Advertisement

Sleep-Disordered Breathing and Cardiovascular Correlates in College Football Players

      This study sought to determine the cardiovascular physiologic correlates of sleep-disordered breathing (SDB) in American-style football (ASF) participants using echocardiography, vascular applanation tonometry, and peripheral arterial tonometry. Forty collegiate ASF participants were analyzed at pre- and postseason time points with echocardiography and vascular applanation tonometry. WatchPAT (inclusive of peripheral arterial tonometry) used to assess for SDB was then performed at the postseason time point. Twenty-two of 40 (55%) ASF participants demonstrated SDB with an apnea-hypopnea index (pAHI) ≥5. ASF participants with SDB were larger (109 ± 20 vs 92 ± 14 kg, p = 0.004) and more likely linemen position players (83% vs 50%, p = 0.03). Compared with those without SDB, ASF participants with SDB demonstrated relative impairments in left ventricular diastolic and vascular function as reflected by lower lateral e′ (14 ± 3 vs 17 ± 3 cm/s, p = 0.007) and septal e′ (11 ± 2 vs 13 ± 2 cm/s, p = 0.009) tissue velocities and higher pulse wave velocity (5.4 ± 0.9 vs 4.8 ± 0.5 m/s, p = 0.02). In the total cohort, there were significant positive correlations between pAHI and pulse wave velocity (r = 0.42, p = 0.008) and inverse correlations between pAHI and the averaged e′ tissue velocities (r = −0.42, p = 0.01). In conclusion, SDB is highly prevalent in youthful collegiate ASF participants and associated with relative impairments in cardiac and vascular function. Targeted efforts to identify youthful populations with SDB, including ASF participants, and implement SDB treatment algorithms, represent important future clinical directives.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rice T.B.
        • Dunn R.E.
        • Lincoln A.E.
        • Tucker A.M.
        • Vogel R.A.
        • Heyer R.A.
        • Yates A.P.
        • Wilson P.W.
        • Pellmen E.J.
        • Allen T.W.
        • Newman A.B.
        • Strollo Jr, P.J.
        • National Football League Subcommittee on Cardiovascular H
        Sleep-disordered breathing in the National Football League.
        Sleep. 2010; 33: 819-824
        • George C.F.
        • Kab V.
        • Kab P.
        • Villa J.J.
        • Levy A.M.
        Sleep and breathing in professional football players.
        Sleep Med. 2003; 4: 317-325
        • Dobrosielski D.A.
        • Nichols D.
        • Ford J.
        • Watts A.
        • Wilder J.N.
        • Douglass-Burton T.
        Estimating the prevalence of sleep-disordered breathing among collegiate football players.
        Respir Care. 2016; 61: 1144-1150
        • Weiner R.B.
        • Wang F.
        • Isaacs S.K.
        • Malhotra R.
        • Berkstresser B.
        • Kim J.H.
        • Hutter Jr, A.M.
        • Picard M.H.
        • Wang T.J.
        • Baggish A.L.
        Blood pressure and left ventricular hypertrophy during American-style football participation.
        Circulation. 2013; 128: 524-531
        • Kim J.H.
        • Sher S.
        • Wang F.
        • Berkstresser B.
        • Shoop J.L.
        • Galante A.
        • Al Mheid I.
        • Ghasemzadeh N.
        • Hutter A.M.
        • Williams 3rd, B.R.
        • Sperling L.S.
        • Weiner R.B.
        • Quyyumi A.A.
        • Baggish A.L.
        Impact of American-style football participation on vascular function.
        Am J Cardiol. 2015; 115: 262-267
        • Baggish A.L.
        • Wang F.
        • Weiner R.B.
        • Elinoff J.M.
        • Tournoux F.
        • Boland A.
        • Picard M.H.
        • Hutter Jr, A.M.
        • Wood M.J.
        Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes.
        J Appl Physiol. 2008; 104: 1121-1128
        • Lin J.
        • Wang F.
        • Weiner R.B.
        • DeLuca J.R.
        • Wasfy M.M.
        • Berkstresser B.
        • Lewis G.D.
        • Hutter Jr, A.M.
        • Picard M.H.
        • Baggish A.L.
        Blood pressure and left ventricular remodeling among American-style football players.
        JACC Cardiovasc Imaging. 2016; 9: 1367-1376
        • Croft L.B.
        • Belanger A.
        • Miller M.A.
        • Roberts A.
        • Goldman M.E.
        Comparison of National Football League linemen versus nonlinemen of left ventricular mass and left atrial size.
        Am J Cardiol. 2008; 102: 343-347
        • Laurent S.
        • Cockcroft J.
        • Van Bortel L.
        • Boutouyrie P.
        • Giannattasio C.
        • Hayoz D.
        • Pannier B.
        • Vlachopoulos C.
        • Wilkinson I.
        • Struijker-Boudier H.
        • European Network for Non-invasive Investigation of Large A
        Expert consensus document on arterial stiffness: methodological issues and clinical applications.
        Eur Heart J. 2006; 27: 2588-2605
        • Yasmin
        • Brown M.J.
        Similarities and differences between augmentation index and pulse wave velocity in the assessment of arterial stiffness.
