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Sleep of professional athletes: Underexploited potential to improve health and performance
Abstract
Sleep disorders have become increasingly prevalent affecting health and working ability. Restorative sleep may be considered important for athletes' successful recovery and performance. However, some athletes seem to experience major problems in sleeping. Thus far, there is limited scientific information about their sleep. This study aimed to evaluate the quality of sleep and the prevalence of sleep disorders as well as the impact of a structured sleep counselling protocol in professional athletes. A total of 107 professional ice hockey players participated in the study. The exploratory observational 1-year follow-up study consisted of questionnaire-based sleep assessment followed by general sleep counselling and, when needed, polysomnography and an individual treatment plan. One in every four players was found to have a significant problem in sleeping. All athletes considered sleep essential for their health and three in every four players considered that counselling would improve their performance. Counselling and individual treatment were found to improve significantly the quality of sleep with the mean alteration of 0.6 (95% CI 0.2-1.0, P = 0.004) in a scale from 0 to 10. Our results support that sleep problems are common in professional athletes. However, systematic examination, counselling and individual treatment planning can improve the quality of their sleep.
... All these elements influence each other through complex interactions. If one neglects one component, there exists a major risk that it will impact the other parts, thus risking the individual's health [1]. Sleep disorders have become increasingly prevalent, it has been estimated that at least one in every five adults suffers from chronic sleep problems [2,3]. ...
... Sleep disorders have become increasingly prevalent, it has been estimated that at least one in every five adults suffers from chronic sleep problems [2,3]. Sleep disturbances have not only become frequent in the general population, but recent studies indicate that elite athletes are faced by multiple sleep problems [1,[4][5][6][7][8]. They are known to get less sleep than non-athletes, and furthermore they have longer sleep latency and lower sleep efficiency for example because of recurrent awakenings at nighttime. ...
... Therefore, the recovery provided by restorative sleep can be viewed as a cornerstone of successful training and performance for athletes. For elite amateur athletes, the frequent exposure to high-intensity training and competition programmes increases their need for recovery, and therefore may increase their overall requirement for sleep [1]. On the other hand, problems in sleeping may affect the balance of training and recovery, also predisposing them to overtraining [11]. ...
Recent studies suggest that professional athletes seem to experience significant sleeping problems. However, little is still known about the occurrence of sleeping challenges at different stages of an athletic career. This descriptive study aimed to compare the sleep of professional athletes with younger elite amateur athletes. A total of 401 sportsmen, 173 youth elite amateur athletes and 228 professional athletes fulfilled a validated questionnaire. The self-estimated quality of sleep (on a linear scale 0–10) was significantly better in youth, being 7.9 compared to 7.4 ( p < 0.001). The professional athletes had a significantly higher risk for sleeping problems, especially during the competitive season (OR = 7.3, 95% confidence interval 4.1–12.9) and they also used significantly more sleep medications (OR = 8.3, 95% confidence interval 1.7–4.1). Interestingly, majority of youth athletes (85.4%) had received adequate sleep counselling compared with professional athletes (58.1%), ( p < 0.001). Furthermore, 75.8% of professional athletes considered that additional sleep counselling would improve their performance compared with only 45.6% of youth athletes ( p < 0.001). Our study demonstrates that compared with the younger counterparts, professional athletes experience impaired sleep quality and significantly more sleeping problems. There may be various underlying factors to induce the problems. The early intervention with sleep counselling may play an important role in preventing these problems and, therefore, it is recommended to be integrated in athletes’ overall training process.
... Importantly for athletes, the cyclical nature of poor sleep and mental ill-health can significantly hinder sporting performance and manifest into a more serious disorder, becoming a burden to general health and wellbeing (Asplund and Chang, 2020). While there has been a considerable amount of research separately examining sleep and mental health problems in current athletes (Gulliver et al., 2014;Cheek et al., 2015;Kong and Harris, 2015;Rao and Hong, 2016;Swinbourne et al., 2016;Kilic et al., 2017;Malhotra, 2017;Thornton et al., 2017;Tuomilehto et al., 2017;Foskett and Longstaff, 2018;Castaldelli-Maia et al., 2019;Asplund and Chang, 2020;Caia et al., 2020;Timpka et al., 2021;Costa et al., 2022), almost none has examined the two areas together. Furthermore, although there is some research on mental health problems in retired athletes (Kerr et al., 2014a;Gouttebarge et al., 2016;Kilic et al., 2017;Fernandes et al., 2019;Mannes et al., 2019;Esopenko et al., 2020), little is known about mental health or sleep problems outside of comorbid conditions (i.e., concussion history, obesity) in ex-contact sport athletes (Hyman et al., 2012;Kerr et al., 2012Kerr et al., , 2014bDidehbani et al., 2013;Hart et al., 2013;Strain et al., 2013;Iverson, 2014;Churchill et al., 2018;Hutchison et al., 2018;Hind et al., 2021;Schaffert et al., 2021). ...
