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Sleep apnea: a review for life insurance medical directors and underwriters.

OBJECT
Obstructive sleep apnea (OSA) is a commonly encountered impairment in both clinical and insurance medicine. Surprisingly, relatively few data exist regarding the mortality or morbidity of sleep apnea. This paper reviews the mortality and morbidity implications of this disorder.


METHODS
Literature review using Medline.


RESULTS AND CONCLUSIONS
Much of the morbidity and mortality attributed to obstructive sleep apnea may be due, in part, to the presence of co-morbid conditions (obesity, hypertension, cardiovascular and cerebrovascular disease). An assessment of additional risk attributable specifically to OSA requires review of polysomnographic results, including the respiratory disturbance index (RDI), minimum arterial oxygen desaturation, minimum and maximum heart rates, and sleep architecture. Integral to this risk assessment is also the presence and severity of the consequences of OSA, chiefly the severity of disability due to daytime hypersomnolence as well as the other co-morbidities (control of hypertension, weight gain or loss). It is this author's opinion that adequately treated OSA may carry little, if any, mortality risk.