        QJM. 1999; 92: 595-600
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • Afilalo J.
        • Armstrong A.
        • Ernande L.
        • Flachskampf F.A.
        • Foster E.
        • Goldstein S.A.
        • Kuznetsova T.
        • Lancellotti P.
        • Muraru D.
        • Picard M.H.
        • Rietzschel E.R.
        • Rudski L.
        • Spencer K.T.
        • Tsang W.
        • Voigt J.U.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 16: 233-270
        • Mosteller R.D.
        Simplified calculation of body-surface area.
        N Engl J Med. 1987; 317: 1098
        • Zou D.
        • Grote L.
        • Peker Y.
        • Lindblad U.
        • Hedner J.
        Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography.
        Sleep. 2006; 29: 367-374
        • Bar A.
        • Pillar G.
        • Dvir I.
        • Sheffy J.
        • Schnall R.P.
        • Lavie P.
        Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies.
        Chest. 2003; 123: 695-703
        • Choi J.H.
        • Kim E.J.
        • Kim Y.S.
        • Choi J.
        • Kim T.H.
        • Kwon S.Y.
        • Lee H.M.
        • Lee S.H.
        • Shin C.
        • Lee S.H.
        Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100.
        Acta Otolaryngol. 2010; 130: 838-843
        • Epstein L.J.
        • Kristo D.
        • Strollo Jr, P.J.
        • Friedman N.
        • Malhotra A.
        • Patil S.P.
        • Ramar K.
        • Rogers R.
        • Schwab R.J.
        • Weaver E.M.
        • Weinstein M.D.
        • Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M
        Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
      1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.
        Sleep. 1999; 22: 667-689
        • Young T.
        • Finn L.
        • Peppard P.E.
        • Szklo-Coxe M.
        • Austin D.
        • Nieto F.J.
        • Stubbs R.
        • Hla K.M.
        Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort.
        Sleep. 2008; 31: 1071-1078
        • Shivalkar B.
        • Van de Heyning C.
        • Kerremans M.
        • Rinkevich D.
        • Verbraecken J.
        • De Backer W.
        • Vrints C.
        Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure.
        J Am Coll Cardiol. 2006; 47: 1433-1439
        • Lisi E.
        • Faini A.
        • Bilo G.
        • Lonati L.M.
        • Revera M.
        • Salerno S.
        • Giuli V.
        • Lombardi C.
        • Parati G.
        Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea.
        Int J Cardiol. 2015; 187: 686-692
        • Korcarz C.E.
        • Benca R.
        • Barnet J.H.
        • Stein J.H.
        Treatment of obstructive sleep apnea in young and middle-aged adults: effects of positive airway pressure and compliance on arterial stiffness, endothelial function, and cardiac hemodynamics.
        J Am Heart Assoc. 2016; 5: e002930
        • Garvey J.F.
        • Pengo M.F.
        • Drakatos P.
        • Kent B.D.
        Epidemiological aspects of obstructive sleep apnea.
        J Thorac Dis. 2015; 7: 920-929
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        • Weber S.
        • Badr S.
        The occurrence of sleep-disordered breathing among middle-aged adults.
        N Engl J Med. 1993; 328: 1230-1235
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        Longitudinal study of moderate weight change and sleep-disordered breathing.
        JAMA. 2000; 284: 3015-3021
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Skatrud J.
        Prospective study of the association between sleep-disordered breathing and hypertension.
        N Engl J Med. 2000; 342: 1378-1384
        • Nieto F.J.
        • Young T.B.
        • Lind B.K.
        • Shahar E.
        • Samet J.M.
        • Redline S.
        • D'Agostino R.B.
        • Newman A.B.
        • Lebowitz M.D.
        • Pickering T.G.
        Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study.
        JAMA. 2000; 283: 1829-1836
        • Chami H.A.
        • Devereux R.B.
        • Gottdiener J.S.
        • Mehra R.
        • Roman M.J.
        • Benjamin E.J.
        • Gottlieb D.J.
        Left ventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study.
        Circulation. 2008; 117: 2599-2607
        • Tavil Y.
        • Kanbay A.
        • Sen N.
        • Ulukavak Ciftci T.
        • Abaci A.
        • Yalcin M.R.
        • Kokturk O.
        • Cengel A.
        The relationship between aortic stiffness and cardiac function in patients with obstructive sleep apnea, independently from systemic hypertension.
        J Am Soc Echocardiogr. 2007; 20: 366-372
        • Jones A.
        • Vennelle M.
        • Connell M.
        • McKillop G.
        • Newby D.E.
        • Douglas N.J.
        • Riha R.L.
        Arterial stiffness and endothelial function in obstructive sleep apnoea/hypopnoea syndrome.
        Sleep Med. 2013; 14: 428-432
        • Tucker A.M.
        • Vogel R.A.
        • Lincoln A.E.
        • Dunn R.E.
        • Ahrensfield D.C.
        • Allen T.W.
        • Castle L.W.
        • Heyer R.A.
        • Pellman E.J.
        • Strollo Jr, P.J.
        • Wilson P.W.
        • Yates A.P.
        Prevalence of cardiovascular disease risk factors among National Football League players.
        JAMA. 2009; 301: 2111-2119