Obstructive Sleep Apnea (OSA) poses a significant, often underestimated threat to the health and performance of college football players. The convergence of unique physiological demands, training regimens, and anthropometric characteristics creates a perfect storm, predisposing these athletes to OSA at rates far exceeding the general population. This report synthesizes current research, highlighting the prevalence, risk factors, impact, diagnostic protocols, and potential interventions for OSA in college football players, while also identifying critical gaps in our understanding.
1. Documented prevalence rates
College football players exhibit a markedly elevated prevalence of OSA compared to their non-athletic peers.
University of Colorado study
A University of Colorado School of Medicine at Colorado State University study revealed that 35% of college football players presented clinically defined mild to moderate OSA, contrasting sharply with the estimated 9-25% in the general population (Broussard et al., 2023).
Meta-analysis on contact sports
A meta-analysis focusing on contact sports, conducted by Howarth et al. (2022), demonstrated an overall OSA prevalence of approximately 30% (95% CI: 24-36%) across various contact sports. Within this cohort, American football players specifically showed a prevalence of 29% (95% CI: 22-36%), a figure significantly exceeding the 2-4% typically reported in the general population.
Photoplethysmography study
Using photoplethysmography, Dobrosielski et al. (2016) estimated the prevalence of Sleep-Disordered Breathing (SDB), a broader category that includes OSA, among collegiate football players to be 8%.
2. Comparative prevalence athletes vs. non-athletes
The elevated OSA rates in college football players become even more stark when compared to other athletic groups and the general male population.
Comparison to other athletes
While precise OSA prevalence data for other specific athletic groups remains limited, studies consistently show that contact sport athletes, particularly football players, face a disproportionately higher risk compared to non-contact sport athletes and the general population.
Contact sports vs. general population
A systematic review by Howarth et al. (2022) indicated that the prevalence of OSA in contact sports is significantly higher than that reported in the general population (30% vs. 2-4%).
Linemen vs. track athletes
Peck et al. (2019) provided further evidence, demonstrating that college football linemen exhibit significantly greater risk factors for SDB compared to track athletes, highlighting the influence of sport-specific demands on OSA risk.
3. Anthropometric characteristics and OSA risk
Specific anthropometric measurements serve as critical indicators of OSA risk in college football players.
Neck circumference
George et al. (2003) reported a mean neck circumference of 45.2 ± 3.6 cm in professional football players diagnosed with OSA.
Body mass index and waist circumference
Peck et al. (2019) found that college football linemen had a mean neck circumference of 44.36 cm, a waist circumference of 107.07 cm, and a BMI of 35.87 kg/m2, all significantly exceeding those of track athletes.
BMI threshold
A BMI exceeding 30 kg/m2 is frequently observed in linemen with OSA, further emphasizing the link between obesity and OSA risk in this population.
4. Positional correlations with OSA risk
Certain player positions, particularly linemen, exhibit a significantly higher propensity for developing OSA.
Linemen vs. non-linemen
Albuquerque et al. (2010) found that defensive linemen were more likely to have SDB (61% vs. 46%; p= 0.02) than non-linemen, underscoring the positional influence on OSA risk.
Dominance of linemen
Kim et al. (2017) corroborated these findings, reporting that 83% of football players with Sleep Disordered Breathing were linemen.
Reasons for positional disparity
These positional disparities likely stem from the unique physical demands placed on linemen, who often carry greater body mass and exhibit larger neck circumferences to excel in their roles.
5. Impact of undiagnosed/untreated OSA on athletic performance and cognitive function
The consequences of undiagnosed and untreated OSA extend far beyond mere daytime sleepiness, significantly impairing athletic performance and cognitive function.
Sleep deprivation impact
Sleep deprivation, a hallmark of untreated OSA, can lead to a staggering 50% reduction in accuracy for tasks demanding precision and focus, such as basketball free throws and three-pointers (Knowlden et al., 2023).
Reaction time and cognitive function
OSA-induced sleep fragmentation and hypoxia result in reduced reaction time and impaired cognitive function, directly affecting decision-making, focus, and overall game performance. Tuomilehto et al. (2017) demonstrated significantly reduced reaction times in sleep-deprived athletes. This phenomenon is not limited to football – even elite players like Kylian Mbappe suffering from a mental problem can see their performance affected by sleep issues.
Academic performance
Studies have also linked OSA to poor academic performance, which can make a student ineligible to compete in after-school activities (Owens, 2009). Similar to how Wembanyama’s back injury sidelines him from competition, untreated OSA can remove players from both academic and athletic participation.
6. Cardiovascular consequences of OSA in football players
OSA’s impact on cardiovascular health presents a serious long-term threat to college football players.
Hypertension and arterial stiffening
Untreated OSA is strongly associated with hypertension, arterial stiffening, and reduced left ventricular function. Kim et al. (2017) documented relative impairments in left ventricular diastolic and vascular function in ASF participants with SDB.
