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2009 (46)10（22%）7（15%）1（2%）0（0%）28（61%）2015 (41)8（20%）4（10%）1（2%）2（5%）26（63%）2021 (42)12（29%）6（14%）0（0%）0（0%）24（60%）examination of treatment. They strongly recom-mend SAS screening and adequate treatment for commercial drivers.Meanwhile, the Japan Trucking Association received a report from one driver on his purchase of group credit life insurance, which is essential for house mortgages, and was rejected because of his CPAP treatment for SAS. Therefore, despite the importance of early detection of SAS through SAS screening and subsequent early treatment to prevent traffic accidents, concerns have been raised that truck drivers would refuse to undergo SAS screening to avoid the refusal of life insurance screening, and that the number of untreated and undiagnosed SAS patients engaging in driving duties would increase. It may not only be a health issue for individual patients, such as an increased risk of cardiovascular diseases, but also pose a danger to the entire society the risk of traffic acci-dents may increase.Based on the above background, in this study, we aimed to clarify the actual status of handling of life insurance applications by patients with SAS and changes in the handling of such patients by life insurance companies in Japan. We conducted ques-tionnaire surveys in all life insurance companies in Japan in 2009, 2015, and 2021.Material and MethodsThe study targets were all life insurance compa-nies in Japan in 2009, 2015, and 2021, and the same questionnaire regarding the handling of life insur-ance applications by patients with SAS was admin-istered to 46, 41, and 42 companies, respectively.The questionnaire forms were sent to persons in charge in the corresponding insurance companies, and their responses were regarded as consent for this study. Because this study was a questionnaire Table 1　Changes in the acceptance criteria for patients with SAS for CPAPa) treatment who wish to purchase life insuranceSurvey year (number of companies)Acceptance criteriaAccepted in the same way as healthy individualsAccepted by changing the premiumNot acceptedOtherNo response to this surveya)CPAP: continuous positive airway pressure *Percentages are rounded to the nearest whole number.survey of life insurance companies and did not collect data from patients or healthy individuals, approval from the institutional review board was waived.Regarding the criterion for accepting the applica-tion of patients with SAS on CPAP treatment, we asked, “Please let us know the criteria for accep-tance in your company in the event that a SAS patient on CPAP treatment wishes to purchase life insurance from your company.” If the answer was either “We will accept the application in the same way as healthy individuals since it is in the accep-tance criteria” or “We will accept the application in the same way as healthy individuals although it is not in the acceptance criteria,” it was regarded as “Accept in the same way as healthy individuals.” If the answer was either “We will accept the applica-tion by changing the premium since it is in the acceptance criteria” or “We will accept the applica-tion by changing the premium although it is not in the acceptance criteria,” it was regarded as “Accept by changing the premium.” If the answer was “We will not accept the application,” it was regarded as “Not accept (denial).” Companies that did not return their answer sheets and those that returned answer sheets without responses were regarded as “Not responded.” We also asked about the reasons for each response and the conditions necessary for patients with SAS on adequate CPAP treatment who wish to purchase life insurance to make a contract under the same conditions as healthy indi-viduals.Table 1 shows the changes in the acceptance criteria for patients with SAS on CPAP treatment who wished to purchase life insurance. The number of companies that answered “We will accept the 607Results