Sleep Apnea Affects Nearly 70 Percent of Former Professional Football Players

Sleep Disordered Breathing and Neuropsychiatric Health in Former Athletes

Former professional athletes who participated in collision sports navigate a complex landscape of long term health risks, particularly regarding cognitive and psychological well being. While clinical attention often focuses on the sequelae of repetitive head impacts and the potential for neurodegenerative disease [1, 2], comorbid conditions frequently complicate the diagnostic picture. Mental health disorders and sleep inadequacies are common among elite competitors, yet these issues are often underreported or attributed to other etiologies [3, 4]. Recent evidence from a survey of 502 participants suggests that former collegiate athletes in high contact sports exhibit significantly higher rates of sleep apnea (p = 0.02) and neuropsychiatric complaints, such as memory loss (p < 0.01) and anxiety (p = 0.04), compared to non contact peers [5]. Furthermore, untreated medical conditions may exacerbate the clinical features of traumatic encephalopathy syndrome (a condition characterized by cognitive impairment and neurobehavioral dysregulation), as affected players are twice as likely to report coexisting disorders (OR 2.04; 95% CI, 1.25 to 3.47) [6]. A new study of 1,951 former professional players now examines the prevalence of sleep apnea, which may affect up to 69 percent of this population, and its specific impact on symptom burden [7].

High Prevalence of Undiagnosed Sleep Apnea

The researchers conducted a cross-sectional survey between 2017 and 2020 as part of the Football Players Health Study at Harvard University, capturing data from a cohort of 1,951 former professional American-style football players who signed professional contracts after 1960. The study evaluated football-related exposures, specifically focusing on player position and career duration, alongside sleep health metrics. To identify those at risk, the authors utilized the STOP-BANG screening tool (a validated eight-item questionnaire assessing snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck circumference, and gender). Among the 1,951 participants, 31.8 percent (n = 621) self-reported a prior clinical diagnosis of sleep apnea. Statistical analysis indicated that these diagnoses were significantly associated with older age, Black race, and playing the lineman position. Furthermore, a higher number of football-accrued concussion symptoms (the total count of symptoms experienced during practice or play) correlated with a higher likelihood of a sleep apnea diagnosis. Of the 1,330 participants without a current diagnosis, 74.6 percent (n = 992) scored in the intermediate or high range on the STOP-BANG screening tool, indicating a high probability of undiagnosed disease. By combining known diagnoses with these high-risk screening results, the researchers estimate that the actual prevalence of sleep apnea among former professional football players may be as high as 69 percent. This discrepancy suggests that more than half of the affected individuals in this cohort may be currently untreated, potentially complicating their long-term cognitive and psychological health.

The Impact of Untreated Sleep Apnea on Neuropsychiatric Symptoms

To isolate the effect of sleep health while accounting for multiple confounding variables, the researchers utilized multivariable logistic and linear regression models (statistical techniques that determine the relationship between a primary variable and an outcome while holding other factors constant). These models examined the relationship between sleep health and recent symptoms of mood, cognition, and pain, while adjusting for head injury exposure measured by the total number of concussion symptoms accrued during a career. The multivariable models demonstrated that both a formal sleep apnea diagnosis and intermediate or high scores on the STOP-BANG screening tool were associated with increased pain, anxiety, depression, and cognitive symptoms. A critical finding emerged regarding the management of the condition: participants with diagnosed but untreated sleep apnea reported the highest symptom burden across all measured categories (all p < 0.001). These findings indicate that mood, pain, and cognitive symptoms are exacerbated in former players with treated, undertreated, or suspected sleep apnea. For the practicing clinician, these data suggest that sleep-disordered breathing may be a significant, modifiable contributor to the complex neuropsychiatric presentations often seen in former contact-sport athletes, rather than these symptoms being solely attributable to past head trauma.

Low Adherence to Positive Airway Pressure Therapy

The study highlights a significant gap between clinical diagnosis and effective management of sleep-disordered breathing in this population. Among the 621 participants who had already received a formal diagnosis of sleep apnea, only 39.8 percent (n = 247) reported using their positive airway pressure therapy four or more times per week. This low rate of adherence is particularly concerning given that the researchers identified the highest symptom burden in those with diagnosed but untreated sleep apnea. For the practicing physician, these data suggest that simply diagnosing the condition is insufficient; longitudinal follow-up and targeted strategies to improve compliance with positive airway pressure are essential to mitigating the associated neuropsychiatric and physical symptoms. Because 74.6 percent (n = 992) of undiagnosed players scored in the intermediate or high range on the STOP-BANG, a high index of suspicion is warranted during routine examinations. For clinicians, these results indicate that screening for sleep apnea should be a routine component of the clinical workup for former contact-sport athletes who present with complaints of depression, anxiety, or cognitive impairment. Addressing sleep health may provide a modifiable pathway to improve quality of life and symptom management in a patient population often presumed to be suffering solely from the irreversible effects of past neurological trauma.

References

1. Patricios J, Schneider K, Dvořák J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine. 2023. doi:10.1136/bjsports-2023-106898

2. Alosco ML, White M, Bell C, et al. Cognitive, functional, and neuropsychiatric correlates of regional tau pathology in autopsy-confirmed chronic traumatic encephalopathy. Molecular Neurodegeneration. 2024. doi:10.1186/s13024-023-00697-2

3. Walsh NP, Halson SL, Sargent C, et al. Sleep and the athlete: narrative review and 2021 expert consensus recommendations. British Journal of Sports Medicine. 2020. doi:10.1136/bjsports-2020-102025

4. Reardon CL, Hainline B, Aron CM, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019. doi:10.1136/bjsports-2019-100715

5. Groh JR, Yhang E, Tripodis Y, et al. Health outcomes of former division I college athletes.. Brain injury. 2025. doi:10.1080/02699052.2024.2405209

6. Grashow R, Eagle SR, Terry DP, et al. Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome. Neurotrauma Reports. 2024. doi:10.1089/neur.2024.0008

7. Terry DP, Grashow R, Creager C, et al. Sleep Apnea Screening and Neuropsychiatric Symptoms in Former Professional American-Style Football Players. Neurology. 2026. doi:10.1212/wnl.0000000000214922