Sleep Disturbances Rate among Medical and Allied Health Professions Students in Iran: Implications from a Systematic Review and Meta-Analysis of the Literature.

Medicine and healthcare professions are prestigious and valued careers and, at the same time, demanding, challenging, and arduous jobs. Medical and allied health professions students, experiencing a stressful academic and clinical workload, may suffer from sleep disturbances. In Iran, several studies have been conducted to explore the prevalence rate among medical and healthcare professions students. The aim of this systematic review and meta-analysis was to quantitatively and rigorously summarize the existing scholarly literature, providing the decision- and policy-makers and educators with an updated, evidence-based synthesis. Only studies utilizing a reliable psychometric instrument, such as the Pittsburgh sleep quality index (PSQI), were included, in order to have comparable measurements and estimates. Seventeen investigations were retained in the present systematic review and meta-analysis, totaling a sample of 3586 students. Studies were conducted between 2008 and 2018 and reported an overall rate of sleep disturbances of 58% (95% confidence interval or CI 45-70). No evidence of publication bias could be found, but formal analyses on determinants of sleep disturbances could not be run due to the dearth of information that could be extracted from studies. Poor sleep is highly prevalent among Iranian medical and healthcare professions students. Based on the limitations of the present study, high-quality investigations are urgently needed to better capture the determinants of poor sleep quality among medical and healthcare professions students, given the importance and the implications of such a topic.

Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis.

Background: Obstructive sleep apnea (OSA) has been associated with mental disorders, but the strength of this association is unknown. The aim of our study was to investigate the association among OSA, depression, and anxiety in adults and to quantitatively summarize the results. Methods: A literature search in Medline, PubMed, PsycInfo, Scopus, and Web of Science was conducted. Seventy-three articles were selected for study. Results: The pooled prevalence of depressive and anxious symptoms in OSA patients was 35% (95% CI, 28-41%) and 32% (95% CI, 22-42%), respectively. Conclusions: The association between OSA, anxiety, and depression indicates the value of an early diagnosis and personalized treatment of OSA to improve mental disorders conditioning compliance to therapy. These conditions share a probably bidirectional relationship.

Sleepiness as a Local Phenomenon.

Sleep occupies a third of our life and is a primary need for all animal species studied so far. Nonetheless, chronic sleep restriction is a growing source of morbidity and mortality in both developed and developing countries. Sleep loss is associated with the subjective feeling of sleepiness and with decreased performance, as well as with detrimental effects on general health, cognition, and emotions. The ideas that small brain areas can be asleep while the rest of the brain is awake and that local sleep may account for at least some of the cognitive and behavioral manifestations of sleepiness are making their way into the scientific community. We herein clarify the different ways sleep can intrude into wakefulness, summarize recent scientific advances in the field, and offer some hypotheses that help framing sleepiness as a local phenomenon.

Association between socioeconomic status, belonging to an ethnic minority and obstructive sleep apnea: a systematic review of the literature.

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder associated with obesity, hypertension and metabolic syndrome. People with low socioeconomic status (SES) who are socially disadvantaged (eg, people belonging to an ethnic minority) have worse health outcomes. Thus, consequently, social inequality may potentially be a risk factor for OSA. This systematic review aims to summarize previous studies from the literature which investigate the association between SES, race/ethnicity and obstructive sleep apnea (OSA). This review was performed in accordance with the PRISMA statement. A literature search in Medline, PubMed, PsycINFO, Scopus, and Web of Science was conducted. Articles published in English, Spanish, French, Italian and Portuguese, without publication date limits, and that aimed to analyze the association between OSA diagnosis and social disadvantage, were selected. In sum, 17 articles met the inclusion criteria. One was a longitudinal study, and the remainder were cross-sectional research. Low SES was indicated as a risk factor for the presence of OSA in most of the articles. Concerning racial/ethnic groups, a clear association with OSA does not emerge, since, in a few articles, the relation disappeared after controlling for variables such as obesity, comorbidities, and SES; suggesting that there may be differences only in OSA severity and sleep apnea phenotypes. The results of this systematic review point out that low SES could be a risk factor for OSA. Obesity, SES and disparities in health care could mediate the association between OSA and racial/ethnic minorities. Socioeconomic circumstance should receive more attention in sleep medicine research.

Development and Preliminary Validation of the "Teacher of Physical Education Burnout Inventory" (TPEBI) in Arabic Language: Insights for Sports and Occupational Psychology.

