Can Treating Obstructive Sleep Apnea Improve Sports Performance?

Obstructive sleep apnea is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. Obstructive sleep apnea occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

Obstructive sleep apnea is increasingly recognized for its wide-ranging effects on physical and mental health. Obstructive sleep apnea can have a profound negative impact on sleep quality, daytime alertness, mood, and cardiovascular health, and effects on metabolic and endocrinologic parameters. There is little known about the prevalence and presentation of obstructive sleep apnea in sports participants and its potential effect on athletic performance. Obstructive sleep apnea can lead to daytime sleepiness, fatigue, and cognitive impairment, all side effects which could negatively impact a sportsperson’s performance.

Recent research has shown that golfers who undergo treatment for obstructive sleep apnea could improve their golf game as well as their overall health. The study found that golfers with obstructive sleep apnea who received nasal positive airway pressure (NPAP) for their disorder improved their daytime sleepiness scores and lowered their golf handicap by as much as three strokes.

The researchers evaluated the impact of NPAP on the golf handicap index (HI) of 12 golfers with diagnosed moderate to severe obstructive sleep apnea. HI was recorded upon study entry, as was the Epworth sleepiness scale (ESS), a validated questionnaire used to assess daytime sleepiness, and a sleep questionnaire (SQ) developed by the authors. After 20 rounds of golf while receiving NPAP treatment (approximately 3 to 5 months), the treatment group demonstrated a significant drop in average HI, 12.4 (+/- 3.5) to 11.0 (+/- 4.7). Patients in the study group also improved their ESS score, 11.8 (+/- 6.6) to 5.5 (+/- 3.6), and the SQ score, 14.3 (+/- 7.5), to 3.1 (+/- 3.1). A control group of 12 subjects demonstrated no change in HI, ESS score, or SQ score during this study.

"As any golfer knows, when your ability to think clearly or make good decisions is compromised, the likelihood of playing your best is greatly diminished," said study author Dr. Marc L. Benton. "Through treatment with NPAP, we can improve many cognitive metrics, such as attention span, memory, decision-making abilities, and frustration management, which may, in turn, positively affect a person's golf game."

Results of the study also showed that the best golfers, defined as HI <12, had the biggest improvements in their game. Within this group, the average HI dropped from 9.2 (+/- 2.9) to 6.3 (+/- 3.0); the SQ score from 10.8 (+/- 1.9), to 2.8 (+/- 2.6).

"The biggest handicap improvements occurred in the lower handicap, often older golfers. This group typically would be expected to trend in the opposite direction due to age-related deterioration in strength and endurance," said co-author Neil S. Friedman. "The drop in handicap among the better golfers probably reflected that the major limiting factor was not golf skill but cognitive compromise that improved when the sleep apnea was treated." Dr. Benton estimates that there are 1 to 3 million regular golfers (regular defined as 10 or more rounds per year) who have obstructive sleep apnea, and most are undiagnosed or untreated.
References:
1. Emsellem HA, Murtagh KE. Sleep apnea and sports performance. Clin Sports Med. 2005 Apr;24(2):329-41, x. PMID: 15892927.
2. Marc L. Benton, et al. American College of Chest Physicians.

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