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Some examples:

Case 1 – A 40-year-old shipmate fell asleep while watch keeping.

His tugboat was towing a barge full of oil. The collision resulted in half a million dollars in damage to the tugboat but no resultant oil leaks or injuries to the workers on board. The worker had admittedly fallen asleep during his watch keeping duties and was not able to pilot the ship as required.

Since the incident the mate has been diagnosed with severe obstructive sleep apnea and has begun continuous positive airway pressure (CPAP) treatment. This patient has a history of being extremely compliant and has used CPAP downloads for monitoring.

Case 2 – Two airline pilots fell asleep while cruising over Hawaii.

They flew past their destination toward open ocean for 18 minutes before waking up and returning for a safe landing. During this time air traffic controllers were frantically radioing the flight from Honolulu to Hilo for 18 minutes but receiving no response from the pilots. Since this incident the airline captain has been diagnosed with severe obstructive sleep apnea.

Another report drew the following conclusions⁶:

Among 348 drivers diagnosed with sleep disordered breathing (SDB) and who were treated, medical costs accrued were slashed in half per month. There was a 73% reduction in preventable driving accidents among a group of 225 SDB-diagnosed drivers treated with continuous positive airway pressure (CPAP) devices, which are essentially breathing masks that use air pressure to ensure airways remain open during sleep. The driver retention rate of CPAP-treated individuals was 2.29 times greater than the total company driver population in 2004

Obstructive sleep apnoea is the cause of excessive daytime sleepiness

These three case studies are real-life occurrences of obstructive sleep apnoea (OSA) in mission-critical positions in the workplace. OSA is the most common medical disorder to cause excessive daytime sleepiness. It is also a risk factor for both drowsy driving and motor vehicle collisions associated with drivers falling asleep.

Other causes for excessive daytime sleepiness include narcolepsy, central sleep apnea, alcohol use, severe restrictive lung disease, insufficient sleep time, neuromuscular disease, medication and drug use, periodic leg movement disorder, shift work, chronic pain, and neurological disease. Insufficient sleep time is an extremely common problem and it can be addressed, but the challenge is to change patients’ sleep-related behavior over the long term.

The clinical manifestations of OSA are commonly daytime sleepiness and snoring. Additional symptoms and signs can include restless sleep periods, fatigue, poor concentration, morning headaches, and awakening with a choking sensation. Physical exam findings can be normal or can include obesity (body mass index greater than 30 kg per m2), elevated blood pressure, a narrow airway, a large neck circumference (for men, a collar size greater than 43 cm; for women, a collar size greater than 40 cm), and signs of pulmonary hypertension.

Medical consequences of sleep apnea include a three- to six-fold increased risk of all causes of mortality: hypertension, pulmonary hypertension, stroke, coronary artery disease, cardiac arrhythmias, and depression.