title: Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-analysis.
abstract: Obstructive sleep apnea (OSA) is the single most important preventable medical cause of excessive daytime sleepiness (EDS) and driving accidents. OSA may also adversely affect work performance through a decrease in productivity, and an increase in the injury rate. Nevertheless, no systematic review and meta-analysis of the relationship between OSA and work accidents has been performed thus far.
  
  
  
  PubMed, PsycInfo, Scopus, Web of Science, and Cochrane Library were searched. Out of an initial list of 1,099 papers, 10 studies (12,553 participants) were eligible for our review, and 7 of them were included in the meta-analysis. The overall effects were measured by odds ratios (OR) and 95% confidence intervals (CI). An assessment was made of the methodological quality of the studies. Moderator analysis and funnel plot analysis were used to explore the sources of between-study heterogeneity.
  
  
  
  Compared to controls, the odds of work accident was found to be nearly double in workers with OSA (OR = 2.18; 95% CI = 1.53-3.10). Occupational driving was associated with a higher effect size.
  
  
  
  OSA is an underdiagnosed nonoccupational disease that has a strong adverse effect on work accidents. The nearly twofold increased odds of work accidents in subjects with OSA calls for workplace screening in selected safety-sensitive occupations.
  
  
  
  A commentary on this article appears in this issue on page 1171.
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.|Department of Health Sciences, University of Genoa, Genoa, Italy.|State Police Health Service Department, Ministry of the Interior, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Garbarino
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.
authors.forename: Ottavia
authors.initials: O
authors.lastname: Guglielmi
authors.affiliation: Pneumology Unit, San Jacopo Hospital, Pistoia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sanna
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Mancardi
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Magnavita
mesh_terms: D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D001334:Automobile Driving / Q000706:statistics & numerical data; D004526:Efficiency; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D017132:Workplace
keywords: excessive daytime sleepiness; injury; mean effect size; meta-analysis; obstructive sleep apnea; safety; systematic review; work accident; workplace