Why this matters
Professional football players are at increased risk for OSA based on major risk factors, including male sex, high body mass index (BMI), and large neck circumference.
Sleep disorders that are undiagnosed and therefore untreated are associated with daytime sleepiness, mood, and cognitive and cardiovascular outcomes, such as high blood pressure and heart attacks.
In 2018, my book titled Not For Long: The Life and Career of The NFL Athlete was published by Oxford University Press. The book manuscript, which grew out of my graduate school dissertation project, seeks to explain why so many athletes experience difficulties in their transition to life after football.
While I was conducting field research for the project, the lives of several current and former NFL athletes were cut short due to tragic circumstances. This was also around the time that the blockbuster movie Concussion, starring Hollywood actor Will Smith, began drawing attention to the dangers of football-related head trauma.
While the public grappled with concerns over concussions and a new disease called chronic traumatic encephalopathy (CTE), something kept drawing me back to news reports from a decade earlier. Like many sports fans across the country, I had been shocked when NFL Hall of Fame defensive end Reggie White died in his sleep at age 43. Perhaps the news was so devastating to me because Reggie and I were members of the same Memphis Showboats draft class of the now-defunct United States Football League.
At the time and for several years following, the disease—sleep apnea—was foreign to me. It was not until my fellowship in sleep and behavioral medicine that I began to understand just how serious sleep apnea is to men like me.
Sleep apnea, or obstructive sleep apnea (OSA), is a highly prevalent sleep disorder characterized by repeated pauses (apneas or hypopneas) in breathing during sleep. As a form of sleep disorder breathing (SDB), OSA is particularly prevalent among elderly populations, older men, and racial minority groups (Black/African American, Hispanic, and Asian). Some experts estimate as many as 90 percent of individuals with sleep apnea are undiagnosed.
Professional football players are at increased risk for OSA based on major risk factors, including male sex, high body mass index (BMI), and large neck circumference. Sleep disorders that are undiagnosed and therefore untreated are associated with daytime sleepiness, mood, and cognitive and cardiovascular outcomes, such as high blood pressure and heart attacks.
It is estimated that among current and former NFL athletes, the prevalence of OSA ranges from 14 percent to 34 percent, with the latter figure representing a high-risk group of offensive and defensive linemen. Both estimates are higher than what is generally seen among men of comparable age in the general public. Previous studies that examined OSA in NFL athletes were limited in size; as a result, it is highly plausible this disease affects more football players than initially observed. The Study of Retired NFL Players (SRNFLP), which was conducted by faculty at the University of Michigan, confirms reports that, in addition to OSA, former NFL athletes are at increased risk of suffering from other SDB-related diseases. However, this problem is not limited to the NFL community. The American Academy of Sleep Medicine (AASM) advises that young football players are increasingly at risk of sleep apnea. With the increase in the number of high school and college lineman weighing more than 300 pounds, medical professionals expect OSA and SDB to become more prevalent.
We now know that, as an African American male who stood at 6 feet, 5 inches and weighed 300 pounds, Reggie White faced a combination of factors that put him at high risk for OSA and SDB. Growing evidence demonstrates that Black/African American men are disproportionately burdened by poor sleep (i.e., short sleep duration, poor sleep quality) and sleep apnea.
Preliminary data drawn from the Jackson Heart Study Sleep Ancillary—which investigated the risk factors and cardiovascular consequences of sleep apnea among Black/African Americans—has shown that 95 percent of the study of sample (N=852) had undiagnosed sleep apnea. At age 43, Reggie was also among a cohort of Black men (aged 38-50) that experienced the shortest sleep duration (5.1 hours per night) of any demographic group.
These conditions, left unrecognized and untreated, could have profound detrimental effects on Black/African American men’s health, performance and productivity. In order to reduce the subsequent health burden of OSA and SDB, it is imperative for researchers to target intervention strategies that promote sleep health, screening and treatment of sleep apnea, and SDB among this vulnerable population of men.
When Dr. Scott Brooks, Director of the Global Sport Institute at Arizona State University (GSI), first contacted me about accepting an appointment as an ASU visiting faculty fellow, I presented the idea of conducting a sleep apnea study. Without hesitation, Dr. Brooks enthusiastically responded, “Let’s do it.”
GSI is dedicated to supporting meaningful research that advances the health and welfare of athletes of all ages. With support from GSI, I am working with a team of talented researchers to conduct a mixed methods study that directly informs the design of an athlete-led intervention to promote the screening and treatment of sleep apnea among Black/African American men and current and former collegiate football players and NFL athletes.
Our overall goal is to produce a media campaign consisting of a series of public service announcement (PSA) videos that encourage men to be screened and treated for OSA and SDB, which may improve overall health and well-being as well as cardiovascular outcomes.
Dr. Robert W. Turner II is an Assistant Professor at The George Washington University School of Medicine and Health Sciences in the department of Clinical Research and Leadership, with a secondary appointment in the department of Neurology. His interest in OSA and SDB developed while he was a fellow in the New York University Behavioral Medicine and Sleep Disorders Training Institute, with financial support from the National Heart, Lung, and Blood Institute (NHLBI).