# Promotion of Preventive Sleep Research from the Perspective of Health and Public Safety in Japan - Secondary Publication

## TL;DR

This paper highlights the importance of sleep health in Japan, showing how sleep apnea increases risks for diabetes, heart disease, and accidents, and promotes screening and interventions to improve public safety.

## Contribution

The paper presents long-term epidemiological findings on sleep apnea's health risks and advocates for policy changes and screening guidelines in Japan.

## Key findings

- Individuals with a 3% ODI ≥15 events/h have a 1.69-fold higher risk of developing diabetes.
- SDB patients have a 2.5 times higher risk of traffic accidents compared to non-SDB individuals.
- PVT and pulse oximetry are recommended for objective SAS screening due to subjective-objective sleepiness discrepancies.

## Abstract

Ensuring good sleep quality and adequate sleep duration is crucial for health. Sleep apnea syndrome (SAS) impairs sleep quality and increases the risk of diabetes, cardiovascular diseases, and accidents. The author has significantly advanced the understanding of SAS in Japan through over 20 years of epidemiological studies. Findings have revealed that individuals with a 3% oxygen desaturation index (ODI) ≥15 events/h have a 1.69-fold higher risk of developing diabetes. Those with mild to severe sleep-disordered breathing (SDB) with a 3% ODI ≥5 events/h face high risks of heart disease and lacunar infarction, at 26.1% and 30.1%, respectively. Among shift workers aged ≥40, SDB was significantly associated with elevated blood pressure. Additionally, the risk of traffic accidents in SDB patients is approximately 2.5 times higher than in those without SDB. The author advocated for routine SAS screening, especially for professional drivers, to enhance public safety. In collaboration with the Ministry of Land, Infrastructure, Transport and Tourism, comprehensive guidelines for SAS screening were developed, emphasizing the necessity of objective methods due to the disconnect between subjective sleepiness and objective alertness. These methods include pulse oximetry and the 3-minute psychomotor vigilance test (PVT). Highlighting the health risks for night-shift workers with SDB, the author promoted regular screening and early intervention. Additionally, pediatric SAS was linked to attention-deficit hyperactivity disorder-like symptoms, stressing the need for early treatment. Post-disaster health initiatives showed increased insomnia among Fukushima recovery workers, with continuous positive airway pressure therapy proving beneficial. The author also developed health security measures using PVT for doctors working long hours, linking reduced wakefulness to depression and burnout. These contributions have significantly improved public health and safety in Japan, influencing health policies and promoting widespread SAS screening and sleep debt evaluation. Continued support from doctors of the Japan Medical Association is essential to maintain these advancements.