Most employers have no idea how much undiagnosed sleep apnoea is costing them, for a straightforward reason: The condition is common, expensive, and almost entirely invisible to the health programmes already running in their workplace.
The short answer
Obstructive sleep apnoea affects close to 30% of working-age adults in the United States, and 80 to 85% of cases remain undiagnosed. Research published in Thorax in 2026 estimates the lost output at US$3,727 per affected worker per year, roughly twice the annual cost of treating them.1 The barrier is not treatment. It is detection.
How common is this in an actual workforce?
The prevalence figures are higher than most employers expect.
| United States | United Kingdom | |
|---|---|---|
| All adults | 23% | 19.5% |
| Working-age adults (18–64) | Nearly 30% | 7% |
| Proportion undiagnosed | 80–85% | |
| Annual productivity loss | US$180.2 billion | £4.22 billion (0.2% of GDP) |
| Loss per affected worker | US$3,727 | £1,840 |
| Annual cost of CPAP treatment | US$1,661 | £1,363 |
The two national figures differ considerably for working-age adults, and the paper does not resolve why. What holds across both is the shape of the problem: a condition present in a substantial minority of the workforce, overwhelmingly undetected, carrying a measurable cost per head.
The Australian picture
Deloitte Access Economics costed sleep disorders to the Australian economy at $51 billion in 2019–20: $14.4 billion in financial costs, equivalent to 0.73% of GDP, and a further $36.6 billion in lost wellbeing.2 Productivity losses alone accounted for around $11 billion. Fewer than 7% of those costs were spent on treating the disorders.
Approximately one in ten Australians experience a sleep disorder substantial enough to affect their wellbeing, safety, and productivity. The prevalence figure is lower than the United States estimate, but the cost structure is the same: The overwhelming majority of the burden is borne outside the healthcare system, in lost output and lost wellbeing.
Why this is a detection problem, not a treatment problem
Sleep apnoea is treatable. Continuous positive airway pressure is established, widely available, and (on the figures above) costs less annually than the productivity loss it prevents.
The obstacle is that four in five people who have it do not know. Its symptoms present as ordinary daytime tiredness, which almost nobody takes to a doctor, and the diagnostic pathway has historically required either an overnight sleep laboratory stay or a specialist referral. Both are significant barriers for someone who simply feels a bit flat in the afternoons.
From an employer’s perspective this produces an unusual situation. The cost is being incurred continuously, by a known proportion of the workforce, for a condition with an established treatment, and no part of the existing health programme is looking for it.
What the cost actually consists of
The Thorax estimate is built on two components, which matters when making the case internally.
- Absenteeism: time not worked. This is the part that shows up in existing reporting, and it is the smaller share.
- Presenteeism: reduced performance while at work. Someone present, working, and measurably less effective than they would otherwise be.
Presenteeism is why sleep apnoea escapes notice in most workforce analytics. An employee with untreated apnoea is not conspicuously absent. They are at their desk or in the cab, working, and carrying an impairment nobody has quantified.
The methodology is worth knowing if the figure is challenged: 3,523 US and 840 UK census respondents reporting breathing pauses during sleep together with excessive daytime sleepiness on three or more nights a week, assessed with a productivity-based approach covering both absenteeism and presenteeism.
The comparison that makes the business case
Two published figures sit next to each other in the same paper.
Lost output per affected worker: US$3,727 per year. Annual cost of CPAP treatment: US$1,661. The United Kingdom figures are £1,840 against £1,363.
The paper’s own conclusion is that productivity losses exceeded the cost of treatment, and that better identification, access, and adherence could produce significant economic benefit. That is a more careful statement than a return-on-investment claim, and it is the one worth quoting: the point is not a modelled saving, it is that the arithmetic runs the right way before any assumptions are added.
Why the safety case is separate, and often larger
For operations with safety-critical roles, productivity is not the main exposure.
Untreated sleep apnoea produces exactly the impairment that matters least in an office and most in a vehicle cab or a control room: fragmented sleep, excessive daytime sleepiness, and reduced sustained attention. In shift-working populations it compounds with circadian disruption and roster-driven sleep restriction.
