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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
� Web Video Link
- 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
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….
0 100 200 300 400 500 600
1970
1980
1985
1990
2000
2009
2010
2012
Number of NFL Players > 300 lbs.
1 3
15
94
301 394
532
426
Weight of NC high school linemen
1NC 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!