OSA and Work-Related Injuries: Searching for Evidence.

In a review published in CHEST (May 2015), Hirsch Allen et al 1 deal with a subject of great interest: the relationship between the common medical condition of OSA and accidents at work. Th is narrative review states, “Th ere is emerging evidence implicating OSA as an important factor in two important societal issues: work disability and work-related injuries.” 1 However, this evidence has not been included in the article. Since the studies reviewed are extremely heterogeneous, the lack of clearly defi ned selective criteria makes it impossible for the reader to form an opinion on this topic. First, some of the research focuses on subjects other than OSA (eg, sleep-disordered breathing 2 or complaints such as snoring and daytime sleepiness 3 ). Second, diff erent methods of diagnosis are used in the studies that deal specifi cally with OSA. In some studies, cases were diagnosed objectively using polygraphy or polysomnography, while in other studies, a broader definition of suspected OSA was adopted, based on standardized or nonstandardized questionnaires. Th ird, the review fails to assess the quality of the studies. Th is means that fi ndings of unequal quality could be placed on the same level. Th ere is broad agreement that OSA causes a signifi cant increase in the risk of traffi c accidents and deterioration in performance. 4 Although there is a lack of decisive evidence that OSA increases the risk of accidents at work, some companies have already started health promotion programs regarding OSA. 5 The elevated prevalence of OSA and the high incidence of work accidents in all countries make it vital to understand what the relationship is between the two phenomena. In conclusion, we believe that this issue is very important and could be addressed by a systematic review and meta-analysis.