Sleep Scores a Touchdown
A recent study involving 300 NFL players raises public awareness about sleep apnea and could have significant implications on the way sleep apnea is looked at and the number of people affected by it.
Sleep apnea may not be just for the old and unfit anymore. A recent study of 300 National Football League (NFL) players found that 14% of them had sleep apneafive times higher than noted in previous studies of similarly aged adults. In addition, the study found that in higher risk players, the prevalence of sleep apnea was 34%. The results of the studysponsored by ResMed Sleep Disordered Breathing Foundation, a charitable foundation funded by ResMed, the National Sleep Foundation, and Medcarewere published in the January 23, 2003, issue of the New England Journal of Medicine. The study was directed by SleepTech Consulting Group, LLC.
Results of the Study
The results of the study indicate that younger men with large necks and high body mass, like many of the NFL participants, may have undiagnosed sleep apnea, meaning the condition may be more widespread than once believed. Professional football players have some of the risk factors associated with sleep apnea, but their age and physical condition previously would not have suggested a prevalence of the disorder until they were much older, says Charles F. P. George, MD, FRCPC, ABIM, D, ABSM, professor of medicine at the University of Western Ontario and the studys principal investigator, in a statement released January 22. Many physicians have never considered such a diagnosis in young, healthy individuals because sleep apnea was previously thought to be associated with middle-aged or older individuals. The study strongly suggests that sleep apnea be considered as a possible condition for larger patients under 30 years of age.
Though the results could have significant implications in the way sleep apnea is looked at and the number of people affected by it, for Peter Farrell, PhD, biomedical engineer and CEO of ResMed, the scope of the problem is old news. He cites a decade-old editorial published in the New England Journal of Medicine in response to an epidemiologic study of the prevalence of obstructive sleep apnea. It called sleep apnea a public health problem akin in scope to tobacco smoking. That was 10 years ago. How far have we come? The answer is, unfortunately, not that far, he says.
How It Got Started
The study was conceived by Vyto Kab, co-managing director of SleepTech Consulting Group, and united his twin interests of sleep medicine and professional football. Kab, himself a NFL veteran, learned about the problem of sleep apnea in the NFL firsthand. My first introduction to the main symptom of sleep apneasnoringcame when I was with the Detroit Lions. While we were on the road, I roomed with a big defensive lineman who weighed 300 pounds, and if I wanted to get a good nights sleep, I had to sleep in the bathtub, he says. I saw that there was a need [for the study]. When I played [from 1982 to 1988], there were about five 300-pound players, and now there are more than 350 in the league. Because of the size of these guys, even though theyre physically fit, a lot of them presented with the prototypical sleep apnea signs.
The study was conducted during the summer of 2002 and was made up of 300 players from eight randomly selected NFL teams, including the Chicago Bears, Jacksonville Jaguars, New England Patriots, New York Giants, Philadelphia Eagles, St Louis Rams, Tennessee Titans, and Washington Redskins. The recent study followed a 1997 pilot SleepTech study with 16 linemen from the New York Giants. In that study, 13 of the 16 players tested positive for sleep apnea.
The players in the 2002 study were divided into high-risk and low-risk categories based on neck size and body mass index. Team physicians assisted with the evaluations, which included 52 overnight polysomnographic studies that were conducted in each teams home city. The study indicated that offensive and defensive linemen accounted for 85% of the positive cases of sleep apnea among the participants, with 34% of the high-risk players showing a prevalence for sleep-disordered breathing. While the study was designed to simply measure the prevalence of sleep apnea in NFL players, the results of the athletes tests were turned over to their team physicians. Proposed future phases of the study will include measuring performance in players with and without sleep apnea and determining the effects of treatment on performance and injuries.
The current study shows that even highly trained athletes in excellent physical condition can suffer from sleep apnea, which can contribute to long-term health problems such as hypertension and stroke if left untreated. What is unique about this study is that these meneven though theyre big guysare professional athletes, so they dont present the way normal people would present as far as the amount of desaturations theyd have or other parameters, Kab says. Theyre much more cardiovascularly fit. The other thing thats unique is the average [age] of the players, which was 25 years old. It identified a population that normally wouldnt be looked at for sleep-disordered breathing. Thats the key. The correlation to the general public [is that] theres probably a large population of young men who are big and arent getting diagnosed because sleep-disordered breathing is seen as more of a middle-aged or older disorder.
The fact that NFL players took part in the test and may publicly admit they have sleep apnea is a benefit of the study and could help raise public awareness about the problem. The bigger challenge, however, is to get the message to physicians. Physician awareness is tougher because youve got [to reach] guys at medical school, Farrell says. You have to get them early because its very hard to teach old dogs new tricks, particularly specialists.
Facts About Sleep Apnea
According to the National Sleep Foundation, it has been estimated that there are as many as 18 million Americans who have sleep apnea. According to Farrell, only about 2 million sleep apnea patients in the world are being treated. [The treatment] penetration is zilch, he says.
Because there are as many people with sleep apnea as those with diabetes and asthma, Farrell says it is important that general practitioners and internists begin treating sleep disorders such as sleep apnea from a practical standpointsleep laboratories cannot handle every sleep disorder case. Sleep apnea is as prevalent [as diabetes and asthma], so we need to get to the family physicians the gatekeepers who actually do the diagnosing, and prescribe the bulk of the treatment and only refer the tough cases to sleep labs, Farrell says. Because with that number of people, you couldnt build enough sleep labs in 100 years. But right now, sleep physicians see the sleep lab as an annuityyouve got a 6-month waiting period [and that] makes you feel comfortable. Patients just have to wait too long to get tested.
Though the expectations are that the study will receive widespread notice, Farrell says, sleep medicine has a long way to go to win the game against sleep apnea. It would be nice if [the study] got us a first down, he says.
C.A. Wolski is associate editor of Sleep Review.