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!

Thank you for your gracious attention!

Gregg Marshall

sm10@txstate.edu