Football Players in Danger of Sleep Apnea
May 12, 2008 in Sleep Apnea, Sleep disorders, obstructive sleep apnea | Tags: Reggie White, Football, athletes, body mass index
Both current and former football players face the dangers of obstructive sleep apnea, the disorder that contributed to the tragic death of former Green Bay Packers superstar Reggie White.
Two of the major indicators for sleep apnea are neck size and body mass index. Perhaps as many as 75% of professional football players, and many college and even high school players, qualify for the neck size indicator, which is 18 inches. And despite being in sensational football condition, many qualify for the body mass index indicator, which is 30 and above.
These indicators plus questions relating to sleep are vitally important for team doctors to consider in player physical examinations. Sleep apnea can be treated very easily, and doing so would likely enhance the performance of athletes who think they are sleeping well, but are constantly exhausted. Certainly, it could reduce the risk of other serious diseases, such as heart disease, stroke, asthma, diabetes and more, and likely would prevent some premature deaths among athletes.
Realistically, any athlete who meets the neck and body mass indicators should consider whether they snore and gasp at night, are feeling exhausted during the day, and then consider talking with their doctor or a physician who specializes in sleep disorders. Some athletes who might wish to think about this are shot-putters, weight lifters, wrestlers and more.
Why take the chance?
You have a very painful learning strategy. I've tried to explain to you that BMI
per se and any girth measurement
per se is not associated with OSA. This is my last attempt at any exchange with you, if you so value your ignorance and status as a broscientist then you can keep it along with your cherished bullshit theories.
The above article you cut-and-pasted is a fine example of bad science journalism and you are fine example of an uneducated and uncritical consumer of bad science journalism.
The simple and short rebuttal to your "theory" and the above piece of amateurish science journalism is that the BMI is an indirect index of adiposity. By relating height to weight (BMI=weight / height^2) BMI aims to identify those individuals with excess weight due to excess adiposity. Since BMI fails to take account of weight composition excess weight due to higher fat-free mass is counfounded with excess weight due to higher fat mass.
What follows is a more detailed rebuttal.
BMI is a proxy measure of body fat composition. Since primary care physicians do not have the equipment and/or time to determine body composition they use the BMI as a proxy for this measure. The BMI can not and does not measure body fat composition -- it is a proxy measure, all it is is the ratio of weight to height squared. When Quetelet formulated the BMI (then known as the
Quetelet Index) in 1832 the purpose was to provide an index of fatness (because it became apparent that fatness was associated with cardiovascular disease at around the same time) which could be used by actuaries in forumulating insurance policies and epidemiologists in classifying people as obese or otherwise
[1]. The BMI is based on Quetelet's observation that
If man increased equally in all his dimensions, his weight at different ages would be as the cube of his height. Now, this is not what we really observe.
The increase in weight is lower, except during the first year afer birth; then the proportion which we have just pointed out is pretty regularly observed. But after this period, and until near the age of pubert, the wight increases nearly as the square of the height.[2]
Quetelet's observation is correct
for most (Caucasian) populations and this is partly why the BMI became popular as a proxy measure for fatness. Quetelet came up with the idea of the
average man and it is to this man that his index applies. The highly muscled man is modern phenonmenon. In Quetelet's time men with large amounts of LBM and BF < 10% would have been so rare that they were irrelevant. Since the 1950s the number of men in which height is dissociated from lean weight has multipled, much so since the 1980s with the wider availability of AAS and peptides. Why is the above article and your theory flawed? Simply because football players and bodybuilders have a total mass that is mainly fat-free i.e. they aren't fat.
Most people with a large neck girth are fat and it is the weight of this fat bearing on their pharynx which contributes to their airway collapse
[13][14]. Football players have thick necks not because they are corpulent but because they perform neck exercises to strengthen their necks. Their neck girth is attributable to muscle not fat. Further, fat covers the front of the neck, muscle does not, so any neck muscle does not bear on the anterior of the pharynx. Some confirmatory empirical data:
Matthews & Wagner (2008) measured BF directly using bioelectrical impedance and indirectly using the BMI in a sample of 85 National Collegiate Athletic Association (NCAA) Division I football players. They found that "BMI overestimated the prevalence of overweight and obesity in 50.6% of the cases" and concluded that "BMI alone is not a valid indicator of overweight and obesity in a strength-trained athletic population."
The relationship between all mortality and BMI is U-shaped i.e. elevated mortality rates are associated with both high and low BMI. This is paradoxical given that fat-loss is associated with lower mortality and morbidity
[7][8]. This paradox is due to BMI being a non-specific measurement i.e. not distinguishing between fat mass (FM) and fat-free mass (FFM). It turns out that low BMI is associated with high mortality because low FFM is associated with high mortality
[9][10]. Thus higher levels of FFM are associated with lower morbidity and mortality rates i.e. the more lean muscular mass you carry the less likely are you to become sick or die (from disease).
BMI undermeasures fatness in Asians. Why? Because again it is a non-specific measure of mass . BMI underestimates FM in Asians because of their comparatively lighter builds (i.e. smaller frames and lower amounts of FFM)
[3][4][5][6]
Janssen et al (2004) found that waist circumference and not BMI are associated with obesity related health risks. Why? Because waist circumference is a better indirect measure of fatness than BMI.
Is a stable (normal) BMI throughout our senior years a good thing? No, not necessarily because the normal course of things for men is that FFM is lost as we age and replaced with FM. The BMI stays the same but risk of mortality (due to disease and accident) and morbidity increases
[11][12]. Again this misclassification of old male folk is due to the non-specificity of BMI.
The limitations of the BMI are well-known to bio-medical researchers and epidemiologists. Primary care physicians, some science journalists and broscientists like you are yet to fully appreciate the limits of BMI.
People like you should stay away from PubMed because you don't have the necessary background knowledge to critically approach what you are reading (and you may lack the intelligence to ever gain it.)
.gif "IP Gear")
