Sleep Apnea and Job Loss During the COVID-19 Pandemic
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Sleep Apnea and Job Loss During the COVID-19 Pandemic
Unfortunately, job loss is a common experience during the COVID-19 pandemic, but for people with sleep apnea, there are additional concerns that can further threaten job security in this time of need. Using data collected by the Assessing Daily Activity Patterns through occupational Transitions (ADAPT) study, a preliminary analysis shows not only that a relationship exists between sleep apnea and job loss, but that those with undiagnosed sleep apnea are twice as likely to have a history of multiple layoffs or firings. While studies in the past have recognized risks of job insecurity among patient populations, analysis of ADAPT participants found that even before the COVID-19 crisis, nearly half of those suffering from sleep apnea had lost work. Higher rates of work disability, as well as any work-duty modifications, were also noted, taking into account the total occupational impact potentially linked to sleep apnea and its effects. While these findings are unfortunate, they can help patient communities identify these challenges and take the proper steps to manage them. Public outreach and diagnosis, for example, remain top priorities in the struggle to prevent the more severe consequences of untreated conditions, followed by ongoing intervention and support to boost treatment compliance. By focusing on the financial impact, researchers hope to attract further attention and resources to this highly prevalent disorder, potentially leading to better health, better sleep, and more job security for millions of Americans with sleep apnea.
Presented at last year’s annual SLEEP meeting, the preliminary analysis, titled Individuals with Obstructive Sleep Apnea have Higher Likelihood of Multiple Involuntary Job Losses, used ongoing research to develop a separate study on the occupational effects of sleep apnea. While the ADAPT study is focused more on the effects of job loss on health and obesity, the sleep apnea analysis was able to access the ADAPT data to focus more on sleep apnea. To offset any potential bias in using participants with recent employment losses, the study used a propensity score model to create more randomized results. The propensity model used age, sex, ethnicity, work hours, work environment, and payment type (hourly vs. salary) as predictors of sleep apnea, irrispective of a previous diagnosis. When researchers looked at apnea-hypopnea index (AHI) scores, the results were not surprising. Even with bias as a consideration, the high rate of sleep apnea within an otherwise random pool of individuals with job losses clearly suggests a causal link. Further considerations such as the number of job losses (history) and whether the condition was treated or undiagnosed continued to show a pattern of correlates.
Funded in part by the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health, this analysis used data from an ongoing, prospective study to highlight an often overlooked aspect of undertreated sleep apnea. In addition to other factors such as daytime sleepiness and comorbid health conditions, sleep apnea can have extremely negative effects on vocational opportunities. Even Individuals with moderate sleep apnea have shown a higher likelihood of experiencing job losses than participants without the disorder. Thus, this analysis provides valuable evidence for a range of sleep apnea consequences beyond those related specifically to health.
The ADAPT study is being conducted by the Mel & Enid Zuckerman College of Public Health, part of the University of Arizona school of research. Set to publish sometime next summer, this long-term prospective study will present a thorough assessment of their findings on the many effects of job loss on health, sleep, and weight. The preliminary analysis was published in the journal Sleep and was presented Sunday, June 9, at the SLEEP 2019 meeting in San Antonio. SLEEP is a meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society.
Financial Impacts of Diagnosis and Treatment
In 2015, the AASM commissioned the market research and consulting firm Frost & Sullivan to publish a report on the economic impact of sleep apnea. Looking at the larger picture of sleep apnea costs to healthcare and society, the now widely used study, titled Hidden Health Crisis Costing America Billions, offers a broad overview of the financial effects of insufficient sleep apnea screening. The report looks mainly at the costs of untreated sleep apnea from a public health standpoint, reporting that undiagnosed obstructive sleep apnea (OSA) cost Americans $150 billion in 2015 alone, including $26.2 billion from automobile accidents, $6.5 billion from workplace accidents, $86.9 billion from lost productivity in the workplace, and $30 billion from the development of comorbid conditions that could have been managed with proper treatment. It was no surprise that the highest of these costs resulted from lost productivity, a devastating consequence of lost sleep and diminished health. In its conclusion, the study estimates the cost of diagnosing and treating all Americans with OSA as roughly $49.5 billion, close to half the amount already spent on lost productivity. In addition, money spent on diagnosing and treating new patients could produce total projected savings of over $100 billion in the following years.