Mortality risk for linemen
Albuquerque et al. (2010) reported that linemen were three times more likely to die of heart disease than non-linemen and had a 52% higher risk of cardiovascular death compared to the general population.
Urgency of intervention
These cardiovascular complications underscore the urgent need for early detection and intervention to mitigate long-term health risks. Just as Neymar’s new injury with Al Hilal requires immediate medical attention, so too does the silent but dangerous condition of OSA in football players.
7. Recommended screening and diagnostic protocols
Implementing effective screening and diagnostic protocols is crucial for identifying and managing OSA in college football players.
Pre-season evaluations
Incorporate comprehensive OSA risk assessments as a standard component of pre-season physicals.
Questionnaires
Utilize validated questionnaires such as the STOP-BANG to assess OSA risk. A STOP-BANG score of ≥3 indicates high risk (Chung et al., 2008).
Wearable devices
Employ wearable devices like the WatchPAT 300 to capture data for the Apnea-Hypopnea Index (AHI). An AHI ≥ 5 is considered abnormal and warrants further investigation.
Polysomnography gold standard
In-lab sleep studies remain the gold standard for definitive OSA diagnosis. According to the American Academy of Sleep Medicine (AASM) guidelines, an AHI ≥ 5 is diagnostic for OSA (Epstein et al., 2009).
8. Effective treatment modalities for athletes with OSA
A range of treatment modalities can effectively manage OSA in athletes, improving their sleep quality, athletic performance, and overall health.
CPAP therapy
CPAP (Continuous Positive Airway Pressure) therapy remains the primary treatment, delivering continuous airflow to maintain open airways during sleep, improving oxygenation, and reducing sleep disturbances. Korcarz et al. (2016) found that PAP therapy improves arterial stiffness and endothelial function.
Oral appliances
Mandibular advancement devices (MADs) can be a viable alternative for athletes who cannot tolerate CPAP. A study by Caia et al. (2020) showed that MAD therapy significantly improved the Respiratory Event Index (p < 0.01), SpO2 min (p < 0.001), and ESS score (p < 0.001).
Lifestyle changes
Weight management, improved sleep hygiene, and positional therapy can complement other treatment modalities.
9. Preventative strategies and policy recommendations
Proactive preventative strategies and policy recommendations are essential for addressing the root causes of OSA and mitigating its impact on college football players.
Mandatory screening
Implement mandatory OSA screening programs for all college football players, particularly linemen.
Education and awareness
Provide comprehensive education on sleep hygiene, the risks of untreated OSA, and the importance of early intervention.
Weight management
Encourage healthy weight management and fitness through tailored nutrition plans and training programs.
Training for staff
Promote awareness among coaches, athletic trainers, and team physicians, empowering them to recognize OSA symptoms and encourage athletes to seek evaluation and treatment.
10. Critical research gaps
Despite significant progress in understanding OSA in college football players, several critical research gaps remain.
Longitudinal studies
Longitudinal studies are needed to comprehensively assess the long-term health consequences of OSA in former college football players, including cardiovascular, neurological, and metabolic outcomes.
Impact of head trauma
Further investigation is warranted to elucidate the impact of head trauma, a common occurrence in football, on OSA development and progression.
Scalable screening approaches
More research is needed to identify effective and scalable screening approaches that can be readily implemented in resource-constrained athletic settings.
Treatment effectiveness studies
Studies are needed to evaluate the effectiveness of different treatment modalities, including CPAP, oral appliances, and lifestyle interventions, in this specific population.
11. Enhanced table presentation
Summary table
| Dimension | Key Findings |
|---|---|
| Prevalence | 35% in college football players (CU study), compared to 9-25% in general population; 29% in American football (Howarth et al., 2022); 8% SDB using photoplethysmography (Dobrosielski et al., 2016). |
| Risk Factors | BMI > 30 kg/m2, neck circumference > 45 cm (George et al., 2003), lineman position, high Multivariable Apnea Prediction Index (0.78) (Peck et al., 2019). |
| Impact | Up to 50% drop in athletic accuracy (Knowlden et al., 2023), increased cardiovascular risk (Kim et al., 2017), cognitive decline, increased injury risk (Raikes et al., 2019). |
| Diagnosis | STOP-BANG questionnaire (score ≥3 indicates high risk) (Chung et al., 2008), WatchPAT 300 (AHI ≥ 5), polysomnography (AASM guidelines). |
| Treatment | CPAP (Korcarz et al., 2016), oral appliances (Caia et al., 2020), weight management, positional therapy. |
| Research Gaps | Longitudinal studies, impact of head trauma, scalable screening approaches, effectiveness of treatment modalities. |
The alarmingly high prevalence of OSA among college football players demands immediate and comprehensive action. By implementing proactive screening programs, promoting education and awareness, and addressing modifiable risk factors, we can safeguard the health and well-being of these athletes. The intersection of athletic prowess and sleep-disordered breathing presents a unique challenge requiring concerted effort from sports medicine physicians, athletic trainers, coaches, and researchers to ensure the long-term health and success of these dedicated athletes.
