The hidden burden of OSA in safety critical workers: How should we deal with it?

Abstract

Sleepiness due to inadequate sleep, circadian effects (usually at night) or sleep disorders is the main cause of the 20% of crashes attributed to fatigue. Obstructive sleep apnoea (OSA) is the most common sleep disorder contributing to this toll, resulting in a 2- to 3-fold increase in risk, although this has not been clearly substantiated among professional drivers. Much of the literature addressing the prevalence and impact of OSA on safety critical work is drawn from the road transport industry but similar impacts would be expected in occupations such as rail workers. While OSA is a common disorder, present in 24% of men and 9% of women, it can remain unrecognized and untreated for prolonged periods, making it potentially appropriate for screening and treatment programmes. The prevalence appears particularly high in some occupational groups, such as truck drivers, where there is a male predominance and high prevalence of obesity that increases the risk of OSA. How best to identify and treat at risk individuals in safety critical occupations and so mitigate accident risk is the subject of intense research and debate.