Background: Burnout is an inappropriate response to chronic work stress, leading to emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA). Burnout can affect workers in the helping professions. To quantitatively assess the burnout level among teachers, Maslach has adapted the "Maslach Burnout Inventory" (MBI) to the educational environment (the so-called MBI Educators Survey version or MBI-ES). Among teachers, sports and physical education teachers may suffer from burnout due to high workload. Aims: No reliable psychometric tool in Arabic language exists that can be used to measure the burnout level among sports and physical education teachers. The objective of the present study was to develop a burnout measurement scale according to the Maslach's three-dimensional theoretical model for physical education teachers in Tunisia and to test its factor structure, in terms of internal consistency/reliability, predictive validity, and sensitivity. Methods: A total of 525 Tunisian teachers teaching in secondary schools from different Tunisian governorates volunteered to participate in this study. The sample comprised of 285 males (54.3%) and of 240 females (45.7%). More in detail, 327 were teachers of primary school of physical education (62.3%) and 198 teachers of secondary school (37.7%). Teachers were administered both the ad hoc developed "Teacher of Physical Education Burnout Inventory" (TPEBI) and the MBI-ES. Both exploratory [principal component analysis (PCA)] and confirmatory factor analyses (CFAs) were performed. Results: The Cronbach's alpha coefficients were excellent (0.93, 0.94, and 0.91 for EE, D, and PA, respectively). The correlation matrix indicated significant correlations between the TPEBI and MBI-ED dimensions. However, CFA fit indices were not completely satisfactory. Conclusion: Given the good PCA factor loadings, the correlation matrix, the sensitivity analysis, and the excellent internal consistency, it can be concluded that the TPEBI is a reliable psychometric tool that can be used to quantitatively assess the burnout level among teachers of physical education in the Arabic-speaking world. However, considering the CFA fit indices, further modifications to fully support the model are warranted.

Sleep Quality among Police Officers: Implications and Insights from a Systematic Review and Meta-Analysis of the Literature.

Poor sleep is associated with bad health outcomes, worse wellbeing and decreases in performance, productivity and safety at work. Police officers are exposed to several risk factors including extended work schedules, shift work, occupational stress, dangerous and traumatic events and can, as such, develop sleep problems. The aim of the present study was to analyze the sleep quality among police officers. A systematic literature search, in PubMed/MEDLINE, PsycINFO, Scopus, ISI/Web of Science (WoS) and the Cochrane Library was conducted. Original articles, published in English, French, Italian, Spanish and Portuguese, the primary objective of which was the evaluation of the quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) in Police Forces, were selected. From an initial sample of 1,149 studies, 13 articles were included in the meta-analysis (3,722 police officers). The pooled prevalence of bad sleep quality in police officers was 51% [95%CI 42⁻60%]. The pooled global score of the PSQI was 5.6 [95%CI 5.0⁻6.3], corresponding to a low average quality. At the meta-regressions, statistically significant associations could be found for work seniority (in terms of years of service) and being on shift. The poor quality of sleep in police officers could have negative consequences for workers' health and for the safety of third parts. The implementation of health and sleep hygiene promotion programs in police forces is strongly recommended.

SleepOMICS: How Big Data Can Revolutionize Sleep Science.

Sleep disorders have reached epidemic proportions worldwide, affecting the youth as well as the elderly, crossing the entire lifespan in both developed and developing countries. "Real-life" behavioral (sensor-based), molecular, digital, and epidemiological big data represent a source of an impressive wealth of information that can be exploited in order to advance the field of sleep research. It can be anticipated that big data will have a profound impact, potentially enabling the dissection of differences and oscillations in sleep dynamics and architecture at the individual level ("sleepOMICS"), thus paving the way for a targeted, "one-size-does-not-fit-all" management of sleep disorders ("precision sleep medicine").

Sleep and Mental Health in Truck Drivers: Descriptive Review of the Current Evidence and Proposal of Strategies for Primary Prevention.

