Gregg Marshall, PhD, RRT, RPSGT, RST Chair/Associate Professor Texas State University / College of Health Professions Department of Respiratory Care & Texas State Sleep Center
Disclosure of Relevant Financial Relationships pertaining to any potential conflicts of interest None
Objectives 1) Contrast the incidence of OSA among US adults versus football athletes 2) Summarize the typical characteristics of athletes with potential SDB issues 3) Organize an athletic sleep wellness plan for your community
Aaron Taylor Honored with 1993 Lombardi Award and first-team All-American selection as offensive tackle Drafted out of Notre Dame (1990-1993) to Green Bay Packers in 1994 Played for Packers Super Bowl XXXI as offensive lineman 1997 Now a CBS Sports Game & Studio Analyst While at Notre Dame roster shows 6 4 / 280
Aaron Taylor - Passionate about OSA education for athletes at the NFL, NCAA and high school football level - Working with 2 NFL teams on OSA screening - A personal message for our TSSP Siesta Texas 2014 Conference Web Video Link
Obj 1: OSA in the US & in football OSA incidence in US 4.41% in adults 12 million Americans or 1 in 22 Undiagnosed estimates 10 million OSA incidence in NFL football players Studies are surprisingly few.why? In 2003, Allan Levy (Team Physician for the New York Giants) published in NEJM 14% of the 8 NFL teams studied (n > 300) had OSA with 34% of linemen with OSA* George, C., Vyto, K., & Levy, A. Increased Prevalence of Sleep-Disordered Breathing among Professional Football Players. N Engl J Med, (2003) 348:4.
OSA in retired NFL players Archie Roberts, MD, Founder of the Living Heart Foundation Retired heart surgeon & NFL quarterback for Cleveland Browns & Miami Dolphins Since 2003, Roberts has screened & studied more than 1,500 retired NFL players Mean age 52 40% of all retirees have OSA 65% of retired linemen have OSA
NCAA football athletes Texas State University Sleep Wellness OSA study Preliminary screening through Head Trainer Various screening devices used since 2006 Level III sleep recording device Actigraphy watch devices OSA surveys Observation of clinical signs/symptoms npsg studies Findings of 14-16% of team with 34-36% of linemen with OSA consistent with Levy s NFL study Grant funding allows Dx at TxState Sleep Center Donated/refurbished PAP allows Tx for uninsured
National focus on TSSW Program The Chronicle of Higher Education Featured in March 2007 issue in the Athletics section Collegiate screening absent in NCAA--? OSA screening of players and coaches OSA disrupts academics, player abilities, physiological functions, quality of life Screening resistance?
Would you try to take the CPAP away from this guy? xxxxxx
High School Football Athletes No studies of incidence Assessment of HS athletes? None noted in the literature Need? Parental concern & involvement Would community education on the long-term effects of OSA on football athletes impact parents?
Obj 2: Characteristics of OSA athletes EDS Morning tiredness/headaches Loud snoring/choking sensations Large neck circumference Hypertension Memory difficulties/difficult focusing Depression Class III / IV Mallampati score Large BMI (Obese?)
The Bigger they are. Number of NFL Players > 300 lbs. 2012 2010 2009 2000 1990 1985 1980 1970 15 3 1 94 301 394 426 532 0 100 200 300 400 500 600
Weight of NC high school linemen 1 NC High School Athletic Association & the National Federation of State High School Association, 2013.
What is the best assessment tool for athletes? npsg HST Actigraphy Surveys PCP/Sleep Specialist (good notes) Whatever qualifies insurance?
Case Study npsg night 23 y.o., 6 4, 340 lbs, offensive lineman Sets 4 alarm clocks to wake up in am C/O: EDS, failing academics, sleeping in football meetings, tired on the field (esp. 3-4 quarters), loud snoring and gasping, hypertension (Rx), no dreams since 12 y.o. npsg Dx night 149 apnea events, 401 hypopneas AHI = 88.1 and RDI = 93.1 Lowest SpO2 66% and 76.1 arousal index
Case Study CPAP titration nite Titration from 8 up to 12 cmh20 AHI of 4.3 (supine, non-supine = 0) Lowest SpO2 = 92% Total arousal index = 8.7/hr REM rebound = 102 min Sleep architecture near normal following rebound
Case Study Follow-up Resolving OSA can resolve sequelae including cardiovascular issues Counseling the athlete on PAP High pressures can be reached to support high BMIs, but long-term improvement with weight loss Challenge athlete to look for improvements and report to trainer/ coach
Obj 3: Bring sleep wellness to your community Q: What is the key to OSA awareness? A: SDB Education Look for community opportunities to insert sleep hygiene and education on sleep Health fairs, wellness events Establish Sleep Wellness programs for local high schools and colleges with athletics
Q: What other athletic groups should be considered? Women s Softball Wrestling Weight-lifting Field athletes Any high BMI athletics
Sleep Wellness Program Community outreach to Joe/Jane Public Tap into grant opportunities that target specific people-groups Partner with local high schools, colleges, or universities with athletic programs and offer screening for coaching staff and students Get physicians on board in the community
Sleep Wellness Program Become the community resource regarding sleep education Speak at civic organizations Work with senior citizen groups Participate/sponsor city-wide wellness events to screen for SDB issues
It s a new day new challenges Think outside the box Be THE community resource on sleep Look for lasting, continuing relationships in the community like schools Get everyone Zzzz-healthy!
Thank you for your gracious attention! Gregg Marshall sm10@txstate.edu