The Impact of Obstructive Sleep Apnea and Daytime Sleepiness on Work Performance: An Observational Cross-Sectional Study in a North African Population

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) has been shown to be associated with many serious health conditions. The impact on occupational health is still unclear as it was scarcely studied. Purpose: The aim of this study was to assess the association of work performance with OSAHS and daytime sleepiness. Methods: A cross-transversal study was conducted including Tunisian active adult subjects referred for suspected sleep disordered breathing. All subjects completed the Epworth Sleepiness Scale (ESS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Patient Health Questionnaire 9 (PHQ9). They all underwent polygraph testing level 3. Result: One hundred thirty-nine subjects completed the survey, including 107 (77%) blue-collar workers, and 32 (23%) white-collar workers. Participants were classified as following: 50 patients with apnea hypopnea index (AHI) ≥ 30 and 89 with AHI <30. Among the four outcomes of the WPAI scale, only presenteeism was associated with AHI (p=0.012). A significant association has been found between daytime sleepiness and three outcomes of WPAI. Sleepy patients with ESS ≥ 11 had lower work performance in terms of presenteeism (42.46 ± 28.40 vs. 24.71 ± 24.77 p=0.0001), absenteeism (12.26 ± 25.51 vs. 6.05 ± 18.32, p=0.101), overall work productivity loss (47.43 ± 31.65 vs. 26.58 ± 28.47, p= 0.0001), and decline in activity (46.67 ± 30.75 vs. 32.14 ± 27.02, p=0.004) in comparison with non-sleepy participants. A strong correlation of presenteeism and overall work productivity loss scores with ESS was demonstrated among white-collar workers (r=0.624, p=0.0001; r=0.602, p=0.0001 respectively). PHQ9 score was significantly higher in sleepy subjects (p=0.0001). Near miss accidents in the workplace and work related accidents were significantly more frequent in those with ESS ≥ 11 (p=0.012, p=0.026; respectively). Conclusion: The most relevant finding of this study was the involvement of daytime sleepiness in performance impairment, while the impact of AHI was less clear.