Background: Professional truck drivers (TDs) are exposed to stressful working (and living) conditions and are vulnerable. They report physical and mental health problems and psychological distress more frequently than the general population and their problems can affect safety on the roads. Actions to improve TDs' health and reduce the risks of (co-)morbidity or unsafe driving are imperative. Methods: The published studies dealing with the TDs' sleep habits and mental health were reviewed to define the scenario and organize the preventive strategies proposed thus far. Results: Awareness among TDs of the high risk for health and safety due to (often co-existing) untreated sleep and mental health problems is critical. Alcohol and prescribed or illicit drugs are often misused to compensate for depression, anxiety, job strain, fatigue, and social isolation. Polypharmacy and dependence increase the chance of unsafe behaviors on the road. The TDs' access to healthcare services is scant, and participation in industry-sponsored wellness programs is limited. Conclusions: Primary prevention is a first unavoidable step to deal with sleep and mental health problems. Educational programs, online support and tele-health assessment/monitoring would help improve the well-being, safety and health of professional TDs and increase safety on the road.

Patterns of Harmful Alcohol Consumption among Truck Drivers: Implications for Occupational Health and Work Safety from a Systematic Review and Meta-Analysis.

Alcohol consumption is one of the main causes of productivity losses arising from absenteeism, presenteeism, and workplace injuries. Among occupational categories most affected by the use of this substance, truck drivers are subject to risk factors and risky behaviors that can have a serious impact on their health, their work, and the general road safety. The use of alcohol during truck-driving activities is, indeed, an important risk factor for traffic accidents. The present systematic review and meta-analysis aims at synthesizing the literature regarding harmful alcohol consumption patterns among truck drivers in a rigorous way. A 'binge drinking' prevalence of 19.0%, 95% confidence interval or CI (13.1, 26.9) was present. An 'everyday drinking' pattern rate of 9.4%, 95% CI (7.0, 12.4) was found, while the rate of alcohol misuse according to the "Alcohol Use Disorders Identification Test" (AUDIT)-"Cut down-Annoyed-Guilty-Eye opener questionnaire" (CAGE) instruments was computed to be of 22.7%, 95% CI (14.8, 33.0). No evidence of publication bias could be found. However, there is the need to improve the quality of published research, utilizing standardized reliable instruments. The knowledge of these epidemiological data can be useful for decision makers in order to develop, design, and implement ad hoc adequate policies.

Sleep quality, obstructive sleep apnea, and psychological distress in truck drivers: a cross-sectional study.

PURPOSE: Sleep disorders are highly prevalent in truck drivers. The aim of this study is to evaluate the prevalence of self-reported obstructive sleep apnea (OSA) and poor sleep quality in truck drivers, and to analyze the relationship between sleep problems and mental health. METHODS: A total of 526 male truck drivers (mean age 45.9; DS 9.4) responded to a questionnaire about risk factors for OSA (STOP-Bang), sleep quality perception (Pittsburg sleep questionnaire inventory, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS), and psychological disorders (general health questionnaire, GHQ-12). RESULTS: It was found that 51.1% of the drivers were at risk of OSA, 17.3% had bad sleep quality, and 8.9% had excessive daytime sleepiness (EDS). The association between psychological distress, OSA (OR = 1.67; CI 95% 0.99-2.83; p = 0.057), bad sleep quality (OR = 2.58; CI 95% 1.52-4.37; p < 0.001), and EDS (OR = 1.65; CI 95% 0.83-3.30; p = 0.151) was assessed. CONCLUSIONS: The high prevalence of sleep problems, especially suspected OSA, and low quality of sleep in truck drivers can worsen the general and psychological wellbeing of the workers. Educational programs focusing on sleep hygiene and behavioral interventions are needed to promote adequate sleep habits and improve individual and public health.

Insomnia is associated with road accidents. Further evidence from a study on truck drivers.

BACKGROUND: Sleep-related problems are known risk factors for road accidents. However, very few studies have investigated the role played by insomnia and its components, and no data are available for a population of occupational drivers at risk, such as the truck driver category. OBJECTIVE: To measure the prevalence and impact of insomnia on motor vehicle accidents (MVAs) and near-miss accidents (NMAs) in 949 truck drivers. DESIGN: Cross-sectional survey. RESULTS: Insomnia affected 27.5% of the sample. Compared to other drivers, in the 3 years prior to the study, truck drivers with insomnia had reported a significantly higher number of MVAs; they had also reported a greater number of NMAs in the previous 6 months. After correction for the presence of obstructive sleep apnea, excessive daytime sleepiness, short sleep duration, and other concurrent diseases, insomniac truck drivers had an almost two-fold risk of driving accidents (OR: 1.82, CI 95%:1.33-2.49) and a more than three-fold increased risk of near-miss accidents (OR: 3.35, CI95%:2.06-5.45) compared to non-insomniac drivers. CONCLUSION: Insomnia emerged as an independent risk factor for MVAs and NMAs. We strongly advise screening commercial drivers for signs and symptoms of insomnia in order to improve health and safety on the road.

Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers.

BACKGROUND: Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents. STUDY OBJECTIVES: To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers. METHODS: 949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS. RESULTS: MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68-3.20), SD (OR = 1.45 CI95% = 1.29-1.63), EDS (OR = 1.73 CI95% = 1.15-2.61) and prevented by naps (OR = 0.59 CI95% = 0.44-0.79) or rest breaks (OR = 0.63 CI95% = 0.45-0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47-3.87) and SD (OR = 1.49 CI95% = 1.27-1.76) and prevented by naps (OR = 0.52 CI95% = 0.32-0.85) or rest breaks (OR = 0.49 CI95% = 0.29-0.82). CONCLUSIONS: When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents.

Screening, diagnosis, and management of obstructive sleep apnea in dangerous-goods truck drivers: to be aware or not?

OBJECTIVE: The aims of this study were: to evaluate a homogeneous sample of truck drivers of dangerous goods (TDDGs) in order to assess the prevalence of obstructive sleep apnea (OSA), and to verify the secondary risk of motor vehicle accidents (MVAs) and near miss accidents (NMAs) in this population. METHODS: A sample of 283 male TDDGs was evaluated. None of the subjects reported OSA symptoms before screening. Clinical and physical evaluation, Epworth Sleepiness Scale (ESS), and the items on OSA from the Sleep Disorder Score (SDS) questionnaire were used to select subjects with suspicion of OSA. Polysomnography (PSG) was performed to confirm the diagnosis of OSA. The frequency of MVAs and NMAs was assessed at baseline for the whole sample, and also for the drivers with severe OSA after two years of continuous positive airway pressure (CPAP) treatment. RESULTS: The mean age of the sample was 42.3 ± 8.3 years. A total of 139 (49.1%) subjects had suspected OSA, and the PSG study confirmed the diagnosis in 35.7%. A significant association between OSA severity and NMAs was observed, and subjects with severe OSA showed a near five-fold increased risk of NMAs (OR = 4.745, 95% CI 1.292-17.424, p = 0.019). After two years of CPAP treatment, the rate of NMAs was comparable with drivers without OSA, showing the efficacy of therapy. CONCLUSION: This study showed an unexpected high prevalence of OSA in TDDGs. Untreated subjects with severe OSA had a significantly increased risk of NMAs. In professional drivers, screening, treatment, and management of OSA are mandatory for reducing road accident risk and improving road safety.

Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-analysis.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is the single most important preventable medical cause of excessive daytime sleepiness (EDS) and driving accidents. OSA may also adversely affect work performance through a decrease in productivity, and an increase in the injury rate. Nevertheless, no systematic review and meta-analysis of the relationship between OSA and work accidents has been performed thus far. METHODS: PubMed, PsycInfo, Scopus, Web of Science, and Cochrane Library were searched. Out of an initial list of 1,099 papers, 10 studies (12,553 participants) were eligible for our review, and 7 of them were included in the meta-analysis. The overall effects were measured by odds ratios (OR) and 95% confidence intervals (CI). An assessment was made of the methodological quality of the studies. Moderator analysis and funnel plot analysis were used to explore the sources of between-study heterogeneity. RESULTS: Compared to controls, the odds of work accident was found to be nearly double in workers with OSA (OR = 2.18; 95% CI = 1.53-3.10). Occupational driving was associated with a higher effect size. CONCLUSIONS: OSA is an underdiagnosed nonoccupational disease that has a strong adverse effect on work accidents. The nearly twofold increased odds of work accidents in subjects with OSA calls for workplace screening in selected safety-sensitive occupations. COMMENTARY: A commentary on this article appears in this issue on page 1171.

Accidentes laborales, absentismo y productividad en pacientes con apneas del sueño / Workplace Accidents, Absenteeism and Productivity in Patients with Sleep Apnea

