Friday, March 19th, 2010

The Power of the Mind:  Better Golf Scores Motivate People with Sleep Apnea . . . You couldn't make this stuff up.  It turns out that golfers with obstructive sleep apnea (OSA) can look forward to knocking several strokes off their golf game by adhering to the standard treatment of continuous positive airway pressure (CPAP), which is nobody's idea of a picnic.

That's not all.  The better the player, the bigger the improvement in golf handicap. Furthermore, according to the study author, "the adherence on this study was absolutely off the charts."

THE CURSE OF OSA

OSA is a condition that affects millions -- most of whom go undiagnosed.  It results in multiple brief episodes during sleep where you stop breathing.  This deprives tissues of oxygen and is a general stress on the system.  The overweight and obese are more likely to suffer from it.  The moderate and more severe forms pose real health risks, including heart disease and premature death.  It is estimated that up to 50% of all people with high blood pressure have OSA.  Dr. Marc L. Benton, the study author, has a sleep disorders clinic and pulmonary practice in Madison, New Jersey.  He estimates 1-3 million golfers suffer from OSA.

STUDY MORE USEFUL THAN IT MAY SEEM

Compliance with CPAP machines is notoriously difficult for patients, which I can attest to myself based on experience with hundreds of patients with OSA over the years.  The device consists of a tight fitting nasal mask that forces room air at a high pressure through your nasal passages down into your lungs.  They are noisy, inconvenient and expensive, although most insurances pick up the cost.  However, CPAP machines can absolutely turn the lives around of folks with more severe forms of OSA.  People wake up refreshed, think more clearly, feel better about themselves, get more done at work, have more energy, lose weight and so on.  In spite of these impressive rewards, many people are unable to manage the devices and simply go untreated.  Although various dental devices are available to reposition the jaw and open up the airway, they can be uncomfortable and difficult to tolerate.   Surgery is rarely an option.  Motivating patients to participate in challenging non-drug treatments is rarely easy.  Perhaps Dr. Benton's small study may end up being a door opener to new ways of getting patients to help themselves.

GOLF PLAYING DOCS TRIGGER STUDY

Dr. Benton treated two physician friends for OSA with CPAP who both reported improved golf  scores.  This gave him the idea for the study.  According to Dr. Benton, " More so than almost any other sport, golf has a strong intellectual component, with on-course strategizing, focus and endurance being integral to achieving good play. With CPAP, we can improve many cognitive metrics, including attention span, memory, decision-making abilities, and frustration management, which may in turn affect a person's golf game."

Dr. Benton's study involved 12 golfers with OSA and 12 without.  After 3-5 months of treatment, during which study subjects played 20 rounds of golf, handicaps in the treated group dropped from an average of 12.4 to 11.0. In the 5 best golfers, handicaps dropped from 9.2 to 6.3!  Typical sleep parameters improved to normal during this time.

These excellent results may be related to the exceptional compliance of the treatment group.  Sleep specialists consider the use of CPAP machines 4 hours or more on 75% of the nights acceptable compliance. The golfers, however, used their devices 5.5 to 7 hours a night on 92% of the nights, which adds up to nearly twice the time spent attached to these noisy machines!

WHERE THERE'S A WILL THERE'S A WAY

The study suggests that when there is sufficient motivation, even something so difficult and uncomfortable as being hooked up to a CPAP device is tolerable.  This echoes recent research that showed cash payoffs worked better than anything for getting people to stop smoking.  Interestingly, both of these are in contrast to the usual fear-based aproach that crops up in conversations surrounding difficult medical treatments that require patient effort.  The spectre of a painful, life-threatening disease just can't compare to the advantages of a lowered golf handicap or money in the bank.  Hmmm . . .

KUDOS TO DR. BENTON

This is a small study and hardly conclusive.  But my kudos to Dr. Benton for opening the way to a whole range of non-drug motivational possibilities for any number of tough to treat conditions.  Poker, anyone?

Derived from an article in INTERNAL MEDICINE NEWS March 1, 2010 issue.

Tags: golf handicaps, obstructive sleep apnea, patient motiviation