Sleep Health and Associations With Early Cardiovascular Risk in U.S. Collegiate Female Athletes.

BACKGROUND

Sleep apnea is common among male competitive athletes and may be associated with early cardiovascular risk. Among female athletes, the prevalence and outcomes of sleep apnea have not been described.

OBJECTIVES

The objective of the study was to comprehensively assess sleep health and associations with markers of cardiovascular risk in an observational cohort of U.S. collegiate female athletes.

METHODS

We conducted a cross-sectional analysis of female collegiate athletes from 2 National Collegiate Athletic Association Division-I programs that included comprehensive measures of sleep health with home-based sleep studies and Pittsburgh Sleep Quality Index surveys; anthropometrics; echocardiography; and vascular applanation tonometry. Prevalence of sleep apnea and associations between sleep apnea and anthropometric data, systolic and diastolic blood pressure, arterial stiffness, and measures of left ventricular structure and function were assessed.

RESULTS

A total of 68 female collegiate athletes (18.00 [18.00, 20.00] years; 63% freshmen; 25% basketball, 41% softball, 34% volleyball) participated in this study. Mild sleep apnea (apnea-hypopnea index ≥5, N = 17, 25%) and poor sleep quality (Pittsburgh Sleep Quality Index >5, N = 24, 36%) were common. Athletes with sleep apnea were older (19.0 [18.0, 21.0] vs 18.00 [18.00, 19.00] years, P = 0.03) and had higher lean mass (61.6 [58.5, 67.3] vs 54.2 [51.8, 59.3] kg, P < 0.01) and pulse wave velocity (5.3 [5.1, 6.0] vs 4.9 [4.5, 5.4] m/s, P = 0.01). Lean mass independently predicted sleep apnea (OR: 1.14; 95% CI: 1.04-1.28; P < 0.01) and higher apnea-hypopnea index was independently associated with higher arterial stiffness (β = 0.09; 95% CI: 0.04-0.15; P < 0.01).

CONCLUSIONS

Poor sleep health, including sleep apnea, was common in this cohort of U.S. collegiate female athletes. Future longitudinal research, focused on sex-specific differences and cardiovascular outcomes, in competitive athletes with sleep-disordered breathing is warranted.