Treatment for Sleep Apnea Can Improve Golf Game

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Men with obstructive sleep apnea (OSA) who received nasal continuous positive airway pressure (NCPAP or NPAP) treatments not only improved their health, but also lowered their golf handicap by as much as three strokes, according to research presented at CHEST 2009, the 75th annual assembly of the American College of Chest Physicians (ACCP).

Obstructive sleep apnea is a condition in which a person as episodes of stopped breathing during sleep. Symptoms include abnormal daytime sleepiness, lethargy, memory difficulties, and poor concentration. The treatment goal is to keep the airway open so that breathing does not stop, usually with a treatment of continuous positive airway pressure, or CPAP.

Dr. Marc Benton and colleagues from Morristown Memorial Hospital in Madison, New Jersey studied 12 golfers who were diagnosed with moderate to severe OSA. At the beginning of the study, each man completed both the Epworth sleepinesss scale (ESS) and a sleep questionnaire developed by the study authors. The Epworth Sleepiness Scale is an evaluation of daytime sleepiness and is helpful in the diagnosis of sleep disorders. It is validated for use primarily in patients with obstructive sleep apnea.

The treatment group began NPAP treatments and played 20 rounds of golf over a period of 3 to 5 months. A control group was also formed of 12 subjects who did not receive NPAP treatment.

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At the end of the study, the treatment group showed improvements to their ESS and sleep questionnaire scores, indicating better sleep was achieved with the treatment. In addition, the group treated with NPAP also had a lowered golf handicap index.

"More so than many sports, golf has a strong intellectual component, with on-course strategizing, focus, and endurance being integral components to achieving good play," said Dr. Benton, of Atlantic Sleep and Pulmonary Associates in Madison. "OSA can lead to daytime sleepiness, fatigue, and cognitive impairment, all side effects which can negatively impact a person's ability to golf to the best of one's ability."

Dr. Benton said also "Through treatment with NPAP, we can improve many cognitive metrics, such as attention span, memory, decision-making abilities, and frustration management, which may, in turn, positively affect a person's golf game."

Compliance with respiratory therapy is a common issue in the treatment of patients with sleep apnea. Studies estimate that compliance rate in men can be as low as 40%. Reasons cited for noncompliance include discomfort, inconvenience, cost, noise, or embarrassment. Finding effective ways to increase compliance can be difficult for many healthcare providers.

"Providers typically attempt to maximize compliance with NPAP by promoting its medical benefits or warning patients of the risks involved in not being treated, but this approach does not always work," said Dr. Benton. "In the case of this study, the possibility of improving one's ability to play golf appears to have been a significant motivation to improve treatment compliance."

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