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Study Title: Obstructive sleep apnea among players in the National Football League: A scoping review

Authors: April J. Rogers, Kevin Xia, Kyaw Soe, Azizi Sexias, Felix Sogade, Barbara Hutchinson, Dorice Viera, Samy I. McFarlane, Giarardin Jean-Louis

Background:

Obstructive sleep apnea (OSA) – a condition associated with significantly reduced quality of life and chronic health risks – has become increasingly prevalent in the last ten years. As a result, this sleep disorder and its treatment have become a public health concern that needs attention from health care providers from a range of disciplines.

OSA presents as repeated loss of airflow during sleep, which results in disrupted, poor quality rest. People suffering from OSA experience lower metabolism, reduced cognitive function, and excessive daytime sleepiness. Adults with a high body mass index (BMI) and/or a large waist circumference relative to their height have a higher risk of developing OSA.

Often occurring comorbidly, both medical obesity and OSA increase patients’ risk of cardiovascular diseases like hypertension and arteriosclerosis. These conditions can exacerbate one another, even among professional athletes. In the US, OSA affects between 2% and 5% of the general population, while the National Football League (NFL) sees OSA rates of between 14% and 19%.

Historically, NFL players have exhibited higher rates of obesity, which may explain in part the league’s elevated rates of OSA. Many prominent NFL players have been diagnosed with the condition, and additional research could illuminate how OSA has affected current and former players’ health and the long-term effects the condition has had on this unique population.

Study Objective: To conduct a scoping review that assesses current literature on obstructive sleep apnea and its impact on NFL players. This review outlines what associations between OSA and poor health outcomes have been investigated regarding the NFL community and indicates important areas for future research.

Methodology: This study applies a scoping review methodology to evaluate and provide an overview of how OSA impacts the cardiovascular health of professional American football players based on over 30 years of literature. To identify studies to include in this review, researchers defined search terms related to the population of interest (NFL players), cardiovascular health conditions (i.e., hypertension, heart disease, heart failure, or vascular disease), and sleep-disordered breathing. Then, peer-review articles were manually screened for relevance.

Results/Discussion:

  • On average, NHL linemen weigh over 300 pounds, which traces back to obesity trends at the college level. Comparatively, there were 30 times as many players over 300 pounds in 2017 as there were in 1986.
  • Studies on the effect of OSA on NFL lineman specifically are lacking, as this population likely affected even more so than the general population of players.
  • NFL players likely suffer significant negative effects on both their cardiovascular health and daytime performance from OSA, which would impact their short- and long-term quality of life, as well as their overall health.

To better understand how OSA has affected players’ long-term cardiovascular health, clinicians need more peer-reviewed research on these associations.

Conclusion: The results of this literature review show that, although available research shows that NFL players exhibit signs and risk factors of OSA (including obesity, cardiovascular disease, hypertension), there is a significant gap in available research for this population. Health care providers commonly recommend weight loss to OSA patients to reduce their symptoms, but this may not be a viable option for current players, as well as those in other professions that require them to retain a certain physique. For such patients, OSA treatments like CPAP or oral appliance therapy may be the best option to reduce or control their symptoms and improve their quality of life and long-term health.

Reference:

  1. Rogers AJ, Xia K, Soe K, Sexias A, Sogade F, Hutchinson B, Viera D, McFarlane SI, Jean-Louis G. Obstructive sleep apnea among players in the National Football League: A scoping review. Journal of Sleep Disorders & Therapy, 6(5): 279. https://dx.doi.org/10.4172%2F2167-0277.1000278