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This study estimates the prevalence and workplace productivity burden of obstructive sleep apnoea (OSA) syndrome in the UK and USA, using self-reported breathing pauses and excessive daytime sleepiness as a proxy. The prevalence of OSA syndrome was 22.8% in the USA and 19.5% in the UK. Annual productivity losses were estimated at US$180.2 billion in the USA and £4.22 billion in the UK. In the UK and USA, individual-level productivity losses exceeded the cost of continuous positive airway pressure (CPAP) treatment, suggesting that improved identification, access to treatment and adherence could yield significant economic benefits in both countries.