Association between continuous positive airway pressure usage and workforce attachment in obstructive sleep apnea

Study objectives We investigated the association of continuous positive airway pressure (CPAP) usage and workforce participation emphasizing the role of sex and education. Methods From Danish nationwide registries we identified individuals aged 30–64 with obstructive sleep apnea (OSA) diagnosed 2005–2017, classified by CPAP use, education and employment. Odds ratios (ORs) for workforce attachment were estimated by CPAP use. Results Among 31,113 individuals (25.9% women), 4448 were CPAP non-users, 19,871 CPAP users, and 8666 had no CPAP treatment. Vocational and college level of education had higher odds of CPAP usage compared to no education OR 1.16 (95% CI 1.07-1.25) and OR 1.17 (95% CI 1.07-1.29), respectively). Proportion of employment declined from one year before diagnosis to three years after: from 74.3% to 68.0% (CPAP non-users), 78.8% to 72.5% (CPAP users) and 77.0% to 71.4% (no CPAP treatment). Unemployment and having left the workforce one year before diagnosis (versus employed) was associated with significantly reduced odds for CPAP-use versus non-use OR 0.72 (95% CI 0.64-0.80). For women employed when diagnosed, unemployment three years after was associated with reduced odds of CPAP usage OR 0.73 (95% CI 0.55-0.98)). Conclusions Higher level of education was associated with CPAP usage, whereas workforce detachment before OSA diagnosis was associated with reduced CPAP usage. Among women employed when diagnosed, unemployment three years after diagnosis was associated with CPAP non-usage. The results highlight the interplay between OSA, workforce attachment and CPAP. Future studies should focus on the impact of CPAP use and adherence on employment participation.