Sleep Apnea, Concussions and Dementia in the NFL

There's been a lot of media coverage recently about the high incidence of dementia in retired NFL pros. One report using a phone survey of retired NFL players revealed that the incidence of dementia or memory-related problems was 19 times higher than normal for men ages 30 to 49. Repeated head trauma is thought to create conditions that significantly increases the chances of developing dementia. A number of states are even enacting legislation that sets certain criteria for removing high school football players after any head injury with prompt and proper medical evaluation.

While these concerns are legitimate, I think the NFL officials are missing a very important piece of the puzzle, and that's the very high incidence of obstructive sleep apnea in current and retired pro football players. One recent Mayo Clinic study showed that 60% of all retired linemen and 46% of all other positions were found to have significant obstructive sleep apnea. Amongst active players in 2003, the overall numbers were 14% and 34% with linemen.

 

If you look at what happens to the brain with repeated episodes of hypoxia during apneas, then you'll see that the implications are profound. Untreated patients with sleep apnea are found to have multiple areas of dead or non-functioning brain tissues. Another similar study showed multiple areas of microscopic strokes, called lacunar infarcts. Chronic hypoxia in mice resulted in brain biopsy studies revealing amyloid plaques (similar to what we see with Alzheimer's disease). 

 

So with this logic, it makes sense that repeated concussions in someone with untreated obstructive sleep apnea is more likely to suffer from the cumulative effects of head trauma compared with someone without sleep apnea. As with everything else in medicine, diseases never exist alone in a vacuum. It would be interesting if they did a study looking at the incidence of obstructive sleep apnea in these ex-players with dementia. I'm willing to bet a very high percentage will have undiagnosed obstructive sleep apnea. Another, more costly and ambitious study would be to screen all current NFL players for sleep apnea and follow them for years (or decades) while undergoing proper treatment, measuring their rate of progression to developing dementia. 

 

What do you think about this issue? Should be continue treating medical conditions in isolation, or look at other co-morbid conditions that can aggravate the original diagnosis? Please enter your comments in the text area below.


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3 thoughts on “Sleep Apnea, Concussions and Dementia in the NFL

  1. The answer seems so obvious. Since learning about the prevalence and seriousness of CPAP, I am reading dozens of medical studies which reach conclusions without ever controlling for SDB. If they did control for SDB, I think the majority of the studies would reach different conclusions.
    Dr. Park, You are doing a great job to create awareness. I am sure many of us who suffered from undiagnosed sleep apnea for years are reading your book and articles. I just hope medical professionals are also reading them.

  2. As a  mid 5o's guy who played and received multiple concusions while playing football and rugby… I've presented with many of these symptoms and combination of conditions,study in  this is an area is needed…

  3. I have OSA as well as central apnea that I am treating with BiPAP. Before the BiPAP I was using an oral appliance and was having several headaches. I was hit by a truck on the way to work last summer in 2010 but I did not hit my head. Afterwards I had and are still having mind fog symptoms. I have been trying to figure out whether the apnea in combination with the shock of the accident has led to my continued brain fog.