Cardiovascular disease risk in former National Football League players: Impact of obstructive sleep apnea

OBJECTIVES Obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are common among former National Football League (NFL) athletes. The Living Heart Foundation Heart-Obesity-Prevention-Education Group aimed to provide an in-depth health assessment for CVD risk factors among former NFL players to examine the role of OSA on blood pressure (BP) and echocardiographic measurements. We hypothesized that OSA, maladaptive echocardiographic measurements, and elevated BP would be highly prevalent in former NFL athletes, and that OSA presence would detrimentally impact echocardiographic parameters. METHODS One hundred fifty-three former NFL athletes were enrolled in the present study by the Living Heart Foundation. Participants (n = 86) completed a cardiovascular health assessment consisting of clinical BP readings and transthoracic echocardiography (TTE), which included measurements of ejection fraction, left atrial size, left ventricle diastolic diameter, intraventricular septal thickness, and ascending aortic diameter. Participants (n = 110) were offered an at-home overnight sleep test to estimate sleep apnea presence and severity. RESULTS Eighty percent (n = 80) of our sample exhibited at least mild OSA. Further, 34% (n = 29) displayed elevated intraventricular septal thickness and subclinical aortic dilation was present in 47% (n = 40) of retired NFL athletes. In a subanalysis of former players with at-home sleep apnea testing results and TTE measures (n = 43), NFL retirees with OSA demonstrated greater ascending aortic diameter compared to former NFL athletes without OSA (p = .048). CONCLUSIONS There is a high prevalence of suspected OSA, in addition to maladaptive cardiac remodeling, among retired NFL athletes. Aortic abnormalities may be related to untreated OSA in this population.