countries, including 3523 respondents in the US and 840 respondents in the UK ranging in age from 45 to 50 years.

OSA was defined using self-reported proxy measures aligned with diagnostic criteria from the International Classification of Sleep Disorders, Third Edition. Respondents who reported both nocturnal breathing pauses and excessive daytime sleepiness on three or more nights per week were classified as having OSA syndrome.

The investigators estimated economic impact using a computable general equilibrium macroeconomic model that incorporated productivity losses due to both absenteeism and presenteeism, and translated them into GDP losses and reduced tax revenue at the national level.

Billions in Lost Productivity

The estimated prevalence of OSA syndrome was 22.8% in the US and 19.5% in the UK. Among working-age adults, nearly 30% in the US and approximately 7% in the UK met the study criteria.

In the US, total annual productivity losses attributable to OSA were estimated at $180.2 billion, which corresponds to approximately $3727 per affected worker per year. In comparison, the estimated annual cost of CPAP treatment was $1661 per patient. Sensitivity analyses showed a near-linear increase in GDP losses as OSA prevalence rose, with productivity losses exceeding $120 billion once prevalence surpassed 20%.

“Symptoms such as unrefreshing sleep, fatigue, and excessive daytime sleepiness directly impair concentration, reaction time, and cognitive function,” Rehman said, noting that untreated OSA reduces productivity by an estimated 4.9% compared with unaffected workers.

In the UK, the total annual productivity losses were estimated at £4.22 billion, which represents about 0.2% of national GDP. On an individual level, productivity losses averaged £1841 per affected worker annually, compared with an estimated £1363 per patient for treatment and associated care. At a 7% prevalence among working-age adults, tax revenue losses were estimated at £1.56 billion.

The investigators noted that these estimates probably underestimate the true economic burden, as the model did not include costs related to healthcare utilization, workplace accidents, or road traffic injuries. 

“Moreover, many of the wider health costs associated with OSA, such as cardiovascular disease, stroke, and workplace accidents, were not included in our estimates,” Rehman said.

The study also had several limitations. It relied on self-reported symptoms of OSA rather than objective measures such as the apnea-hypopnea index, which precluded assessment of disease severity and introduced potential recall bias and/or misclassification.

“Importantly, the prevalence estimates generated in our study mirror those reported in prior published literature, suggesting that our proxy definition captures a clinically meaningful population,” Rehman said. “While we cannot confirm disease severity, our findings should be interpreted as estimates of symptomatic OSA syndrome rather than confirmed diagnoses.”

He added that the symptom-based estimates served as a pragmatic framework for estimating the population-level economic and productivity burden of untreated OSA. 

OSA Screening at Work? 

Given the significant economic and productivity burden of untreated OSA, workplace screening has been proposed as a strategy to identify high-risk employees and help reduce associated costs.

“Our findings support the idea that workplace screening could be beneficial, particularly in high-risk occupations such as transport, heavy machinery operation, and safety-critical roles,” Rehman said. Early identification in these groups could improve health outcomes while reducing accident risk and productivity losses, he added. 

In an accompanying editorial, Ryohei Kinoshita, PhD, a sleep researcher and epidemiologist at the School of Public Health, Faculty of Medicine, Imperial College London, and colleagues agreed on the need for carefully designed workplace screening programs targeting high-risk, safety-sensitive occupations.

“The introduction of workplace screening, with prescreening counselling about the health risks of OSA (and the benefits of CPAP) and the diagnostic pathway, coupled with a likely increase in OSA diagnoses in the workplace, could result in better general awareness around the disease,” Kinoshita and colleagues wrote.

Employer liability concerns make screening more justifiable in high-risk roles such as truck driving.

Kinoshita and colleagues recommended testing it in occupations with high OSA prevalence.

“Ultimately, the way to test whether workplace screening would be a worthwhile strategy would be to select an occupation in which OSA is prevalent and has severe consequences, such as professional driving, and see whether relevant outcomes such as road traffic accidents and absenteeism are clinically and statistically significantly different in a screened group compared with a standard care group,” they wrote.

However, they cautioned that workplace screening for OSA may create unintended issues, including higher insurance premiums, restrictions on social driving, and concerns about personal privacy, with implications varying by occupation.

Differences between the US and UK healthcare systems also matter. In the UK, a publicly funded system may allow more standardized pathways for screening and follow-up, whereas in the US, access to diagnosis and treatment may be influenced by insurance coverage and employer-based health benefits.

Aware of these potential consequences, Rehman emphasized that OSA screening should be “framed as supportive and preventive, with clear pathways to treatment and reassurance that diagnosis will not automatically jeopardize employment.”

The study was supported by the Isaacson Family Foundation and the Stanford Head & Neck Surgery Research Fund. Rehman reported no relevant financial disclosures. Kinoshita is currently employed at Asahi Kasei Pharma Corporation, but the company had no involvement in this research.