A literature review examines the economic and societal burden of sleepiness in patients with obstructive sleep apnea.

By Yoona Ha

Obstructive sleep apnea (OSA) can have deadly consequences but what about the costly ones? A recent literature review highlights the shortage of research focused on the financial burden of excessive daytime sleepiness in people with OSA.

Excessive daytime sleepiness is associated with increased risk for motor vehicle accidents and decreased work productivity, just to name a few adverse outcomes. Carl Stepnowsky, PhD, co-author of the clinical review “The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea,” says he and co-investigator Damien Leger, MD, PhD, were surprised to find so few studies to review. Of the 40 publications they identified, 15 studied North American samples, 16 European, 5 Asian, 3 Australian, and one Brazilian.1

Analyzing the true cost of OSA can be tricky, especially when it’s difficult to measure the magnitude and frequency of outcomes like career progression, financial outlook, productivity, etc. An analysis prepared for the American Academy of Sleep Medicine estimated almost $150 billion in productivity and healthcare costs for motor vehicle and workplace-related injuries.2

[RELATED: Older Undiagnosed Sleep Apnea Patients Incur More Costs, to the Tune of Almost $20,000 Per Year]

The comprehensive clinical review had the following takeaways.

  • Most drivers with excessive daytime sleepiness as a symptom of OSA had a significantly higher rate of motor vehicle accidents. Once you add up the vehicle insurance claims, repair costs, healthcare costs, and reduced work productivity, the financial burden can be enormous.
  • Excessive daytime sleepiness also negatively affects work productivity. Studies that measured absenteeism rates found a higher rate of absenteeism in the United States, compared to other countries analyzed.
  • Excessive daytime sleepiness independent from OSA has a detrimental impact on long-term work duties such as missed promotions, raises, and changes in job descriptions.
  • The combination of OSA and excessive daytime sleepiness diagnoses is associated with an increased risk of both short-term work disability and longer-term work duty modifications.
  • OSA patients with excessive daytime sleepiness had greater rates of depression and tend to have significantly lower scores on mental and physical quality of life scales.

Stepnowsky, associate adjunct professor of medicine at the University of California, San Diego, says that patient-reported symptoms like sleepiness are often not the focal point of investigation in sleep apnea-related studies.

The way healthcare systems are structured in the United States often makes it difficult to document excessive daytime sleepiness as a symptom, especially when it’s not something providers are asked to record for coding purposes.

In addition, the review suggested most researchers consider OSA a respiratory disease of which excessive daytime sleepiness is a single symptom that improves with treatment. But excessive daytime sleepiness can persist among patients who don’t always stick to their CPAP therapy. This not only leads to a dearth in scholarship examining the symptom but also reveals new opportunities for research.

“Our field knew the large negative impact sleep apnea was having on our patients, yet medicine didn’t really accept sleep apnea as an important medical condition until it was linked to other known serious medical conditions, like hypertension, cardiovascular diseases, and diabetes,” Stepnowsky says. “We need to revitalize our field into looking again at a cure for sleep apnea.”

Finding a cure for OSA will take some time, Stepnowsky says, but taking advantage of what we already know and leveraging interventions early on is one way providers can improve outcomes for patients. In the short-term, providers can focus on stopping the progression of severity in OSA, though this is easier said than done, he adds.

Yoona Ha is a freelance writer and healthcare public relations professional.


  1. Léger D, Stepnowsky C. The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea. Sleep Med Rev. 2020 Jun;51:101275.
  2. American Academy of Sleep Medicine, Frost & Sullivan. Economic impact of obstructive sleep apnea. 2015. Available at https://aasm.org/advocacy/initiatives/economic-impact-obstructive-sleep-apnea.

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