A systematic review on sleep-related breathing disorders in athletes and para-athletes.
Level 3 - non-randomized controlled study
Systematic review consisting predominantly of observational prevalence and cohort studies rather than randomized trials
PubMed 41160949 · doi:10.1016/j.sleep.2025.106882
What was done
Authors systematically searched seven databases from inception through July 2024 to examine the frequency, consequences, risk factors, and treatment outcomes of sleep-related breathing disorders (SRBDs, defined as apnea-hypopnea index ≥5 events/hour) in athletic populations and para-athletes. Across 3,925 screened records, 20 publications met inclusion criteria.
What was found
SRBD frequency ranged from 7% to 86.5% across sports: - Rugby players: 24% to 86.5% (n = 4 studies) - Active football players: 8% to 62.5% (n = 4 studies) - Retired football players: 22% to 41% (n = 4 studies) - Judo athletes: 68% (n = 1 study) - Ice hockey players: 61% (n = 1 study) - Golf players: 58.5% (n = 1 study) - Elite swimmers: 30% (n = 1 study) - Para-athletes with spinal cord injury: 22% (n = 1 study) - Basketball players: 8% (n = 1 study) - Brazilian Olympic athletes: 7% (n = 1 study) Reported health consequences (n = 9 studies) included excessive daytime sleepiness, cognitive impairment, depression, and impaired cardiac function. Key risk factors (n = 12 studies) included older age, male sex, higher BMI, heavy weight, large neck circumference, prior concussion history, and playing forward or lineman positions. CPAP therapy (n = 2 studies) improved sleep quality, daytime sleepiness, and athletic performance; mandibular advancement devices (n = 2 studies) reduced apnea severity and snoring in rugby players.
Why it matters
SRBDs are prevalent in collision and high-body-mass sports, potentially impairing both cardiovascular health and athletic performance. Targeted screening based on neck circumference, BMI, and concussion history can identify athletes who may benefit from airway therapies.
Limits
Most individual sports were represented by only a single study, and only one study evaluated para-athletes. Interventional evidence was limited to four small studies, and the abstract does not report pooled effect estimates, risk of bias assessments, or total participant sample size.
Cited by
- context Approximately 50% of elite athletes have a clinical sleep disorder.