The Gap Between Subjective Sleep Complaints and Objective Obstructive Sleep Apnea Burden Among Professional Drivers

Obstructive sleep apnea (OSA) is highly relevant among professional drivers; however, self-reported symptoms may not reflect the objective disease burden. This cross-sectional study examined the relationship between subjective sleep complaints and the objectively measured OSA burden in 207 professional metropolitan public transport drivers undergoing respiratory polygraphy. Daytime sleepiness, insomnia symptoms, sleep quality, and OSA risk were assessed using the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), and STOP–BANG questionnaire. The objective OSA burden was assessed using the apnea–hypopnea index (AHI) and the sleep apnea-specific hypoxic burden (SASHB). Moderate-to-severe OSA (AHI ≥ 15 events/h) was identified in 65.2% of participants, whereas excessive daytime sleepiness was reported by only 2.4%. The ESS, AIS, and PSQI scores were correlated with one another but not with the AHI or SASHB. A model combining these subjective measures showed limited discrimination for moderate-to-severe OSA (area under the curve [AUC] = 0.533), whereas a model including age and body mass index (BMI) showed modest discrimination (AUC = 0.637), with BMI independently associated with the outcome. Subjective sleep complaints were poorly associated with the objectively measured OSA burden, supporting the use of clinical risk assessment and objective sleep evaluation when indicated.