From the Guidelines
Patients with obstructive sleep apnea (OSA) should undergo comprehensive sleep assessment and treatment before receiving sports clearance, with treatment typically involving continuous positive airway pressure (CPAP) therapy or alternative therapies such as mandibular advancement devices or positional therapy, as recommended by the European Respiratory Society guideline on non-Cpap therapies for obstructive sleep apnoea 1.
Key Considerations for Sports Clearance
- Athletes with suspected or confirmed OSA should be evaluated and treated before participating in sports to minimize the risk of cardiovascular strain, impaired recovery, and cognitive function impairment during exercise.
- Treatment should be tailored to the individual, with CPAP therapy being the first-line treatment for most patients, and alternative therapies considered for those who cannot tolerate CPAP or have mild OSA.
- Athletes should demonstrate adequate symptom control, including reduced daytime sleepiness (Epworth Sleepiness Scale <10), before returning to full sports participation.
- Follow-up sleep studies may be necessary to confirm treatment efficacy and ensure that the athlete's OSA is well-controlled.
Importance of Treatment Before Sports Participation
The rationale for treating OSA before sports clearance is that untreated sleep apnea can increase the risk of injury, cardiovascular events, and other adverse outcomes during exercise, as noted in the American College of Physicians guideline on management of OSA in adults 1.
Recommendations for Athletes with OSA
- Athletes with well-controlled OSA can participate in all sports without restrictions, but should maintain regular follow-up with their sleep specialist to ensure that their condition remains well-controlled.
- Athletes with uncontrolled OSA or those who are not adhering to their treatment plan shouldn't participate in sports that require high levels of alertness or physical exertion, as recommended by the European Respiratory Society guideline on non-Cpap therapies for obstructive sleep apnoea 1.
From the Research
OSA and Sports Clearance
- The relationship between Obstructive Sleep Apnea (OSA) and sports clearance is complex, with several factors to consider when evaluating an individual's fitness for athletic participation 2.
- Studies have shown that OSA can have a negative impact on sleep quality, daytime alertness, mood, and cardiovascular health, all of which can affect athletic performance 2.
- However, research has also suggested that OSA may not necessarily predict a decrease in aerobic fitness, as measured by cycle ergometry, in individuals with mild to moderate OSA 3.
- In fact, one study found that individuals with OSA had increased maximum oxygen consumption (VO2max) compared to a normal population, although those with more severe OSA (apnea-hypopnea index > 20) had decreased VO2max 3.
- When considering sports clearance for individuals with OSA, it is essential to assess their overall health and fitness, including their aerobic capacity, as well as the severity of their OSA and the effectiveness of their treatment 2, 4.
- Treatment of OSA with positive airway pressure (PAP) therapy has been shown to improve sleep quality, reduce daytime sleepiness, and decrease the risk of cardiovascular complications, all of which can impact athletic performance 5, 4.
- Additionally, alternative treatment options, such as oral appliances, implantable and wearable devices, and surgery, may also be effective in managing OSA and improving athletic performance 5.
Key Considerations for Sports Clearance
- The severity of OSA, as measured by the apnea-hypopnea index, should be taken into account when evaluating an individual's fitness for athletic participation 3.
- The effectiveness of OSA treatment, including PAP therapy and alternative options, should also be considered when assessing an individual's overall health and fitness 5, 4.
- Aerobic capacity, as measured by cycle ergometry, may be an important factor in evaluating an individual's fitness for athletic participation, particularly in sports that require high levels of endurance 3.
- Further research is needed to fully understand the relationship between OSA and athletic performance, as well as the impact of OSA treatment on sports clearance 2, 3.