Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Respiratory Unit, University-Hospital of Ferrara, Ferrara, Italy.
PLoS One. 2018 Jul 19;13(7):e0201045. doi: 10.1371/journal.pone.0201045. eCollection 2018.
Whether the association of work disability with obstructive sleep apnea (OSA) is mainly due to the disease, i.e. the number and frequency of apneas-hypoapneas, or to coexisting factors independent from the disease, is not well-established. In this study, we aim to evaluate work ability in a group of subjects undergoing OSA workup and to identify the major contributors of impaired work ability. In a cross-sectional study, we enrolled 146 consecutive subjects who have been working for the last five years and referred to the sleep disorders outpatients' clinic of the University-Hospital of Ferrara, Italy, with suspected OSA. After completing an interview in which the Work Ability Index (WAI) and the Epworth Sleepiness Scale (ESS) questionnaires were administered to assess work ability and excessive daytime sleepiness, respectively, subjects underwent overnight polysomnography for OSA diagnosing and spirometry. Of the 146 subjects, 140 (96%) completed the tests and questionnaires and, of these, 66 exhibited work disability (WAI < 37). OSA was diagnosed (apnea-hypopnea index ≥ 5) in 45 (68%) of the 66 subjects. After controlling for confounders, a lower level of forced expiratory volume at 1 second (FEV1), [odds ratio 0.97 (95% CI 0.95-1.00)], older age [1.09 (95% CI 1.03-1.15)], excessive daytime sleepiness [3.16 (95% CI 1.20-8.34)] and a worse quality of life [0.96 (95% CI 0.94-1.00)], but not OSA [1.04 (95% CI 0.41-2.62)], were associated with work disability. Patients with a higher number of diseases, in which OSA was not included, and a lower quality of life had an increased probability of absenteeism in the previous 12 months. In subjects with suspected OSA, FEV1 can be an important predictor of work disability.
工作能力障碍与阻塞性睡眠呼吸暂停（OSA）之间的关联主要是由疾病本身引起，即呼吸暂停-低通气次数和频率，还是由与疾病无关的共存因素引起，目前尚无定论。本研究旨在评估一组接受 OSA 检查的受试者的工作能力，并确定导致工作能力受损的主要因素。
在这项横断面研究中，我们纳入了 146 例连续就诊于意大利费拉拉大学医院睡眠障碍门诊、工作年限≥5 年且疑诊 OSA 的患者。所有患者在完成访谈后，分别接受了工作能力指数（WAI）和嗜睡量表（ESS）问卷调查，以评估工作能力和日间嗜睡程度，之后进行整夜多导睡眠图检查以明确 OSA 诊断并进行肺功能检查。
在 146 例患者中，140 例（96%）完成了测试和问卷调查，其中 66 例（68%）患者出现工作能力障碍（WAI＜37）。66 例患者中，45 例（68%）被诊断为 OSA（呼吸暂停-低通气指数≥5）。校正混杂因素后，用力呼气量第一秒（FEV1）水平较低（比值比 0.97，95%可信区间 0.95-1.00）、年龄较大（1.09，95%可信区间 1.03-1.15）、日间嗜睡（3.16，95%可信区间 1.20-8.34）和生活质量较差（0.96，95%可信区间 0.94-1.00）与工作能力障碍相关，而 OSA 无此相关性（比值比 1.04，95%可信区间 0.41-2.62）。在过去 12 个月中，患 OSA 以外的疾病数量较多和生活质量较低的患者缺勤的可能性更高。在疑似 OSA 的患者中，FEV1 可能是工作能力障碍的一个重要预测因素。
