Prevalence
of Sleep Disordered Breathing in Retired NFL Players
Felipe Albuquerque, MD; Fatima Sert Kuniyoshi, PhD; Abel Romero-Corral, MD, Justo Sierra-Johnson, MD; Daniel
Levendowski; David Rapoport MD; Charles George, MD;
Bijoy Khandheria,
MD; Arthur Roberts, MD; Virend Somers, MD, PhD
Living Heart Foundation and Department of Cardiovascular
Diseases. Mayo Clinic, Rochester, MN
BACKGROUND
Sleep disordered breathing (SDB) has been
reported to have a high prevalence
in active National Football League
(NFL) players. Our aim was to assess
prevalence of SDB and other major cardiovascular risk factors
among retired NFL players and to
compare this between linemen and other
position players.
METHODS
The Living
Heart Foundation conducted an open multi-city health screening
for retired NFL players and performed
an unattended, limited but multichannel
SDB diagnostic test in 167
retired NFL players.
We used an apnea-hypopnea index (AHI)
cutoff value of 10 events/hour to define
SDB and divided the players in two groups: linemen (offensive
and defensive linemen) and
non-linemen (every other position).
Continuous variables are shown as
mean ± SD, and
binary data as %, an unpaired t –test was used to
compare the variables between groups.
RESULTS
The mean age was 54 ± 12 years, body mass index
(BMI) was 32 ± 4 kg/m˛,
and neck circumference was 17.5 ± 1.4
inches. The prevalence of SDB was 51.5%, self reported
hypertension was 37 %, diabetes was 6 %,
stroke was 1%, and heart disease
was 6 %.
Univariate analysis identified significant associations
between SDB and age, BMI, and the
presence of hypertension. Age and BMI
remained significantly associated with SDB,
after adjustment for neck circumference
and the presence of hypertension. Neck circumference and the presence
of hypertension were not statistically
associated with SDB after adjustment
for age and BMI. (Table 2)
0.11
13.4 ± 1.5
18.7 ± 1.9
AHI
(events/hour)
<0.01
30.5 ± 3.6
34.2 ± 4.3
BMI (kg/m2)
<0.01
17.1 ± 1.4
18.1 ± 1.2
Neck
(inches)
0.84
53.9 ± 1.8
54.3 ± 1.5
Age
(year)
p
Nonlinemen (n=106)
Linemen (n=61)
0
20
40
60
80
linemen (n = 61)
nonlinemen (n = 106)
p=0.07
p=0.09
p=0.34
p=0.11
0.9
(0.7-1.4)
1.0
0.4
(0.9-1.4)
1.1
Neck (inches)
0.5
(0.6-2.9)
1.3
<0.01
(1.6-5.9)
3
Hypertension
0.03
(1.1-3.1)
1.8
<0.01
(1.1-2.2)
1.5
BMII (5kg/m2)
<0.01
(1.6-3.3)
2.3
<0.01
(1.5-2.7)
1.2
Age (10 years)
p
95% CI
OR
p
95% CI
OR
Multivariate
Univariate
Table 1.
Patient characteristics according to
position
Table
2. Logistic regression models for the association between age, BMII, hypertension, neck
circumference and the presence of sleep disordered breathing.
We constructed a
univariate logistic regression
model with the variables that could
be associated with the presence of SDB.
The 4 variables that we believed to be
clinically important were placed in a multiple variable logistic regression model. All statistical tests were 2 sided and a p < 0.05 was considered significant. JMP version 7.0.1 (SAS Institute Incorporate, Cary, NC) was used.
Figure 1: Presence of comorbidities
according to the players’ positions. SDB = sleep disordered breathing.
ACKNOWLEDGMENTS
VKS is supported by NIH
Grants HL65176 and M01 RR00585. FHSK is supported by AHA grant 09-20069G. AJR is supported by ResMed, SleepTech and
Advanced Brain Monitoring.
REFERENCES
1.Miller M.,
MD; Croft L.., MD; Belanger A., et al Prevalence of Metabolic Syndrome in Retired
National Football League Players.. Am J Cardiol. 2008 May 1;101(9):1281-4
2.George C.,
MD; Kab V.; Levy A., MD; Increased prevalence of Sleep-Disordered Breathing
among Professional Football Players. NEJM 348;4 2003
CONCLUSIONS
SDB
was highly prevalent among retired NFL players. SDB was higher in linemen compared to non-linemen. BMI and age were
significantly associated
with SDB, independently of neck circumference and hypertension.
