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608application in the same way as healthy individuals” was 10 (22%) in the survey in 2009, 8 (20%) in 2015, and 12 (29%) in 2021, showing that there are approximately 10 companies with slight increases or decreases. The number of companies that answered “We will accept the application by changing the premium” was 7 (15%) in the survey in 2009, 4 (10%) in 2015, and 6 (14%) in 2021. The number of companies that answered “Not accept” was 1 (2%) in the survey in 2009, 1 (2%) in 2015, and 0 (0%) in 2021.When we asked why they did not accept these applications under the same conditions as healthy individuals, 8 companies responded to the survey in 2009, 5 in 2015, and 4 in 2021. These companies gave various reasons, such as “CPAP is a treat-ment, and it is not possible to accept the application under the same conditions as healthy individuals” and “It is difficult to individually grasp the compli-ance with treatment,” indicating that the reasons for not accepting the life insurance application vary by company (Table 2).Similarly, it was revealed that each company holds a different view on the conditions necessary to accept the application of patients with SAS on adequate CPAP treatment who wish to purchase life insurance under the same conditions as healthy individuals (Table 3).DiscussionApproximately 10 life insurance companies answered that they would accept the application of patients with SAS on CPAP treatment in the same way as healthy individuals, which is about 20% to 25% of all insurance companies. Additionally, as shown in Table 3, it was found that various condi-tions must be met, even at insurance companies that answered that they would accept the applica-tion in the same way as healthy individuals.Accumulating evidence suggests that adequate treatment of OSA with CPAP reduces health and safety risks. Meta-analysis data demonstrated that CPAP treatment significantly reduced OSA severity, sleepiness, blood pressure, and motor vehicle acci-dents in patients with OSA8). OSA is also linked to adverse effects on employees’ healthcare costs and workplace productivity9). Burks et al. reported that mandatory OSA screening and CPAP treatment programs lead to substantial savings in medical costs10).Burks et al. published the first large-scale program to screen, diagnose, and monitor OSA treatment adherence among truck drivers. Drivers with OSA who did not adhere to CPAP had a five-fold greater rate of crashes compared to the control group. They also reported that drivers with OSA who were fully compliant with CPAP treatment had a crash rate that was similar to that of the control group11). These data show that OSA is an underdi-agnosed disease with preventable adverse effects not only on health but also on work and traffic acci-dents. Therefore, workplace screening for OSA, especially in safety-sensitive occupations, should be encouraged12-14).However, the results of this survey suggest that the overall recognition of the effects of CPAP treat-ment on SAS patients differs among insurance companies. Companies, such as #1 in Table 2, changed their comments in a favorable direction over the three surveys. This is probably because it updated its acceptance criterion based on the latest knowledge and the social environment.Meanwhile, the criterion for accepting the appli-cation varies among life insurance companies. By informing drivers about life insurance companies that accept the application of patients on CPAP treatment in the same way as healthy individuals, it may be possible to prevent drivers from refusing SAS screening because they cannot purchase life insurance.The results of this survey revealed that some health insurance companies still do not accept the life insurance application of patients with SAS on CPAP treatment in the same way as healthy indi-viduals, and this situation has not changed over the last 10 years. The handling of these patients by life insurance companies affects SAS screening and is an important factor for the continuation of treat-ment. Therefore, it is necessary to take measures to prevent patients with SAS from being disadvan-taged in purchasing life insurance, for example, by disclosing the names of the companies that handle such patients in the same way as healthy individ-uals. Since each life insurance company has different criteria for the acceptance of the life insurance application of patients with SAS, it is important to promote efforts, such as presenting evidence on the effect of CPAP treatment in reducing the inci-