... The psychological demands of sport, performance anxiety and overthinking delaying sleep behaviours can play a role in the development of these symptoms (Asplund and Chang, 2020). Within athletes, up to 45% report, or have shown to suffer from, OSA (Thornton et al., 2017;Tuomilehto et al., 2017;Caia et al., 2020); however, previous OSA research in sport has focussed on collision sports (e.g., American football, rugby). Players of these sports often have large body mass indices (>28 kg/m 2 ) and neck circumference (>40 cm) (Swinbourne et al., 2016), which despite being advantageous to participate in collision sports, do predispose these athletes to not only OSA, but other health issues later in life (Swinbourne et al., 2016). ...
... Education and interventions have demonstrated efficacy in improving sleep and psychological wellbeing in sports settings (Tuomilehto et al., 2017;Donohue et al., 2018), yet athletes fail to report these issues to support staff. Juliff et al. (2014) showed that over half of athletes do not seek help for sleep problems, whilst 13% are given sleeping pills with no actual diagnosis. ...
Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.
... Of note, interventions were generally not targeted to athletes with sleep disorders. No studies specifically recruited athletes with sleep problems/disorders, although two studies reported 35% of their sample had suspected sleep concerns at baseline (Bender, Lawson, Werthner, & Samuels, 2018;Tuomilehto et al., 2017). Beyond these two studies, none indicated that their sample had sleep disorders. ...
... Amongst these studies, interventions endorsed similar recommendations, including the effective use of napping; ensuring a quiet, cool, and dark bedroom environment; eliminating the bedroom clock; avoiding light-emitting technology devices prior to sleep; limiting caffeine, alcohol, or other stimulants before sleep. Six of 10 studies implemented uncontrolled designs (Bender et al., 2018;Driller, Lastella, & Sharp, 2019;Harada et al., 2016;O'Donnell & Driller, 2017;Tuomilehto et al., 2017;Van Ryswyk et al., 2017). All 10 articles reported at least one positive change in sleep-related outcomes, ranging from reduced subjective sleep difficulty scores (Bender et al., 2018), improved subjective sleep quality (Driller et al., 2019;Harada et al., 2016;Tuomilehto et al., 2017;Vitale, La Torre, Banfi, & Bonato, 2019), objective sleep onset variance (Driller et al., 2019), objective sleep efficiency (Driller et al., 2019), objective and subjective sleep duration (Fullagar, Skorski, Duffield, & Meyer, 2016;O'Donnell & Driller, 2017;Van Ryswyk et al., 2017), and cortisol awakening responses (Bonato et al., 2020). ...
... Six of 10 studies implemented uncontrolled designs (Bender et al., 2018;Driller, Lastella, & Sharp, 2019;Harada et al., 2016;O'Donnell & Driller, 2017;Tuomilehto et al., 2017;Van Ryswyk et al., 2017). All 10 articles reported at least one positive change in sleep-related outcomes, ranging from reduced subjective sleep difficulty scores (Bender et al., 2018), improved subjective sleep quality (Driller et al., 2019;Harada et al., 2016;Tuomilehto et al., 2017;Vitale, La Torre, Banfi, & Bonato, 2019), objective sleep onset variance (Driller et al., 2019), objective sleep efficiency (Driller et al., 2019), objective and subjective sleep duration (Fullagar, Skorski, Duffield, & Meyer, 2016;O'Donnell & Driller, 2017;Van Ryswyk et al., 2017), and cortisol awakening responses (Bonato et al., 2020). However, one controlled article reported negative changes, where increased sleep duration and time in bed was coupled with reduced sleep efficiency (Caia, Scott, Halson, & Kelly, 2018). ...
Sleep is fundamental to sports performance and other health outcomes such as mental
wellbeing. This systematic review explored the effects of sleep interventions
implemented among athletes on performance, sleep, and mood outcomes. From 5,996
records screened, 27 articles were selected for narrative review (562 athletes; female
n=102). Narrative synthesis of all studies based on intervention type suggested that
sleep hygiene, assisted sleep, and sleep extension interventions are favourable
strategies for improving sleep, performance, and mood outcomes. Twelve controlled
trials were eligible for meta-analysis, investigating the effect of sleep interventions on
athlete sleep, performance, and negative affect, compared to controls. Sleep
interventions improved subjective sleep quality (g=0.62), reduced sleepiness (g=0.81)
and decreased negative affect (g=0.65), but did not appear to influence subjective
sleep duration. No effects were identified for objective sleep measures (e.g.,
actigraphy), or aerobic/anaerobic performance indices. While sleep interventions may
offer some benefit to athletes, caution is warranted given limitations of the extant
research relating to small, non-representative studies with methodological concerns.
... The AMES, which is based on the Horne-Östberg morningness/eveningness questionnaire [91], is a four-item questionnaire used to classify an athlete's chronotype in terms of self-identification as being a morning or evening type, preferred sleep/wake phase and preferred competition and training time [92]. The AMES provides a global score which is used to categorise chronotype: extreme evening type (10)(11)(12), moderate evening type (13)(14)(15)(16)(17), mid-range type (18)(19)(20)(21)(22)(23), moderate morning type (24)(25)(26)(27)(28) and extreme morning type (29)(30)(31) [55]. ...
