To be honest, we first thought this report might be a joke: Could anybody, with a straight face, test whether treating sleep apnea could improve a golf score? Then we linked up with New Jersey golfer Marc Benton, who pays for his greens habit by working as a pulmonary physician, and we got religion.
Benton reported this week on his study of 12 golfers to a meeting of the American College of Chest Physicians in San Diego.
We must digress. In sleep apnea, the airway temporarily closes, causing partial awakenings that drain sleep of its restorative function. Among many other effects, apnea raises the blood pressure and causes drowsiness, car accidents, and difficulties with memory, thinking and decisions.
Apnea strikes an estimated 3 to 5 percent of Americans and is more common among the old and the obese. Most people are unaware of the condition, although their bed partners may notice the repeated starts and stops of breathing.
Apnea is common among snorers, but it is defined by those brief breaks in breathing, not by noisy breathing or snoring.
Air pressure positively helps!
Sleep apnea can often be treated by wearing a mask that conveys pressurized air into the airway, but getting patients to use these “positive airway pressure” devices can be difficult, says Benton. As a doctor, “It’s always important to try to find anything and everything you can do to enhance compliance, because without compliance, you are not going to get a successful outcome.”
Because the proven, long-term benefits of treating apnea are not always an effective motivator, Benton may concentrate on selling more tangible benefits. “Not everybody is going to respond to the idea that their quality of life will be better, that they will have less heart attacks and strokes, that they will live longer,” he says. For bus and truck drivers, “we know for sure that treating apnea will result in a much lower frequency of accidents,” so safety becomes the sales pitch.
Down with the bogey
After Benton, who says he’s an avid golfer, treated some “golf buddies” for apnea, they mentioned that their game was improving, so he studied another 12 golfers with apnea.
You may think golf is all about looking as suave as the Tiger, but Benton says it’s a game of decisions. “In any situation, you can do A or B or C. You can hit a particular kind of shot, use a particular club, can take a high- or low-risk option.”
Golfers are a prime group for apnea, Benton says. “Golf, to a very large degree, is played by middle aged males, 25 to 75 years old, and 10 percent to 15 percent of them could have clinically significant apnea.” Most people in the study had severe apnea, with at least 10 partial or complete cessations of breathing per hour. One of them had 75 an hour.
Each stoppage causes a tiny awakening that eviscerates the quality of sleep.
To gauge a golfer’s ability, Benton used the handicap, which measures how many strokes above par that person usually plays. Few sports have such a neutral measure of prowess, Benton points out, and that made golf a good vehicle for studying the impact of apnea treatment on sports that require a lot of thinking.
A handy handicap
Benton found a significant reduction in handicap after 20 rounds, meaning the subject’s games had improved. Interestingly, the best golfers, who tended to be the oldest, had the biggest reduction, suggesting that they were the most limited by the effects of apnea.
Treatment requires motivation because the masks are not always pleasant at first, Benton says. Patients may object to dryness, to swallowing forced air, or feel embarrassed by the need to sleep while tethered to a noisy machine. But once they start to get a good night’s sleep, the picture changes, Benton adds. “For a lot of people, it’s a true lifesaver. They say, ‘I don’t know how I lived without this.’”
Among the golfers, Benton says, “Not only did they see an improvement in alertness and quality of life, they saw an improvement in their ability to play. They were astoundingly compliant with therapy. The level of enthusiasm was very powerful.”
So next time you see a golf-cart full of doctors putting away on a sunny Wednesday afternoon, consider this: Maybe they are actually planning a new research project…
Okay, it’s just a thought.
David J. Tenenbaum