OBJECTIVES:  Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) increase the risk of cardiovascular disease, and lead to motor vehicle and public transportation accidents. SDB is therefore considered a problem requiring attention from both clinical and public health perspectives. The objective of this study was to estimate the cost-effective of screening for identification of patients with SDB using simple scoring system (Four Item-Screener for Sleep Apnea Syndrome; FISSAS) in community setting. METHODS:  A Markov model was constructed to assess the cost-effectiveness of screening and subsequent intervention for SDB compared with no screening. The model depicted the management of a 50-year-old patient with severe OSAHS as defined by an apnoea-hypopnoea index of 30 or more. Base available clinical data from publications, national surveillance data, and claim data was used. One-way and probabilistic sensitivity analyses were performed considering uncertainties in the parameters. RESULTS:  In the base-case analysis, the strategy with a screening for severe SDB resulted in an incremental cost of 266,740 Japanese yen (¥; £1,749) and incremental effective of 0.125 quality-adjusted life years (QALYs) per 0.125 per person screened. The incremental cost-effectiveness ratio was ¥2,129,915 (£13,962) per QALY. Sensitivity analyses suggested in order to achieve both reductions in cardiovascular disease and traffic accidents and cost-effective in Japan. CONCLUSIONS:  Within the limitations of the model, screening for SDB using FISSAS was found to be cost-effective than no screening, applying the willingness to pay threshold of £