Rail investigations illustrate the consequence. In the 2013 Spuyten Duyvil derailment in New York, the National Transportation Safety Board identified diagnosed sleep apnoea in a case where a curve was taken at almost three times the speed limit. In a separate 2001 collision in Michigan, both conductors had diagnosed sleep apnoea that had been neither recorded nor treated. An organisation running heavy vehicles, rail, or plant is carrying a risk that a productivity calculation does not capture.
What screening changes, and what it does not
Screening is not diagnosis. This distinction is important and it is not a technicality.
A workplace screening test identifies signs of a possible sleep issue and recommends a next step: seeing a doctor. It does not establish that someone has sleep apnoea, it does not grade severity, and it does not prescribe anything. Diagnosis remains a clinical process.
What screening does is close the detection gap. It converts a condition nobody is looking for into one where the people most likely to have it are told, in a setting they were already in, that a conversation with a doctor is worthwhile.
Optalert’s Owl Eye Enterprise uses an eyelid-movement biomarker to do this on site, in minutes, without an overnight laboratory stay or a wearable device. The underlying science is the same lineage as the Johns Drowsiness Scale (JDS™) used in mining and transport, and the biomarker was developed with Monash Medical Centre, the Monash Biomedicine Discovery Institute, and the Institute for Breathing and Sleep. Optalert reports an accuracy of 95.6%: higher than the consumer smartwatch algorithms that hold FDA clearance for the same purpose, and achieved from a single test rather than multiple nights of wear.
Frequently asked questions
How many employees are likely to have sleep apnoea?
Research published in Thorax in 2026 puts obstructive sleep apnoea at 23% of US adults and nearly 30% of US working-age adults, and 19.5% of UK adults. Between 80 and 85% of cases are undiagnosed.
What does undiagnosed sleep apnoea cost an employer?
An estimated US$3,727 in lost output per affected worker per year in the United States, and £1,840 in the United Kingdom. Aggregate annual losses were estimated at US$180.2 billion and £4.22 billion respectively: the UK figure equivalent to 0.2% of national GDP.
Is treating sleep apnoea cheaper than the productivity loss?
On the published figures, yes. Annual CPAP treatment was costed at US$1,661 against US$3,727 in lost output per affected worker, and £1,363 against £1,840 in the United Kingdom. The paper concludes that productivity losses exceeded treatment cost.
Why do most cases go undiagnosed?
The symptoms present as ordinary daytime tiredness, which is rarely taken to a doctor, and the diagnostic pathway has typically required an overnight sleep laboratory stay or a specialist referral. Both are meaningful barriers for someone who feels tired rather than unwell.
Does workplace screening diagnose sleep apnoea?
No. Screening identifies signs of a possible sleep issue and recommends seeing a doctor. Diagnosis remains a clinical process. A screening result is a prompt to seek assessment, not a finding about someone’s health.
Why does sleep apnoea not show up in our absence data?
Because most of the cost is presenteeism rather than absenteeism: reduced performance while at work rather than time off. An employee with untreated apnoea is generally present and working, carrying an impairment that existing reporting does not measure.
Is this a safety issue as well as a productivity issue?
For organisations with safety-critical roles, the safety exposure is usually the larger one. Untreated sleep apnoea produces fragmented sleep, excessive daytime sleepiness, and reduced sustained attention, and it compounds with shift work. Diagnosed but untreated apnoea has appeared as a factor in rail investigations, including the 2013 Spuyten Duyvil derailment.
A cost that is being paid either way
The unusual feature of undiagnosed sleep apnoea is that an organisation is already paying for it. The choice is not whether to incur the cost: it is whether to find out where it sits.
Contact Optalert to discuss how workplace sleep screening could be delivered in your organisation, or to talk about partnering to deliver it.
References
- Neglected burden of obstructive sleep apnoea: workplace productivity loss in the USA and UK. Thorax. 2026. doi:10.1136/thorax-2025-223550. PMID: 41735061.
- Deloitte Access Economics. Rise and try to shine: the social and economic costs of sleep disorders in Australia. 2021, covering the 2019–20 financial year. Commissioned by the Sleep Health Foundation. sleephealthfoundation.org.au
