Sleep-apnea risk and subclinical atherosclerosis in early-middle-aged retired National Football League players

Faith S Luyster,¹ Reginald E Dunn,² Diane S Lauderdale,³ Mercedes R Carnethon,⁴ Andrew M Tucker,⁵ Robert A Vogel,⁶ Andrew E Lincoln,² Kristen L Knutson,⁷ Elliot J Pellman,^8–10 Patrick J Strollo Jr<sup>11

1</sup>School of Nursing, University of Pittsburgh, Pittsburgh, PA, ²Sports Medicine Research Center, MedStar Health Research Institute, Baltimore, MD, ³Department of Public Health Sciences, University of Chicago, ⁴Department of Preventive Medicine, Northwestern University, Chicago, IL, ⁵MedStar Sports Medicine, MedStar Union Memorial Hospital, Baltimore, MD, ⁶Cardiology Section, Department of Veterans Affairs Medical Center, Denver, CO, ⁷Department of Medicine, University of Chicago, Chicago, IL, ⁸ProHealth Care Associates, Lake Success, ⁹Department of Medicine, ¹⁰Department of Orthopedics, Mount Sinai School of Medicine, New York, NY, ¹¹Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Purpose: Limited data from former National Football League (NFL) players suggest that obstructive sleep apnea (OSA) may be highly prevalent after retirement. It remains unclear whether the high prevalence of OSA in retired players is comparable to nonathletes. This retrospective analysis compared sleep apnea (SA) risk in retired NFL players to a community cohort (CARDIA Sleep study), and examined associations between SA risk and cardiovascular risk factors, including subclinical atherosclerosis.
Materials and methods: Retired NFL players (n=122) were matched to CARDIA Sleep participants by age ±2 years (range 37–55 years), body mass index ±2 kg/m², race, and male sex. Participants underwent electron-beam computed tomography to measure coronary artery calcium (CAC) and completed the Berlin Questionnaire to determine SA risk. The presence of CAC was defined as an Agatston score >0.
Results: Retired NFL players had a greater prevalence of high SA risk than the matched CARDIA Sleep participants (27% vs 11.5%, P=0.002). Compared to the CARDIA Sleep participants, retired players were less likely to smoke, and had higher blood pressure, lower fasting glucose levels, and higher cholesterol levels. However, there was no difference in the prevalence of detectable CAC (30% vs 30%, P=1). In both players and the community cohort, SA risk was not significantly associated with CAC after controlling for age, race, and body mass index.
Conclusion: Retired NFL players have a greater prevalence of high SA risk but similar prevalence of CAC compared with a well-matched community cohort.

Keywords: sleep apnea, cardiovascular risk, coronary artery calcium, national football league