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Daisaku SAWADA, Kiyohide TOMOOKA, Takeshi TANIGAWADepartment of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan606Corresponding author: Takeshi TanigawaDepartment of Public Health, Juntendo University Graduate School of Medicine2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, JapanTEL: +81-3-5802-1049 FAX: +81-3-3814-0305 E-mail: tataniga@juntendo.ac.jp〔Received Jul. 8, 2022〕〔Accepted Sep. 30, 2022〕J-STAGE Advance published date: Dec. 1, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ22-0026-OAObjective: Recent studies have revealed that sleep apnea syndrome (SAS) increases the risk of cardiovascular diseases and their risk factors, as well as the risk of traffic accidents. Although SAS screening and early treatment are important, truck drivers may avoid SAS screening to prevent the denial of their application for life insurance due to receiving continuous positive airway pressure (CPAP) treatment. Thus, this study investigated how life insurance companies handle patients on SAS treatment.Material and Methods: We conducted a questionnaire survey on how they handle life insurance applications of patients with SAS on CPAP treatment for 46, 41, and 42 companies in 2009, 2015, and 2021, respectively, and analyzed the changes in their handling of life insurance applications of patients with SAS.Results: The results revealed that while about 10 life insurance companies handle the application of life insurance of patients on CPAP treatment in the same way as healthy individuals, many life insurance companies handle them differently. This survey also revealed the differences in handling patients with SAS on CPAP treatment among companies and their policies regarding the reasons.Conclusions: The survey revealed that there are differences among life insurance companies in handling patients with SAS on CPAP treatment. It is important to provide information about the companies that would not give disadvantages to patients with SAS on CPAP treatment who purchase life insurance. It is also crucial to provide life insurance companies with evidence of reduced risk of traffic accidents in patients with SAS on CPAP treatment.Key words: CPAP treatment, acceptance criteria, life insurance company, traffic accidentJuntendo Medical Journal2022. 68(6), 606-612Original ArticlesChanges in Attitudes of Life Insurance Companies Towards Patients with Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure in JapanIntroductionObstructive sleep apnea (OSA) is characterized by frequent episodes of upper airway collapse and partial collapse during sleep. It is also associated with congestive heart failure, stroke, atrial fibrilla-tion, ischemic heart disease, and systemic hyper-tension1). OSA has also been associated with the development of diabetes2, 3). The odds ratio of work accidents was 2.2 (95% confidence interval=1.5-3.1) in workers with OSA4), which is consistent with a 2.5-fold increase in motor vehicle crash risk with OSA estimated by a meta-analysis5).Continuous positive airway pressure (CPAP) treatment is effective in treating sleep apnea syndrome (SAS). It improves the risk of traffic accidents to the level of healthy individuals, according to a previous report6).The Ministry of Land, Infrastructure, Transport, and Tourism (MLIT) has established the “Manual for sleep apnea syndrome measures in motor carrier operators - Use of the necessity of SAS measures”7) for occupational drivers and transpor-tation companies. They clarified the points that business operators should pay attention to in each process, starting from a screening test, to a detailed

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