CTE vs Sleep Apnea

Quick answer: Chronic traumatic encephalopathy (CTE) can currently only be diagnosed after death, through examination of brain tissue. That means any "CTE diagnosis" given to a living person is not a confirmed diagnosis, it's a clinical judgment based on symptoms that also overlap heavily with obstructive sleep apnea (OSA): memory loss, difficulty concentrating, mood changes, and depression. Research on former football players found that people who reported a premortem CTE diagnosis were also significantly more likely to have sleep apnea and other treatable comorbidities, raising the concern that some cognitive symptoms attributed to CTE may actually be undiagnosed, treatable sleep apnea.

What Is CTE?

Chronic traumatic encephalopathy is a neurodegenerative brain disease linked to repeated head trauma. Once called "punch-drunk syndrome," it's most associated with impact-sport athletes, including boxers, hockey players, and football players, and has also been diagnosed in combat veterans and survivors of repeated domestic abuse. Reported symptoms include mood swings, depression, suicidal thoughts, difficulty concentrating, and short-term memory loss.⁴

The critical detail that gets lost in public discussion: CTE can currently only be confirmed through postmortem brain tissue examination. There is no validated test or criteria for diagnosing it in a living person.

The Overlap Problem

A study led by researchers at Harvard Medical School and the Harvard T.H. Chan School of Public Health surveyed 3,913 former professional football players. Despite the postmortem-only nature of an actual CTE diagnosis, 108 players (2.8%) reported having received a CTE diagnosis from a physician or clinician while still alive.¹ The researchers' core concern: clinicians evaluating former players with cognitive symptoms may be reaching for a CTE explanation without thoroughly ruling out treatable conditions that produce a nearly identical clinical picture.

Players who reported a CTE diagnosis were also significantly more likely to report other comorbidities, including sleep apnea, heart disease, hypertension, stroke, depression, high cholesterol, and obesity.¹ Sleep apnea in particular produces cognitive symptoms that closely mirror those attributed to CTE, which is exactly why it's worth ruling out first, since unlike CTE, it's both diagnosable and treatable in a living person.

Symptoms That Overlap Between CTE and Sleep Apnea

Obstructive sleep apnea occurs when the muscles at the back of the throat relax enough to block the airway, cutting off oxygen during sleep. In severe cases, these breathing pauses can happen up to 30 times per hour. Common symptoms include:

• Loud snoring

• Gasping for air during sleep

• Difficulty concentrating during the day (overlaps with CTE)

• Waking with a dry mouth

• Forgetfulness (overlaps with CTE)

• Morning headaches

• Difficulty staying asleep

• Excessive daytime sleepiness

• Mood changes (overlaps with CTE)

Why Athletes Face Elevated OSA Risk

Football linemen in particular show a measurably higher OSA risk profile than other athletes. A recent study comparing college linemen to track athletes found linemen averaged a 44.4 cm neck circumference, a 107.1 cm waist circumference, and a BMI of 35.9, all well past standard clinical risk thresholds for OSA.² The same research found that linemen with OSA had slower reaction times, reduced alertness, and a higher injury rate than teammates without the condition, evidence that undiagnosed OSA doesn't just affect long-term brain health, it affects performance and safety on the field in real time.²

The Broader Health Case for Diagnosing OSA Early

Untreated sleep apnea isn't just a cognitive concern. It's linked to increased risk of heart disease, stroke, diabetes, and depression, independent of any CTE-related discussion.⁵ For both current and former athletes, sleep apnea remains widely underdiagnosed: an estimated 22 to 29 million American adults have OSA, and roughly 80% of moderate-to-severe cases go undiagnosed.³

Whether someone is a current college athlete or a retired professional decades removed from their playing career, ruling out sleep apnea is a straightforward, low-burden step, typically starting with a home sleep apnea test, and treatment through CPAP therapy is well established and effective.

Frequently Asked Questions

Can CTE be diagnosed while someone is alive?

No. CTE can currently only be confirmed through postmortem examination of brain tissue. Any diagnosis given to a living person is a clinical judgment based on symptoms and history, not a confirmed diagnosis, which is exactly why ruling out treatable conditions like sleep apnea matters.

Why do sleep apnea and CTE symptoms look so similar?

Both conditions can produce memory problems, trouble concentrating, mood changes, and depression. The overlap is substantial enough that a 2020 Harvard-led study found people who reported a premortem CTE diagnosis were also significantly more likely to have sleep apnea and other conditions that independently cause similar symptoms.¹

Are football players at higher risk for sleep apnea specifically?

Yes, particularly linemen. Research shows linemen have significantly higher neck circumference, BMI, and body fat percentage than other athletes, all established OSA risk factors, and OSA-positive linemen showed measurably slower reaction times and higher injury rates.²

If I suspect sleep apnea instead of a cognitive disorder, where should I start?

A home sleep apnea test is a simple first step, followed by a conversation with your doctor about the results. If OSA is confirmed, CPAP therapy is a well-established, effective treatment.

This article is for general informational purposes only and is not medical advice. If you or someone you know is experiencing suicidal thoughts, contact the 988 Suicide & Crisis Lifeline by calling or texting 988. For questions about a CTE-related diagnosis or cognitive symptoms, talk to a neurologist or your doctor; for sleep-related symptoms, a sleep medicine specialist can help determine whether OSA is a contributing factor.

If you receive a sleep apnea diagnosis, our customer care team at The CPAP Shop can help you find the right equipment. Call 866-414-9700 or email questions@thecpapshop.com.

This post was originally published June 19, 2020, and updated September 21, 2026.

References

1. Grashow, R., Weisskopf, M.G., Baggish, A., et al. "Premortem Chronic Traumatic Encephalopathy Diagnoses in Professional Football." Annals of Neurology, 2020. pmc.ncbi.nlm.nih.gov/articles/PMC7383807

2. "Obstructive Sleep Apnea and Recovery in Athletes: BMI and Neck Circumference and Their Impact on Recovery Capacity and Injury Risk." PMC. pmc.ncbi.nlm.nih.gov/articles/PMC12843434

3. American Academy of Sleep Medicine / Frost & Sullivan. "Hidden Health Crisis Costing America Billions." aasm.org/resources/pdf/sleep-apnea-economic-crisis.pdf

4. Mayo Clinic. "Chronic Traumatic Encephalopathy." mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy

5. American Sleep Apnea Association. Sleep apnea health risk information. sleepapnea.org