This kind of data concerning the comorbidities of OSAS can also be found in the international literature and in the previous chapters of this book. We believe that the above figures significantly underestimate the comorbidity. For example, obesity is both a cause and an effect of OSAS. Ninety percent of the respondents in the same study were overweight (BMI > 25). Fifty-two percent had severe to morbid obesity (BMI > 30). However, a large number of respondents did not report this as a disease. There can only be one conclusion: many patients suffer from several different diseases at the time of diagnosis. Besides OSAS, they might also be obese and have diabetes and/or hypertension and/or heart problems, etc. In a pilot study conducted at Antonius Hospital (Nieuwegein 2012), we found that OSAS patients had an average of 3.4 comorbidities at the time of their OSAS diagnosis. The majority already had an extensive (often unsuccessful) history of treatment for the other diseases. This should have implications for the treatment of OSAS (see below).

Depression and burnout do not fit completely in this context. Although very high HADS scores are common in OSAS patients at the time of diagnosis, it is possible that this is a consequence of the damage caused by untreated OSAS. One thing is for sure: treatments for depression will not take the OSAS away. Some of the medications prescribed for burnout or depression may even worsen the OSAS (e.g., if they have a muscle relaxant effect). It is very likely, on the other hand, that treatment of OSAS may in many cases eliminate the symptoms of burnout and depression. Therapies for depression and burnout are reduced by more than half after a diagnosis of OSAS.

The consequences of untreated OSAS on a person’s work are quite significant. Less than 50 % of the people in the Netherlands that are now treated for OSAS are employed. A large part retired earlier than the normal age of 65 years. The rate of disability is also very high. In the category of 18–39 years of age, 12 % is disabled (compared to 2 % on average in the Netherlands), between 40 and 59 years, 14 % is disabled (6 % is average in the Netherlands), and those over 60 years have doubled the average rate of disability (8 % versus 4 % for the Dutch population). Obviously, a large percentage of those who currently have OSAS are being diagnosed too late. For them, returning to a normal work situation is no longer possible.

To conclude this paragraph on the personal impact of OSAS, we would like to quote Jennum once more. He writes, “Although CPAP treatment reduces mortality, earlier disease detection could have a greater impact on disease complications.”