Athletes Can Suffer from Obstructive Sleep Apnea Too

Traits that make a professional athlete formidable, including increased BMI from upper-body muscular hypertrophy and large muscular necks, can also leave them gasping for breath as they sleep.

By Peter Blais, RPSGT

Dentists should screen athletic individuals and other patients who may not fit the obstructive sleep apnea (OSA) stereotype, says a physician and researcher who has studied OSA in athletes.

“Dentists see many patients who do not regularly access general health care from a physician,” Eric Mair, MD, FAAP, FACS, tells Dental Sleep Corner. “Dentists should ask simple questions to their patients. ‘Do you snore?’ Are you sleepy during the daytime?’” Mair is an otolaryngologist a contributor to the study “Does obstructive sleep apnea affect aerobic fitness?”, which analyzed the relationship between apnea and aerobic fitness among members of the US Air Force.

“Physicians primarily look for stereotypical obese body characteristics on physical exam when screening for OSA. The potential OSA diagnosis is often overlooked in athletic individuals,” he says. “Dentists primarily look for bruxism, worn dentition, periodontal disease, and TMJD [temporomandibular joint disorder]—all potentially associated with OSA. The dental physical exam does not discriminate athletic from non-athletic individuals.”

In fact, dentists can be as or potentially more effective in treating aerobically active OSA patients as their physician counterparts, Mair says. Dentists can incorporate validated screening questionnaires followed by simple inexpensive home sleep tests to help identify and treat OSA, Mair says. Mandibular repositioning devices (MRDs) managed by dentists can significantly improve quality of life and PSG parameters in patients with mild to moderate OSA. Athletic individuals with OSA tend to have hypopharyngeal obstruction, which is well treated by MRDs, Mair says, adding that many athletes are already comfortable wearing mouthguards (similar to MRDs) and that nighttime MRDs are generally well-tolerated in many athletes.

Athleticism/being muscular can in some ways put men and women at risk of OSA, Mair notes. “The traits that make a professional athlete or highly conditioned soldier formidable on the gridiron or battlefield, including increased BMI from upper-body muscular hypertrophy and large muscular necks, can leave them vulnerable while gasping for breath as they sleep. Our large study 10 years ago measuring aerobic fitness by maximum oxygen consumption with cycle ergometry in Air Force personnel found that OSA does not predict a decrease in aerobic activity.”

Eric Mair, MD

A study this year, he continues, estimated OSA prevalence at 8% among collegiate football players. Another study revealed that young NFL football linemen have a 34% prevalence of OSA. Physical characteristics of athletes that are associated with maximal performance may predispose these same athletes to OSA.

This runs against the normal stereotype that obese individuals are the obvious stereotypes for OSA, Mair notes. Medical providers may tend to overlook that athletic muscular men and women may also have OSA. But “if an athlete has signs of OSA, we need to diagnose and treat early. Over 75% of moderate to severe OSA remains undiagnosed. This impairs quality of life and leads to cardiovascular disease, hypertension, stroke, diabetes, altered mental status, and depression,” Mair says.

“Optimal care for OSA is found where dentists and physicians work together identifying patients at risk for OSA,” he concludes. “As an otolaryngologist treating sleep patients, I am well versed in PAP [positive airway pressure] and surgical therapy. However, I commonly send athletic/muscular men and women with mild or moderate OSA to my dental colleagues for MRDs. My dental friends will commonly refer those patients who fail MRDs to me for other therapy. Working together provides superior results with less invasive therapy.”

Mair is a board-certified otolaryngologist with two fellowships in pediatric otolaryngology. His practice specializes in minimally invasive surgery for sinusitis, airway, and sleep-disordered breathing in both children and adults. He is a recipient of multiple Best Doctors awards both locally and nationally. He is a clinical professor at the University of North Carolina and is principal investigator of several clinical research protocols at Charlotte Eye Ear Nose & Throat Associates PA.