Introducción: El síndrome de apneas-hipopneas del sueño (SAHS) provoca consecuencias sobre la salud, pero el impacto del SAHS sobre la salud laboral ha sido escasamente estudiado. El objetivo fue evaluar la influencia del SAHS en la presencia de accidentes laborales, absentismo y productividad laboral. Método: Untotal de 182pacientes conSAHS y 71personas sinSAHS contestarona la escala de somnolencia de Epworth, el índice de calidad de sueno˜ de Pittsburgh, el índice de impacto de la enfermedad en la productividad laboral y algunas preguntas sobre la frecuencia de accidentes laborales y el número de días de bajas laboral por enfermedad. Los participantes fueron clasificados mediante polisomnografía en un grupo con o sin SAHS. Resultados: Los pacientes con SAHS presentaron más bajas laborales > 30 días (16,6% vs 7%; p = 0,049) y una menor productividad laboral (63,80% vs 83,20%; p = 0,000) respecto a las personas sin SAHS, aunque la proporción de accidentes laborales fue similar (27,4% vs. 25,4%; p > 0,05). Ninguna de las variables asociadas al SAHS se relacionó con los accidentes laborales. Se evidenció una asociación entre el absentismo y el diagnóstico de SAHS, y entre este último, el distrés psicológico y la productividad laboral. Conclusiones: El SAHS provoca limitaciones en la vida laboral de los pacientes, con un número más elevado de bajas laborales y una menor productividad. El diagnóstico de SAHS fue la variable con mayor influencia en la vida laboral de los pacientes

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity. Method: One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results. Results: Patients with OSAHS had more sick leave lasting longer than 30 days (16.6% vs. 7%, P = .049) and lower productivity (63.80% vs. 83.20%, P = .000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P > .050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity. Conclusions: OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients

Effect of CPAP therapy on job productivity and psychosocial occupational health in patients with moderate to severe sleep apnea.

PURPOSE: The aim of the present study was to assess the effect of continuous positive airflow pressure (CPAP) therapy on burnout symptoms and job productivity, stress, and satisfaction in patients with obstructive sleep apnea syndrome. METHODS: The sample was composed of 55 patients (mean age 48.5 ± 8.9, BMI 31.1 ± 5.7, AIH 56.8 ± 22.1), diagnosed with obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG) with a therapeutic indication of CPAP. Before and after 6 months of receiving CPAP therapy, participants completed the following questionnaires: the index of the impact of the disease on job productivity (IMPALA), the job content questionnaire(JCQ), the Maslach burnout inventory-general survey (MBI-GS), the Shirom-Melamed burnout questionnaire (SMBQ), the index of job satisfaction, the Epworth sleepiness scale (ESS), and the Pittsburgh sleep quality index (PSQI). We explored the efficacy of CPAP therapy at improving the indices of severity of OSAS using therapeutic PSG. RESULTS: CPAP therapy was associated with a beneficial effect on job productivity (IMPALA) (p = 0.000) and decreasing burnout symptoms such as physical fatigue (SMBQ) (p = 0.000), emotional exhaustion (SMBQ) (p = 0.014), cognitive weariness (SMBQ) (p = 0.004), exhaustion (MBI) (p = 0.000), and cynicism (MBI) (p = 0.002). However, CPAP did not decrease job stress or job dissatisfaction. DISCUSSION: In patients with severe OSAS, CPAP therapy has a beneficial effect on patients' occupational well-being and job productivity.

Workplace accidents, absenteeism and productivity in patients with sleep apnea.

INTRODUCTION: Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity. METHOD: One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results. RESULTS: Patients with OSAHS had more sick leave lasting longer than 30days (16.6% vs. 7%, P=.049) and lower productivity (63.80% vs. 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity. CONCLUSIONS: OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients.

Occupational health of patients with obstructive sleep apnea syndrome: a systematic review.

PURPOSE: The aim of this systematic literature review was to assess the impact of obstructive sleep apnea syndrome (OSAS) on patients' occupational health. METHODS: We selected 19 studies that dealt with issues related to job performance and productivity, absenteeism, and psychosocial health of patients with OSAS and assessed the risk of bias in their conclusions. RESULTS: Although methodologically rigorous studies are needed to confirm these findings, the results obtained suggest the existence of multiple relationships between OSAS and work limitations of patients (i.e., difficulties maintaining attention, learning new tasks, or performing monotonous tasks). The studies reviewed reached more scientifically consistent conclusions about such patients' risk of taking more days of sick leave or having work disability, particularly if they reported excessive daytime sleepiness. Very few studies have explored the relationship between OSAS and psychosocial occupational health of patients. Thus, there is a need for research to clarify these aspects of occupational medicine. CONCLUSIONS: OSAS has numerous effects on patients' occupational health, yet, in general, results should be confirmed by studies with sufficiently large samples in which OSAS is diagnosed with reliable methods and occupational variables are assessed with standardized and validated questionnaires.