Obstructive Sleep Apnea (OSA)

Impacting Workplace Safety and Cost

September 11, 2012

Mike Hummel
Watermark Medical
 Adequate sleep,
like adequate nutrition and
adequate exercise, is required
for good health

So if you fall asleep while I am

talking, you may be better off than if
you listened.
Obstructive Sleep Apnea (OSA): What is
it and why is it important?

OSA inadequate breathing during sleep due

to sleep-induced collapse of the upper airway

Prevalence is High and Growing

20-40 million in U.S.
> 90% undiagnosed

Most of those with OSA are in the workforce

Obstructive Sleep Apnea

Pathophysiology

Awake Asleep

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OSA: Consequences in the Workplace

Work performance:
Impaired alertness & memory, inability to
concentrate
Impaired judgment & poor decision making
Decreased motivation & productivity
Increased absenteeism
Increased risk of accidents
Difficult interactions with co-workers
 Obesity Trend

1990 2000 2010

No <10% 10%- 15%- 20%- 25%- 30%

Data 14% 19% 24% 29%
Over the past 35 years we have learned

Obstructive Sleep Apnea is:

Common
Dangerous
Diagnosable
Treatable
 Prevalence of Sleep-Disordered Breathing
Among Working-Age Adults

Government Employees in Wisconsin

SBD Men Women

Habitual Snorers 44% 28%

AHI > 5 24% 9%
AHI > 10 15% 5%
AHI > 15 9% 4%

Young, et. al. NEJM 1993; 328: 1230-5

 Prevalence of Sleep-Disordered Breathing
Among Working-Age Adults

approximately 10% of all habitual snorers will

have an AHI of 20 or more

we estimate that roughly 1 of every 5

adults has as least mild OSA and
that 1 of every 15 has at least
moderate OSA

Young, et. al. NEJM 1993; 328: 1230-5

Young, et. al. Am J Respir Crit Care Med 2002; 165: 1217-39
Obstructive Sleep Apnea

Consequences for the

Worker
OSA: Consequences for the worker

Drowsiness and memory loss

3-5 times increased risk for
accidents
Greatly reduced productivity
Increased risk of fatal disease
(Myocardial infarction, CHF, CVA)
OSA: Health Consequences for the worker

1.3 to 2.5 times more hypertension

2.2 times increased risk of nocturnal cardiac
arrhythmia
3.9 times more likely to have congestive
heart failure
1.6 times increased chance of stroke
1.4 to 2.3 times greater risk of myocardial
infarction
40% increased risk of depression
Increased risk of diabetes
OSA: Costs for all

More than two times the number of physician

claims
1.9 times more cardiac medication
2.7 times more hypertension medication
50% more hospital stays
2.63 times the amount of absenteeism
20% reduction in performance
Estimated additional healthcare costs for
untreated OSA patients is $2000 per patient per
year
Sleep Disorders in Commercial Drivers

Stanford U. & U. of Penn.studies- 5-10% of commercial

drivers have untreated severe OSA*
Driving performance in sleep-deprived people & OSA
patients is similar to a blood alcohol content of .06 - .08
9 out of 10 police officers have stopped a driver who
they believed was drunk, but was drowsy

Stoohs, R.A., et al., Chest, 1995. 107(5).; Pack, A.I., et al., 2002, FMCSA: Washington D.C.
 Car Accidents and Sleep Disorders

Powell NB et al. Otolaryngol Head Neck Surg. 2002; 126:217-227

Avoid this guy on the road!
Obstructive Sleep Apnea

FMCSA / DOT
Recommendations
General Recommendations Regarding OSA
MCSAC-MRB Joint Recommendations

Screening
The driver has a Body Mass Index (BMI) of greater than
or equal to 35 kg/m2
Diagnosis
Methods of diagnosis include in-laboratory
polysomnography, at-home polysomnography, or an
FDA-approved limited channel ambulatory testing device
which ensures chain of custody.
Treatment
PAP is the preferred OSA therapy New OSA screening
technologies will likely emerge.
OSA Consequences

Remember

Almost all workers drive

Accidents involve innocents

It is a disease that can kill you even if

you dont have it!
Diagnosis of OSA

In-lab Polysomnography and

Home Sleep Testing
OSA Clinic Evaluation

History and Physical

Screening Questionnaires
Epworth Sleepiness Scale
Berlin Questionnaire
ARES Questionnaire
STOP Bang
Assess risk
Move on to testing
 Current Diagnostic Procedures

PSG is utilized as a reference standard in

many clinical trials; however, we do not
believe it is a true gold standard
CMS, March 2008
 Cost Analysis: Lab PSG versus Focused
Home SDB Testing*

2008 allowed/member PSG 2 night home test

CPAP Titration Assume 6% require attended
Slit-Night in-lab CPAP titration

Diagnostic Test Cost $1033.16 $303.30

+$42.66 ($711.16 for CPAP
titration x .06)

Total Cost $1033.16 $345.96

*Cost estimates from a VERY large insurance company.

They will routinely authorize only home testing because its cost is
only 1/3 of the cost of a laboratory PSG.
Obstructive Sleep Apnea

ARES Home Sleep Study

with the Chain of Custody
OSA Treatment
What are the Therapeutic Goals?

Resolution of the clinical signs and

symptoms of OSA
Prevention of the cardiovascular and
neurological consequences of OSA

Ensuring Fitness for Work

OSA Treatment Options

Multiple Proven Treatments:

Continuous Positive Airway Pressure (CPAP)
Oral appliances (fitted by dentist)
Provent (Nasal adhesive device)
Positional therapy
Surgery (many different procedures)
Weight Loss (good luck!)
What Now?
ensuring a successful outcome and a positive experience

Screen Test Diagnose Treat

Sleep Coach

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