Sleep and breathing in professional football players

Objectives: To evaluate sleep in professional football players and describe clinical features of players at risk for sleep for sleep-disordered breathing (SDB). Methods: The Multivariable Apnea Prediction (MAP) index was used to stratify players into high (MAP greater than or equal to 0.5) and low (MAP < 0.5) risk for SDB. Players from both risk groups were randomly selected for overnight polysomnography, with over-sampling from the High-risk group. Of 302 players from eight professional football teams; 52 underwent attended polysomnography. Anthropometrics including neck circumference, airway size (Mallampati score, maxillary overjet) and sleepiness measured by Epworth scores (ESS) were recorded. The primary outcome measures were ESS and an apnea-hypopnea index (AHI) greater than or equal to 10. Results: Ninety-two percent of players were < 30 years old (mean (SD) age: 25.5 +/- 2.7 years) with large necks (45.2 +/- 3.6 cm) and elevated BMI (31.5 +/- 4.6). More than 20% of players had an ESS > 10 with ESS highest in habitual snorers. An AHI of ! 10 was found in 13 (34%, 95% confidence interval (CI) 21-50%) high-risk players but only one (7%,95% CI 1-31%) of 14 low-risk players. Offensive (9) or defensive (3) linemen accounted for the majority of the positive cases. Based on our sample, we estimate the prevalence of SDB to be 14% (2-25%). Conclusions: Excessive daytime sleepiness (EDS) is present in a large fraction of professional football players. Some but not all of this may be due to an increased prevalence of SDB. Further study is required to understand all of the factors responsible for EDS and to determine which of the biggest players will have SDB, which may impact not only performance and productivity but also future health. (C) 2003 Published by Elsevier B.V.