Along with the Hidden Health Crisis report was a companion paper titled, “In an age of constant activity, the solution to improving the nation's health may lie in helping it sleep better.” For this report, the firm surveyed patients being treated for sleep apnea, primarily with continuous positive airway pressure (CPAP) or related devices (i.e. APAP or BiPAP). While positive effects of treatment were expected, the extent of their benefits was noteworthy. In summary, the percentage of respondents who reported that their quality of life was “good or very good” nearly tripled from 26 percent to 76 percent after only a few weeks of treatment. Patients also reported longer sleep durations, improvements in sleep quality, and greater productivity as a result of treatment, as well as a number of additional health benefits beyond the cessation of sleep apnea. Together, these two reports resulted in unprecedented support for the adoption of more aggressive and widespread sleep apnea diagnosis and treatment, a public health priority now emphasized by the current pandemic and its impact on nearly every aspect of patient lives.
The Frost and Sullivan reports remind us just how much sleep apnea affects patient lives, but they also highlight the need for proper treatment in our current environment, alongside COVID-19. During such an unexpected, large-scale threat to public health and welfare, it can become harder to maintain proper health and sleep, which ultimately affects your work. Worried about COVID, some individuals may pay less attention to signs of sleep apnea, especially if they are struggling to make ends meet. While more rigorous screenings are clearly in order, limited resources due to the COVID-19 crisis present further challenges to these aims. The number of patients seeking treatment for sleep apnea has steadily increased since the publication of these reports back in 2016, but only by a slim margin. Unfortunately, sufferers are still four times as likely to remain undiagnosed, untreated, and according to the ADAPT analysis, unemployed as well.
What This Means for Patients
A primary hypothesis of the ADAPT study is that “reemployment will be associated with a reversal of the negative trajectories.” This not only suggests a reciprocal relationship between health and employment, but also places emphasis on the importance of employment in the overall trajectory of a patient’s life and wellbeing. Losing work, as the study suggests, makes the routine of healthy living much more difficult to maintain. Financial struggles tend to take precedence over other life concerns, including one’s own health. At the same time, health problems contribute to loss of production, lack of energy, and financial burdens, making the situation a vicious circle of negative outcomes. But if you know you have sleep apnea, you can take steps toward healthier living. The dangers are much more severe for those left unaware. One of the benefits of the current pandemic is its effect on public awareness and attitudes toward health in general. The virus turns our collective attention on two things in particular: our health and our jobs. Perhaps, with the help of cutting edge research firms and lengthy reports like those of Frost and Sullivan, America can lead the way to a more comprehensive, patient-centered approach to sleep apnea testing and treatment. It is often during difficult times that governments and other institutions take more drastic steps toward effective public health policy, and more attention on the costs, both to individuals and to society, may just be enough to force the hand of progress.
ADAPT study - http://adapt.arl.arizona.edu/
AASM - https://aasm.org/sleep-apnea-job-loss/
Dental Sleep Practice- https://issuu.com/medmark/docs/dsp_spring2014_proof
Frost and Sullivan - Hidden Health Crisis - https://aasm.org/resources/pdf/sleep-apnea-economic-crisis.pdf
Frost and Sullivan - Companion Report - https://aasm.org/resources/pdf/sleep-apnea-patient-experience.pdf
Sleep - Previous Study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690567/
Sleep - Preliminary Analysis - https://academic.oup.com/sleep/article-abstract/42/Supplement_1/A194/5451423?redirectedFrom=fulltext
SLEEP - Current - https://www.sleepmeeting.org/
SLEEP - 2019 - https://aasm.org/sleep-meeting-2019/
Sleepapnea.org - https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/
Sleepeducation.org - http://sleepeducation.org/news/2019/08/06/six-facts-about-sleep-apnea