Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea

Background and Objectives

Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players.

Methods

The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested.

Results

Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup.

Discussion

Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.

Measurement of polybrominated diphenyl ethers on hand wipes: estimating exposure from hand-to-mouth contact

Estimates of exposure to the flame-retardant polybrominated diphenyl ethers (PBDEs) in dust are very poor due to limited knowledge about dust ingestion. This study was undertaken to determine if PBDEs could be measured on hand wipes, and if so, to determine the distribution of levels present on the skin surface area to provide preliminary exposure estimates from hand-to-mouth contact. Hand wipes were collected from 33 individuals residing in the United States using sterile gauze pads soaked in isopropyl alcohol. The total PBDE residue collected on the wipes ranged from 2.60 to 1982 ng, with a median value of 130 ng, or normalized to hand surface area, a concentration of 135 pg/cm2. The fully brominated congener, BDE 209, was also detected and ranged from < DL to 270 ng with a median value of 26 ng. Congener patterns observed on the wipes were similar to patterns observed in house dust samples, consisting of congeners associated with the PentaBDE and DecaBDE mixtures, suggesting that the source of PBDEs to the hands may be dust particles. However, PBDE hand residues may also be a result of direct contact with PBDE-laden products, leading to adsorption to the skin surface oils. Repeated wipe sampling from three individuals suggests that sigmaPBDE levels on the hand may be relatively consistent for some individuals but not for others. Furthermore, levels of sigmaPBDEs were greater on the bottom of the hands relative to the top of the hands. Using these values we have calculated potential human exposure from hand-to-mouth contact. The median exposure estimates for children and adults are 1380 and 154 ng/day, respectively, whereas the 95th percentile exposure estimates were 6090 and 677 ng/day, respectively. These estimates are greater than dietary intake rates and suggest hand-to-mouth contact may be a key exposure route for PBDEs.