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Golfers treated with PAP therapy have enhanced performance

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Golfers with OSAS who undergo PAP therapy have a better handicap

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The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. Obstructive sleep apnea (OSA) is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The "apnea" in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe, according to the National Sleep Foundation

Positive airway pressure (PAP) Therapy is a generic term applied to all sleep apnea treatments that use a stream of compressed air to support the airway during sleep. PAP therapy consists of wearing a mask during sleep hooked up to a portable machine gently blows pressurized room air from into your upper airway through a tube connected to the mask.

In a new study Dr. Marc Benton, MD, FAASM, and Neil S. Friedman, RN, RPSGT, of Morristown Medical Center had evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS.

Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). NPSG is the most commonly used test in the diagnosis of obstructive sleep apnea syndrome. The NPSG is a test of sleep cycles and stages through the use of continuous recordings of brain waves (EEG), electrical activity of muscles, eye movement (electro-oculogram), breathing rate, blood pressure, blood oxygen level, heart rhythm and direct observation of the person during sleep.

The study consisted of 24 participants, 12 participants with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry, and 12 golfers without OSA as the control group.

All participants maintained a handicap with the Golf Handicap and Information Network, part of the U.S. Golf Association (USGA), to keep things honest in regard to golf score. A handicap is defined as the average number of strokes shot over or under par, over a period of time, according to the U.S. Golf Association. The handicap index is used as a reference of a golfer’s skill level where the lower the handicap, the better the player’s golf scores.

After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. The treatment ranged from three to five months.

The results showed that the golfers in the treatment group had a significant drop in their handicap, from 12.4 to 11 and also showed significant improvements in sleepiness. The best players in the treatment group with an average of 9.2 in the start of study dropped to 6.3 after six months of treatment. The average HI dropped by an even greater degree 31.5%. The control group had an average handicap of 12.2 at the start of the study and at the end of the study had a 12.6 average.

The researchers write in their conclusion “Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.”

According to Dr. Benton, lead author of the study, "The degree of improvement was most substantial in the better golfers who have done a superior job of managing the technical and mechanical aspects of golf.” "With the cognitive enhancement afforded by successful treatment of their sleep apnea, they saw measurable improvement early and more significantly than those who were less skilled."

“Any golfer knows, when your ability to think clearly or make good decisions is compromised, the likelihood of playing your best is greatly diminished. 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 games.”

In this study the compliance rate was 90%. However, it has been reported that among men who use the NPAP device, 40% are compliant.

Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotence, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes.

According to the National Sleep Foundation, over 18 million American adults have sleep apnea.

More information on sleep apnea can be found online at the American Sleep Apnea Association.

This study appears in the Journal of Clinical Sleep Medicine.

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