Nov. 2, 2009 -- Men and women who undergo treatment for sleep apnea not only can improve their general health, but their golf games as well, new research indicates.
A study presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians, finds that golfers who have obstructive sleep apnea and who received a therapy called nasal positive airway pressure (NPAP) improved their daytime sleepiness scores.
And they also lowered their golf handicap by as much as three strokes, according to Marc L. Benton, MD, FCCP, of the Atlantic Sleep and Pulmonary Associates in Madison, N.J.
People who think they can improve their golf scores are likely to be more receptive to nasal positive airway pressure therapy, says Benton and colleague Neil S. Friedman, RN, RPSGT, of Morristown Memorial Hospital.
"More so than many sports, golf has a strong intellectual component, with on-course strategizing, focus and endurance being integral components of achieving good play," Benton says in a news release. "[Sleep apnea] 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."
With obstructive sleep apnea, breathing becomes periodically blocked during sleep. Treatment with nasal positive airway pressure therapy involves the use of specialized nasal masks with pressurized air to push air into the windpipe to keep it open.
The researchers analyzed the impact of the treatment on the golf handicap index of 12 players who'd been diagnosed with moderate to severe obstructive sleep apnea. The handicap index was recorded on each golfer, who also filled out a sleepiness scale and a sleep questionnaire developed by the researchers.
After 20 rounds of golf while receiving the nasal therapy during sleep over three to five months, the golfers in treatment demonstrated a significant drop in their average handicap, from 12.4 to 11.
They also improved their scores on the Epworth Sleepiness Scale and on the sleep questionnaire.
Twelve golfers without obstructive sleep apnea and NPAP treatment were used as a comparison group; they showed no change in any of the measurement scores.
"As any golfer knows, when your ability to think clearly or make good decisions is compromised, the likelihood of playing your best is greatly diminished," Benton says in a news release. "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."
Golfers With Sleep Apnea
The study also finds that the best golfers had the biggest improvements in their scores. In this group, the average handicap dropped from 9.2 to 6.3, and their scores also improved from 10.8 to 2.8 on the sleep questionnaires.
"The biggest handicap improvements occurred in the lower handicap, often older golfers," says Friedman. "This group would be expected to trend in the opposite direction due to age-related deterioration in strength and endurance. The drop in handicap among the better golfers probably reflected that the major limiting factor was not golf skill but cognitive compromise that improved when the sleep apnea was treated."
According to Benton, it's likely that up to 3 million regular golfers have obstructive sleep apnea, and most are undiagnosed or untreated.
When proper treatment is offered, it's effective only if used regularly, the researchers say.
Studies in men have reported compliance rates as low as 40%, with people blaming discomfort, inconvenience, cost, noise, or embarrassment for skipping therapy, the researchers note in the news release.
In this study, patients in treatment had a compliance rate above 90%. "Providers typically attempt to maximize compliance with [the therapy] by promoting its medical benefits or warning patients of the risks involved in not being treated, but this approach does not always work," Benton says. "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."
Kalpalatha Guntupalli, MD, FCCP and president of the American College of Chest Physicians, says finding new ways to encourage people with sleep apnea to undergo the therapy is "definitely encouraged."
Golf, the researchers conclude, may be a strong motivator to seek therapy.
The CHEST meeting is being held this week in San Diego.