A systematic review on sleep-related breathing disorders in athletes and para-athletes

This comprehensive review aims to examine the frequency, consequences, risk factors, and treatment outcomes associated with sleep-related breathing disorders (SRBDs) among athletic populations.

A systematic literature search was conducted across seven databases from inception through July 2024.

Of 3925 studies captured in the search, 20 publications met the inclusion/exclusion criteria. The frequency of SRBDs (apnea-hypopnea index ≥5 events/hour) varied from 7 % to 86.5 %, according to sport modality: (a) 24 % to 86.5 % in rugby players (n = 4 studies); (b) 8 % to 62.5 % in active football players (n = 4); (c) 22 % to 41 % in retired football players (n = 4); (d) 8 % in basketball players (n = 1); (e) 30 % in elite swimmers (n = 1); (f) 61 % in ice hockey players (n = 1); (g) 68 % in judo athletes (n = 1); (h) 58.5 % in golf players (n = 1); (i) 7 % in Brazilian Olympic athletes (n = 1); and (i) 22 % in para-athletes with spinal cord injury (n = 1). Reported consequences (n = 9) included impaired cardiac function, depression, cognitive impairment, and excessive daytime sleepiness. Identified risk factors (n = 12) included: older age, male sex, high body mass index, heavy weight, large neck circumference, prior history of concussion, and playing the lineman or forward position. Treatment with continuous positive airway pressure (CPAP) therapy (n = 2) improved sleep quality, reduced daytime sleepiness, and enhanced athletic performance among golfers and judo athletes; mandibular advancement device (n = 2) reduced apnea severity and snoring among rugby players.

SRBDs occur frequently in athletic populations and pose significant health and performance implications if untreated. There is a paucity of research on SRBDs in para-athletes, which highlights a major knowledge gap.