Chest
Volume 136, Issue 1, July 2009, Pages 130-136
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Original Research
Sleep Medicine
Increased Risk of Lost Workdays Prior to the Diagnosis of Sleep Apnea

https://doi.org/10.1378/chest.08-2201Get rights and content

Background

The impact of sleep apnea on work disability, in terms of sickness absence and disability pension, is unclear. We sought to estimate the total number of lost workdays caused by sleep apnea either due to medically certified sickness absences or disability pensions during the 5 years prior to the year of a sleep apnea diagnosis.

Methods

This is a register-linkage case-control study of Finnish public sector employees who had received a diagnosis of sleep apnea between 1995 and 2005 (n = 957) and randomly selected control subjects who had not received a diagnosis of sleep apnea (n = 4,785), matched for age, gender, socioeconomic position, type of employment, and organization. The annual sum of lost workdays, due to either medically certified sickness absences or disability pensions prior to diagnosis, was calculated for each participant (mean follow-up time, 5 years).

Results

After adjustment for comorbid conditions (eg, hypertension, ischemic heart disease, diabetes, asthma/other chronic lung disease, and depression), an increased risk of lost workdays was found in employees in whom sleep apnea developed compared to control subjects (rate ratio [RR], 1.61; 95% confidence interval [CI], 1.24 to 2.09 in men; and RR, 1.80; 95% CI, 1.43 to 2.28 in women). In women, the excess risk was already pronounced 5 years prior to the year of diagnosis, whereas in men the highest risk was noticed 1 year before the year of diagnosis.

Conclusion

Sleep apnea may severely threaten work ability years before diagnosis. These results emphasize the importance of the early identification and treatment of employees with sleep apnea.

Section snippets

Study Population and Design

The data were derived from the ongoing prospective Finnish Public Sector Study.24 The participants' personal identification numbers (a unique number assigned to each Finnish citizen used for all contacts with the social welfare and health-care systems) were used to link the participants to hospitalization, sickness absence, and disability pension records from national registers covering the years 1994 to 2005. Based on employers' records, 151,618 public sector employees were employed for at

Results

Table 1 shows the baseline characteristics of the 957 sleep apnea case patients and 4,785 control subjects. Sociodemographic and occupational characteristics did not differ between the groups, confirming the success of matching. As expected, the case patients had significantly more comorbid medical conditions than the control subjects (Table 1).

In men, the overall rate of lost workdays was 1.6 times greater (RR, 1.61; 95% CI, 1.24 to 2.09 times greater) and in women 1.8 times greater (RR, 1.80;

Discussion

In this register-linkage study of Finnish public sector employees, an increased risk of lost workdays due to work disability was found prior to diagnosis in employees in whom sleep apnea developed. The overall rate of lost workdays during the 5-year period preceding the year of diagnosis was 1.6 times greater in male case patients and 1.8 times greater in female case patients compared to control subjects, resulting in 30.0 and 80.5 extra lost days, respectively, in men and women. The

Conclusion

Data from this large register-based study of public sector employees suggest that the development of sleep apnea substantially increases the number of lost workdays. These results add to the evidence demonstrating the importance of the early identification and treatment of employees with sleep apnea. Further research is needed to examine whether our findings are generalizable to other populations.

References (42)

  • PE Peppard et al.

    Longitudinal association of sleep-related breathing disorder and depression

    Arch Intern Med

    (2006)
  • SD West et al.

    Prevalence of obstructive sleep apnoea in men with type 2 diabetes

    Thorax

    (2006)
  • S Marti et al.

    Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment

    Eur Respir J

    (2002)
  • HK Yaggi et al.

    Obstructive sleep apnea as a risk factor for stroke and death

    N Engl J Med

    (2005)
  • NS Marshall et al.

    Sleep apnoea as an independent risk factor for all-cause mortality: the Busselton Health Study

    Sleep

    (2008)
  • A Bahammam et al.

    Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment

    Sleep

    (1999)
  • J Ronald et al.

    Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients

    Sleep

    (1999)
  • MH Kryger et al.

    Utilization of health care services in patients with severe obstructive sleep apnea

    Sleep

    (1996)
  • M Albarrak et al.

    Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP

    Sleep

    (2005)
  • V Kapur et al.

    The medical cost of undiagnosed sleep apnea

    Sleep

    (1999)
  • S Greenberg-Dotan et al.

    Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients

    Sleep

    (2007)
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    This work was performed at the Finnish Institute of Occupational Health, Finland.

    This study was supported by the Social Insurance Institution of Finland, and the Academy of Finland (projects No. 117 604, No. 124 271, No. 124 322, No. 126 602, No. 129 262, and No. 129 264).

    Dr. Saaresranta has received a total of €2,100 due to presentations in national symposia for Boehringer Ingelheim, Finland; Resmed Finland; and MSD Finland. Drs. Sjösten, Vahtera, Salo, Oksanen, Virtanen and Kivimäki, and Ms. Pentti have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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