Sleep Apnea Therapy Improves Golf Game

Mon Nov 2, 2009 1:00pm EST

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Men Find New Motivation for Using CPAP

SAN DIEGO, Nov. 2 /PRNewswire-USNewswire/ -- Golfers who undergo treatment for
sleep apnea may improve their golf game as well as their overall health, shows
new research. A new study presented at CHEST 2009, the 75th annual
international scientific assembly of the American College of Chest Physicians
(ACCP), found that golfers with obstructive sleep apnea (OSA) who received
nasal positive airway pressure (NPAP) for their disorder improved their
daytime sleepiness scores and lowered their golf handicap by as much as three
strokes. Researchers suggest that the possibility of improving your golf game
may be a significant motivator to improve NPAP compliance rates among golfers.

"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 Marc L. Benton, MD, FCCP, Atlantic Sleep and
Pulmonary Associates, Madison, NJ. "OSAS 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 and colleague Neil S. Friedman, RN, RPSGT, from Morristown Memorial
Hospital, Madison, NJ, evaluated the impact of NPAP on the golf handicap index
(HI) of 12 golfers with diagnosed moderate to severe OSA. HI was recorded upon
study entry, as was the Epworth sleepiness scale (ESS), a validated
questionnaire used to assess daytime sleepiness, and a sleep questionnaire
(SQ) developed by the authors. After 20 rounds of golf while receiving NPAP
treatment (approximately 3 to 5 months), the treatment group demonstrated a
significant drop in average HI, 12.4 (+/- 3.5) to 11.0 (+/- 4.7). Patients in
the study group also improved their ESS score, 11.8 (+/- 6.6) to 5.5 (+/-
3.6), and the SQ score, 14.3 (+/- 7.5), to 3.1 (+/- 3.1). A control group of
12 subjects demonstrated no change in HI, ESS score, or SQ score during this

"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," said Dr. Benton. "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."

Results of the study also showed that the best golfers, defined as HI <12, had
the biggest improvements in their game. Within this group, the average HI
dropped from 9.2 (+/- 2.9) to 6.3 (+/- 3.0); the SQ score from 10.8 (+/- 1.9),
to 2.8 (+/- 2.6). 

"The biggest handicap improvements occurred in the lower handicap, often older
golfers. This group typically would be expected to trend in the opposite
direction due to age-related deterioration in strength and endurance," said
Mr. Friedman. "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."

Dr. Benton estimates that there are 1 to 3 million regular golfers (regular
defined as 10 or more rounds per year) who have OSA, and most are undiagnosed
or untreated. However, even when proper treatment is offered, it is only
effective if it is used regularly. In men, studies have reported compliance
rates as low as 40 percent.  Patients cite many reasons for noncompliance with
NPAP, including discomfort, inconvenience, cost, noise, or embarrassment. In
the current study, nearly all patients in the treatment group had a compliance
rate of above 90 percent.

"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 with CPAP therapy is an ongoing issue in the treatment of patients
with sleep apnea," said Kalpalatha Guntupalli, MD, FCCP, President of the
American College of Chest Physicians. "Finding new and more effective ways to
increase CPAP compliance based on individual motivations is definitely

CHEST 2009 is the 75th annual international scientific assembly of the
American College of Chest Physicians, held October 31-November 5 in San Diego,
CA. The ACCP represents 17,400 members who provide patient care in the areas
of pulmonary, critical care, and sleep medicine in the United States and
throughout the world. The ACCP's mission is to promote the prevention and
treatment of diseases of the chest through leadership, education, research,
and communication. For more information about the ACCP, please visit the ACCP
Web site at

SOURCE  American College of Chest Physicians

Jennifer Stawarz of the American College of Chest Physicians, +1-847-498-8306,
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