New research from medical students and faculty members associated with the University of Colorado School of Medicine at Colorado State University finds that college football players experience higher rates of obstructive sleep apnea (OSA) than the general population.
Often, OSA, a sleep disorder caused by the collapse or obstruction of the upper airway that interrupts breathing during sleep, is associated with a high body mass index (BMI), large neck size, and narrowed airway. Those diagnosed with OSA also tend to be older in age and male. The research, recently published in the Journal of Clinical Sleep Medicine, reveals even people who are young, lean, and still undergoing physical development can experience OSA, which is associated with cardiometabolic diseases.
“This is not a condition we typically associate with younger individuals,” says sleep researcher and lead study author Josiane Broussard, PhD, an associate professor of Health and Exercise Science at Colorado State University and adjoint faculty in the Division of Endocrinology, Metabolism, and Diabetes at the CU School of Medicine. “That may be a reason college football players often fly under the radar and remain undiagnosed.”
‘Validating’ results
The study recruited 58 CSU football players who were free of any known cardiovascular disease and type 2 diabetes and instructed them to wear a device, called the WatchPAT 300, that captured data to form an apnea-hypopnea index (AHI). These measurements, along with others and a questionnaire, helped the researchers determine OSA prevalence in this student athlete population.
Based on the WatchPAT 300 data analyses, 35% of participants had clinically defined mild to moderate OSA. This prevalence is notably higher than the estimated rate of 9-25% in the general population, but “consistent with reports of higher OSA prevalence in professional football players in the National Football League,” the researchers say.
The players who were determined to have OSA had higher BMI, but neck circumference was generally the same as the players who didn’t exhibit OSA symptoms.
“There have been a couple of studies in the last few years that have looked at college football athletes and the data showed similar findings, so it was validating to see these results,” Broussard says. “We often think of this population as especially healthy because they exercise so much and have high muscle mass, but they’re still at an increased risk. It’s something to think about because if they’re 18 or 20 years old and are never screened for OSA, they may go on to live with the condition without treatment for another few decades and it could have been addressed early on.”
Raj Trikha, MD, MS, a co-author of the study and a recent graduate of the Fort Collins branch of the CU School of Medicine, echoes the importance of sleep and the research behind it.
“Untreated OSA leads to increased risk in virtually every chronic disease; including heart disease, cancer, and dementia,” he says. “I chose to work in Dr. Broussard’s lab during medical school because her research is vital and this presented a unique opportunity to learn more about sleep’s impact on health.”
Essential screenings for players
Untreated OSA can have serious health implications. Beyond symptoms like sleep disturbances, snoring and daytime sleepiness, OSA is often associated with cardiovascular diseases.
Prevalence of OSA in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke, is as high as 40% to 80%.
For many people with OSA, it might not be obvious to them that they have the condition.
“Many people discover they have OSA because of their bed partner,” Broussard says. “It can be alarming to witness—someone appears to stop breathing during sleep, and it often sounds like they’re struggling to breathe but just can’t.”
Those episodes, which can happen as often as 60 times per hour in serious cases, lead to physiological changes, including increases in heart rate and stress hormones, “and the person may have little to no awareness that it's happening,” Broussard says.
“You could have someone who believes they’re getting eight to nine hours of sleep each night, yet they still feel exhausted during the day,” she says.
Some of the CSU football players in the study scored high on the Epworth Sleepiness Scale, but didn’t meet the criteria for excessive daytime sleepiness. The finding, the researchers say, may explain why most participants reported taking regular daytime naps.
Researchers say OSA screening in collegiate football players is essential for many of the health conditions that can follow, but it can be difficult to get a diagnosis because it requires a screening, which isn’t common for young people, and can require intense testing in a sleep clinic.
“…there is an urgent need for simple, effective, and scalable screening approaches for collegiate football players, especially given the absence of intercollegiate athletics screening protocols,” the researchers write in their findings.
The methods used in the study — implementing a wearable device and questionnaires —might be part of the answer, especially because those traditional screenings take time.
“What busy college athlete wants to take a half-day to get screened for a disease they might not believe is actually affecting them?” Trikha says. “Combining the questionnaire with the wearable device may be a revolutionary tactic to help screen young athletes —or really anybody at all — for their risk of OSA in hopes of preventing the sequelae of diseases later in life.”
Developing a more accessible screening model wasn’t a primary aim of the research, but Broussard and her colleagues say it turned out to be a promising outcome.
“Not everyone has access to tools like the WatchPAT 300, but many athletic departments do have pulse oximeters. When paired with a simple questionnaire, this combination could serve as a practical first step—prompting someone to say, ‘Hey, maybe you should get this looked into.’”
