Around one in five people in the UK and the US have the breathing disorder obstructive sleep apnoea, likely costing both economies billions in lost productivity every year, suggests a new paper led by a UCL researcher.
The peer-reviewed study, published in BMJ Thorax and funded by the Isackson Family Foundation and Stanford Head & Neck Surgery Research Fund, calls for new workplace screening to be trialled in those most at risk of harm from the daytime sleepiness associated with the condition, such as professional drivers.
It estimates that untreated obstructive sleep apnoea (OSA) is associated with annual productivity losses of £4.22 billion in the UK (equivalent to 0.2% of national GDP) and US$180.2 billion in the United States.
OSA occurs when the throat walls narrow or close for 10 seconds or more during sleep, causing those affected to snore or wake up, gasping for breath. It is associated with serious long-term health risks such as cardiovascular disease, diabetes and dementia but remains under-recognised.
The international study team, made up of 15 researchers across the UK, US and Canada and led by Professor Matt Lechner (UCL Surgery and Interventional Science & UCL Cancer Institute), sought to estimate OSA’s prevalence in the UK and US and assess the societal costs of leaving the condition untreated.
They analysed representative samples of respondents to the 2021 US and UK censuses and found the prevalence of OSA syndrome was 22.8% in the US and 19.5% in the UK. Among working-age adults (18-64 years), nearly 30% in the US and 7% in the UK met the study’s symptom-based criteria.
To estimate the economic impact, the study calculated productivity losses associated with OSA in working-age adults, considering both absenteeism (time off work) and presenteeism (reduced performance at work). In the US, total annual productivity losses linked to OSA came to US$180.2 billion - approximately US$3,727 per affected worker per year.
In the UK, total annual losses were estimated at £4.22 billion, or around £1,840 per affected worker each year.
Professor Lechner said: "’The burden of obstructive sleep apnoea syndrome and its economic impact have been consistently underestimated in recent years. We are urging policymakers to prioritise investment in effective screening strategies, alongside targeted public health campaigns and supportive policies."
In both countries, the estimated productivity loss per person exceeded the annual cost of air pressure mask (CPAP) treatment, which keeps the airway open during sleep and is used to moderate severe sleep apnoea. Annual CPAP treatment was estimated at around US$1,661 per patient per year in the US and £1,363 in the UK.
The study concludes that effective identification and treatment of OSA among the working populations of the US and the UK could result in substantial economic benefits. It argues that the following four key developments have now made setting up a workplace screening programme for the condition worth serious consideration:
- Screening algorithms to identify high-risk job roles and industries, such as lorry drivers, construction workers, train drivers, pilots, heavy machinery operators, surgeons and people caring for vulnerable children or adults
- The advent of low-cost diagnostic technologies - wirelessly connected testing devices
- Better understanding of the science of CPAP adherence, which many patients find difficult
- More alternatives to CPAP, including GLP-1 agonists (weight loss drugs), hypoglossal nerve stimulation (an implant to stimulate the tongue nerve), mandibular advancement devices (a mouth guard to keep the airway open) or positional approaches
They also addressed potential arguments against screening. Workers might fear being penalised if they are unable to tolerate treatment or their condition remains inadequately controlled, and a successful screening programme would probably need to offer some form of employment guarantee.
Professor Lechner added: "Early identification and treatment of obstructive sleep apnoea, combined with proactive follow-up, could deliver substantial savings - potentially amounting to billions of dollars in the United States and billions of pounds in the United Kingdom each year through improved productivity alone."
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