# Obstructive Sleep Apnea and Recovery in Athletes: BMI and Neck Circumference and Their Impact on Recovery Capacity and Injury Risk

## TL;DR

This review explores how obstructive sleep apnea (OSA), linked to BMI and neck size, affects athletes' recovery and injury risk, especially in collision sports.

## Contribution

The paper highlights the underdiagnosed impact of OSA on athletic performance and recovery, emphasizing BMI and neck circumference as key risk indicators.

## Key findings

- OSA is prevalent in athletes, particularly in collision sports like rugby and American football.
- Higher BMI and neck circumference are consistently linked to increased OSA risk and impaired recovery.
- OSA leads to reduced sleep quality, slower reaction times, and increased injury susceptibility.

## Abstract

Obstructive sleep apnea (OSA) is an underdiagnosed condition in athletes, strongly influenced by anthropometric factors such as body mass index (BMI) and neck circumference, which often reflect long-term sport-specific training and nutritional strategies. This review examines the impact of OSA on athletes’ recovery, injury risk, and performance, with emphasis on BMI and neck circumference as key risk markers. A comprehensive search was conducted in PubMed, Web of Science, EBSCO, and Google Scholar for studies published between 2015 and 2025. Eleven studies met the inclusion criteria. The findings indicate a substantial prevalence of OSA in athletes, particularly those involved in collision sports such as rugby and American football, where higher BMI and increased neck circumference were consistently associated with increased risk of OSA. OSA was associated with reduced sleep quality, hormonal disruption, excessive daytime sleepiness, and slower reaction times. These factors may collectively impair recovery, increase injury susceptibility, and negatively affect aerobic capacity, cognitive function, and sport-specific performance. The results highlight the need for routine sleep screening in athletes, especially those with elevated BMI or larger neck circumference. Early detection and management of OSA may improve recovery and performance. Further longitudinal studies are needed to evaluate the long-term effects of OSA treatment in athletic populations.