Correspondence

Increased Prevalence of Sleep-Disordered Breathing among Professional Football Players

N Engl J Med 2003; 348:367-368January 23, 2003

Article

To the Editor:

Sleep-disordered breathing is a clinical disorder consisting of apnea and hypopnea during sleep; it affects about 4 percent of the general population.1 We examined sleep-disordered breathing in a group of National Football League players. We used a value of 0.5 on the multivariable apnea-prediction index, on the basis of data from eight randomly selected teams, to stratify players according to the risk of sleep-disordered breathing (high or low).2 Players from both risk groups were randomly selected for overnight polysomnography, with oversampling from the high-risk group. Of a total of 302 players who could be evaluated (mean [±SD] age, 25.5±2.7 years; body-mass index [the weight in kilograms divided by the square of the height in meters], 31.5±4.6), 52 players gave written informed consent for full overnight polysomnographic studies. We used a conservative apnea–hypopnea index cutoff value of 10 to define sleep-disordered breathing.3

Offensive and defensive linemen accounted for 85 percent of the cases of sleep-disordered breathing (Table 1Table 1Prevalence of Sleep-Disordered Breathing in Professional Football Players.); linemen also had the largest neck circumference (19.1±0.9 in. [48.5±2.3 cm]) and highest body-mass index (36.6±2.6). Both systolic blood pressure (129±11 vs. 122±9 mm Hg) and diastolic blood pressure (84±9 vs. 77±8 mm Hg) were significantly higher in the linemen than in all the other players (P<0.01). From these data, we estimate the prevalence of sleep-disordered breathing among all professional football players to be 14 percent overall and 34 percent within the high-risk group (Table 1). The estimated prevalence is higher than that found in a cross-sectional study of men of similar age,4 and emphasizes the importance of physiognomy over physical conditioning as a risk factor for sleep-disordered breathing. Although young and ostensibly in excellent physical condition, professional football players have many of the risk factors for sleep-disordered breathing. For a group that is young (mean age, <30 years), healthy, and physically fit, this is a worrisome finding. The presence of sleep-disordered breathing (apnea–hypopnea index, ≥5), even in persons without symptoms, is a known risk factor for the development of hypertension.5 Treatment of sleep-disordered breathing will presumably reduce the risk of cardiovascular disease, but its presence must first be recognized.

As the trend toward bigger football players continues, unrecognized and untreated sleep-disordered breathing may affect not only the players' performance and productivity but also their future health. Many physicians may have never considered such a diagnosis in young, healthy persons, particularly those who are in top condition. Clinical suspicion should now be raised in these and other athletes as well as members of the general population who are of similar age and size.

Charles F.P. George, M.D.
University of Western Ontario, London, ON N6A 4G5, Canada

Vyto Kab
SleepTech Consulting Group, Kinnelon, NJ 07405

Allan M. Levy, M.D.
New York Giants, East Rutherford, NJ 07073

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Citing Articles (7)

Citing Articles

1. 1

   R. Todd Hurst, Matthew R. Nelson, Christopher B. Kendall, Stephen S. Cha, Steven W. Ressler, Steven J. Lester. (2011) Carotid Intimal–Medial Thickness in Active Professional American Football Players Aged 23 to 35 Years. The American Journal of Cardiology
   CrossRef

2. 2

   Felipe N. Albuquerque, Fatima H. Sert Kuniyoshi, Andrew D. Calvin, Justo Sierra-Johnson, Abel Romero-Corral, Francisco Lopez-Jimenez, Charles F. George, David M. Rapoport, Robert A. Vogel, Bijoy Khandheria, Martin E. Goldman, Arthur Roberts, Virend K. Somers. (2010) Sleep-Disordered Breathing, Hypertension, and Obesity in Retired National Football League Players. Journal of the American College of Cardiology 56:17, 1432-1433
   CrossRef

3. 3

   John H. Helzberg, Joseph F. Waeckerle, Joel Camilo, Michael A. Selden, Fengming Tang, Steven A. Joyce, Jon E. Browne, James H. O'Keefe. (2010) Comparison of Cardiovascular and Metabolic Risk Factors in Professional Baseball Players Versus Professional Football Players. The American Journal of Cardiology 106:5, 664-667
   CrossRef

4. 4

   David Vearrier, Barbara Phillips, Michael I. Greenberg. (2010) Addressing obstructive sleep apnea in the emergency department. The Journal of Emergency Medicine
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5. 5

   Michael A. Selden, John H. Helzberg, Joseph F. Waeckerle. (2009) Early Cardiovascular Mortality in Professional Football Players: Fact or Fiction?. The American Journal of Medicine 122:9, 811-814
   CrossRef

6. 6

   Michael A. Selden, John H. Helzberg, Joseph F. Waeckerle, Jon E. Browne, Joseph H. Brewer, Michael E. Monaco, Fengming Tang, James H. O'keefe. (2009) Cardiometabolic Abnormalities in Current National Football League Players. The American Journal of Cardiology 103:7, 969-971
   CrossRef

7. 7

   J.A. Stockman. (2006) Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children. Yearbook of Pediatrics 2006, 87-89
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