Untreated Sleep Apnea May Cost U.S. Workers $3,727 Each in Lost Productivity Per Year

Approximately one in five adults in the United States and United Kingdom may have obstructive sleep apnea. Most of them have never been diagnosed. The condition - in which the throat repeatedly narrows or closes during sleep, sometimes hundreds of times per night - is known to raise the risk of cardiovascular disease, diabetes, and dementia. A new analysis published in Thorax calculates what that undiagnosed burden costs in economic terms, and the numbers are large enough that the authors argue it is time to run a pilot workplace screening program.

The prevalence estimates and their basis

The analysis drew on self-reported symptom data from 3,523 respondents to the 2021 U.S. census and 840 respondents to the 2021 U.K. census. Researchers identified individuals reporting two symptoms characteristic of obstructive sleep apnea: breathing pauses during sleep and excessive daytime sleepiness occurring three or more nights per week.

By that measure, roughly 23% of U.S. adults and 19.5% of U.K. adults showed signs consistent with the condition. Among working-age adults (18 to 64), the proportions meeting study criteria were higher: nearly 30% in the U.S. and 7% in the U.K. The difference between overall prevalence and working-age prevalence reflects both demographic factors and the specific symptom criteria used.

Obstructive sleep apnea is identified by proxy measures in this study - self-reported symptoms rather than objective sleep testing - which the researchers acknowledge prevents assessing severity or ruling out other causes of excessive daytime sleepiness. The estimates should therefore be treated as indicative rather than definitive.

Translating sleepiness into economic loss

To estimate productivity losses, the researchers applied an established economic framework that captures both absenteeism - days missed from work - and presenteeism, meaning reduced performance while physically present. Presenteeism is harder to measure but often represents the larger economic burden of chronic conditions, because symptomatic workers show up but function below capacity.

For the U.S., the analysis estimated total annual productivity losses of up to $180.2 billion, corresponding to roughly $3,727 per affected worker when expressed against gross domestic product. Annual CPAP therapy costs, including associated healthcare resources and supportive care, run approximately $1,661 per patient. Treatment is less expensive than the productivity loss it would prevent.

In the U.K., the equivalent figures were up to 4.22 billion pounds in total annual productivity loss - about 0.2% of national GDP - or approximately 1,840 pounds per affected worker. CPAP treatment costs 1,363 pounds per patient per year in the U.K. The productivity cost-to-treatment-cost ratio is consistent across both health systems.

The authors flag that these are almost certainly underestimates. They exclude healthcare system costs from increased medical expenditure associated with untreated sleep apnea, and they do not count the costs of road traffic or workplace accidents linked to daytime sleepiness - a category with real public safety implications, particularly for professional drivers.

The case for workplace screening

Between 80 and 85 percent of people with obstructive sleep apnea remain undiagnosed. Among those who do experience daytime sleepiness from the condition, workplace injury risk doubles compared with people without the condition. Authors of a linked editorial in the same journal argue that four developments now make a pilot workplace screening program worth testing seriously.

First, validated screening algorithms can identify high-risk occupational groups including lorry drivers, train operators, construction workers, pilots, heavy machinery operators, and workers caring for vulnerable people. Second, low-cost wireless home diagnostic devices now make testing feasible outside clinic settings. Third, research has improved understanding of why many patients struggle with CPAP adherence - a long-standing barrier to treatment effectiveness. Fourth, alternatives to CPAP have expanded, including GLP-1 receptor agonists (a class that includes weight-loss drugs like semaglutide), hypoglossal nerve stimulators, mandibular advancement devices, and surgical options.

The editorial authors acknowledge counterarguments. Workers may fear employment consequences if their condition cannot be adequately controlled, and any effective program would likely require employment guarantees. Countries with private health insurance face the risk of higher premiums for diagnosed workers. Driving restrictions may extend beyond professional contexts. Privacy concerns are legitimate.

Their proposed resolution is pragmatic: select an occupational group where sleep apnea is prevalent and its consequences severe - professional driving is the suggested exemplar - and conduct a randomized trial comparing screened workers with a standard care control group, measuring road accident rates and absenteeism as primary outcomes. "We suggest the time is now approaching for a trial of workplace screening in an exemplar high-risk occupational group," they conclude.