The Hidden Costs of Sleep Apnea

For many people, the 24/7 nature of our society has caused people to believe that chronic fatigue is an acceptable way of life. This has led many people to disregard their sleep issues (e.g. waking up in the middle of the night, difficulty falling asleep). However, what is often believed to be a simple sleep issue is actually a diagnosable sleep disorder.

A significant but commonly overlooked concern in 24/7 workforce health and safety is the high prevalence of “Obstructive Sleep Apnea Syndrome” (OSA), which is one of the roughly 70 sleep disorders listed in the International Classification of Sleep Disorders Diagnostic & Coding Manual. Obstructive Sleep Apnea can become a serious health issue if left untreated. Symptoms of OSA can include disturbed sleep and excessive sleepiness during the day (National Sleep Foundation, 2014).

The ripple effect of OSA can dramatically impact not only the sufferer, but also their spouse, friends, family, and even their employer. Most managers recognize that understanding and addressing the issues of a 24/7 lifestyle can dramatically improve the bottom line of the company; yet, health issues like OSA continue to be overlooked as contributing to excess costs.

How much do employees with sleep apnea cost their employers? CIRCADIAN conservatively estimates that each undiagnosed employee in the workforce costs an additional $6,000 per year in OSA-related expenses.

What is OSA?

Obstructive Sleep Apnea (OSA) is a disorder of the respiratory system manifested by repeated cessations of breathing during sleep that can cause arousal from sleep multiple times per hour. In OSA, the upper airways collapse during sleep so as to prevent the movement of air into the lungs. Obstructive Sleep Apnea typically develops with increasing severity over a period of several years.

The period of cessation of breathing called “apneas” prevent the oxygenation of the blood in the pulmonary capillaries and, as a result, the arterial blood oxygen levels rapidly fall. Carotid body oxygen sensors detect the drop in oxygen levels, causing an abrupt arousal from sleep and gasping for air before the sufferer falls back into sleep again. Because this pattern can repeat many times per hour, the result of sleep apnea is reduced sleep quality and quantity, leading to chronic sleep deprivation. The effects of sleep deprivation and the repeated episodes of blood deoxygenation affect the neurological and cardiovascular systems.

Animation of Obstructive Sleep Apnea

Risk Factors & Prevalence

Several studies have described the average prevalence of OSA in different populations as ranging from 2% to 33% (Young, 1993; Agency for Healthcare, Research and Quality, 2000).

The sleep specialist community conservatively estimates that 5% of the U.S. working-age population suffers from OSA. However, a steady increase in the proportion of obese people in the U.S. population may directly increase the prevalence of OSA going forward.

CIRCADIAN’s databases (containing data from more than 10,000 shift workers) show that 11% of shift workers have OSA and 15% display key symptoms of OSA or other sleep disorders related to excessive sleepiness. Given the increased prevalence of OSA risk factors among shift workers, it is not surprising that OSA is more common in shift work populations as compared to other populations.

Recognized risk factors for OSA include:

  • Smoking (Kashyap, 2001)
  • Obesity
  • Having a neck size of 17” or greater
  • Regular use of alcohol or sleeping pills
  • Moderate sleep deprivation (National Institute of Health, 2003)

Health Implications

Due to interrupted sleep patterns, many individuals with OSA infrequently have restorative sleep episodes, which can potentially manifest into excessive daytime sleepiness, increased accidents, and more frequent health problems, such as:

  • 40% increased rate of excessive daytime sleepiness (Ulfberg, 1996)
  • 2 times as many traffic accidents per mile (Horstmann, 2000)
  • 3 times greater risk of occupational accidents (Ulfberg, 2000)
  • 1.3 to 2.5 times more hypertension (Krieger, 2002; Smith, 2002)
  • 2.2 times increased risk of nocturnal cardiac arrhythmia (Smith, 2002)
  • 3.9 times more likely to have congestive heart failure (Smith, 2002)
  • 1.6 times increased chance of stroke (Mooe, 2001; Shahar, 2001)
  • 1.4 to 2.3 times greater risk of heart attack (Saito, 1991; Shahar, 2001)
  • 40% increased risk of depression (Smith, 2002)

In one study consisting of 421 patients being evaluated for possible sleep apnea, researchers found that up to 95% of people who were positively diagnosed with OSA thought that they just had a snoring or fatigue problem, causing sleep specialists to suggest that high-risk groups should be educated and screened (Baumel, 1997).


Given the myriad of health problems associated with OSA, it is no surprise that employees with untreated OSA cost employers significantly more each year than employees with treated sleep apnea or no apnea.

According to CIRCADIAN’s calculations, a highly conservative estimate of the yearly excess cost per employee with unmanaged OSA is approximately $6,091. This means that in a shiftwork population where 11.6% of the workers are unmanaged OSA sufferers, these costs would equate to $706,556 per one thousand workers every year ($6,091 x 116 workers).

These apnea-related excess costs are often accrued from increased physician and hospital visits, cardiovascular treatment costs, increased on the-job injuries, and absenteeism, to name a few. Table 1 details the discrepancies between employees with treated vs untreated sleep apnea in terms of the average yearly excess costs per employee.

Table 1. Yearly Excess Costs per Employee: Treated vs Untreated Sleep Apnea

OSA costs

In order to mitigate the risks associated directly with OSA, and lower the sufferer’s risk to the same level as a non-OSA worker, the obstruction of the airway during sleep must be prevented. In short, the individual with OSA needs to keep breathing.

General measures are often effective. These include weight loss, avoidance of alcohol and sleeping pills, use of medication to relieve nasal congestion, and use of oral appliances that modify the position of the tongue, soft palate or jaw. More extreme measures include nasopharangeal surgery, although the long term efficacy of this approach is questionable due to the accumulation of scar tissue. However, the medically recognized method for maintaining an open airway in those suffering from moderate to severe OSA is “Continuous Positive Airway Pressure,” or CPAP for short.

Most employees receiving CPAP treatment experience a dramatic improvement in their health and quality of life (Sin, 2002), and their health care costs return to normal levels. Performance (as measured by tests of simulated driving, daytime sleepiness, cognitive performance and mood) shows significant improvements (Weaver, 2001), while absenteeism diminishes after treatment (Servera, 1995). Adverse health and performance consequences and costs associated with OSA can be reversed in compliant, treated employees.

Managing Employee OSA

Though OSA can be a highly disruptive disorder in its unmanaged state, the costs of accidents and health problems are mitigated when OSA sufferers receive treatment to correct the airway obstruction during sleep. However, in order to receive a non-invasive, corrective treatment, the individual needs to know that he or she has OSA in the first place.

Company Sponsored Education Initiatives

There are several challenges to overcome in order to ensure a successful outcome for a company-sponsored OSA education initiative; however, the benefits of implementing a program can be substantial.

Managers report returns from reductions in healthcare, absenteeism, turnover, presenteeism, and overtime costs, as well as longer-term benefits in workers’ compensation payments, insurance premiums, and ultimately brand value.

Interested in learning more about employee education initiatives?

Visit to download a free white paper titled “Shiftwork Lifestyle Training: Employee and Employer Benefits”.


CIRCADIAN® is the global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock.  Through a unique combination of consulting expertise, research and technology, software tools and informative publications, CIRCADIAN helps organizations with traditional and/or extended operating hours optimize employee performance and reduce the inherent risks and costs of sleep deprivation and fatigue.



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