... In the current study, poor sleep was attributed by the athletes in both groups to a number of factors, i.e., injury, children, anxiety, making weight (boxing) and bathroom use. Previous research has highlighted issues that impair an athlete's sleep such as stress [32,112], pain/injury [26,32,33] and anxiety [25,29]. The relationship between poor sleep and impaired mood has been reported in non-athletic populations [113]. ...
... A previous study of NFL players (n = 137) demonstrated that 19% (n = 26) had OSA [120]. Previous research in elite ice hockey players (n = 107) has demonstrated sleep problem, 11% (n = 14) had insomnia, 10% (n = 13) had OSA and 3% (n = 4) had RLS/PLMD [26]. Athletes with poor sleep habits and/or a sleep disorder must be identified and diagnosed and individual interventions (e.g., sleep hygiene, nutrition) must be implemented in order to athlete recovery and performance. ...
Background:
Athletes maintain a balance between stress and recovery and adopt recovery modalities that manage fatigue and enhance recovery and performance. Optimal TST is subject to individual variance. However, 7-9 h sleep is recommended for adults, while elite athletes may require more quality sleep than non-athletes.
Methods:
A total of 338 (elite n = 115, 74 males and 41 females, aged 23.44 ± 4.91 years; and sub-elite n = 223, 129 males and 94 females aged 25.71 ± 6.27) athletes were recruited from a variety of team and individual sports to complete a battery of previously validated and reliable widely used questionnaires assessing sleep, recovery and nutritional practices.
Results:
Poor sleep was reported by both the elite and sub-elite athlete groups (i.e., global PSQI score ≥5-elite 64% [n = 74]; sub-elite 65% [n = 146]) and there was a significant difference in sport-specific recovery practices (3.22 ± 0.90 vs. 2.91 ± 0.90; p < 0.001). Relatively high levels of fatigue (2.52 ± 1.32), stress (1.7 ± 1.31) and pain (50%, n = 169) were reported in both groups. A range of supplements were used regularly by athletes in both groups; indeed, whey (elite n = 22 and sub-elite n = 48) was the most commonly used recovery supplement in both groups. Higher alcohol consumption was observed in the sub-elite athletes (12%, n = 26) and they tended to consume more units of alcohol per drinking bout.
Conclusion:
There is a need for athletes to receive individualised support and education regarding their sleep and recovery practices.
... For example, sleep related breathing disorders such as OSA are associated with impaired aerobic performance, even amongst non-athletes, (Mansukhani, Allison, Lopez-Jimenez, Somers, & Caples, 2013) with the degree of impairment increasing with disease severity (Beitler et al., 2014). Despite the potential for sleep disorders to negatively affect athletic performance there are few studies which have examined the prevalence of sleep disorders in athletes (Gupta, Morgan, & Gilchrist, 2016b;Rice et al., 2010;Sargent, Schmidt, et al., 2013a ;Tuomilehto et al., 2016). ...
... Obstructive sleep apnea is characterised as repeated events of partial or complete obstruction of the upper airway during sleep. To date, only four studies have assessed the prevalence of OSA in athletes and have been conducted primarily with contact athletes in American football and ice hockey with a prevalence of OSA reported ranging from 8-19% (Dobrosielski et al., 2016;George, Kab, Kab, Villa, & Levy, 2003;Rice et al., 2010;Tuomilehto et al., 2016). The first study used a single channel, home based, unattended, portable, sleep apnea monitors in 137 NFL players and reported that 19% of players had mild OSA, defined as an apnea hypopnea index (AHI) ≥ 5 events/hr (Rice et al., 2010). ...
... Based upon the questionnaire scores, those players suspected of having a sleep disorder underwent a home-based PSG study. The study reported that 13% (n = 14) of the 107 athletes screened for a potential sleep disorder had OSA (Tuomilehto et al., 2016). ...
... Further, most athletes are obligated to undertake significant travel in order to reach their competition venues, with potential consequences for both physiological and psychological status and potential harm to their performance capability . In a study by Tuomilehto et al. (2017) 107 professional ice hockey players participated in an exploratory observational 1-year follow-up study which consisted of a questionnaire-based sleep assessment followed by a general sleep counselling and, when needed, polysomnography and an individual treatment plan. As a result, one in every four players was found to have a significant problem in sleeping and three in every four players considered that counselling would improve their performance (Tuomilehto et al., 2017). ...
... In a study by Tuomilehto et al. (2017) 107 professional ice hockey players participated in an exploratory observational 1-year follow-up study which consisted of a questionnaire-based sleep assessment followed by a general sleep counselling and, when needed, polysomnography and an individual treatment plan. As a result, one in every four players was found to have a significant problem in sleeping and three in every four players considered that counselling would improve their performance (Tuomilehto et al., 2017). Nevertheless, studies assessing sleep in ice hockey players are scarce and further studies are urgently needed in order to understand the specific needs and demands of the sporting discipline itself and its specific competition setups in order to implement sport specific interventions. ...
Objectives: Objectives were to examine subjective sleep quality and daytime sleepiness of the German ice hockey junior national team prior to the world championship to identify athletes of concern and areas of optimization with the intention of equally preventing injury and enhancing performance.
Methods: Twenty-one athletes (Mage = 18.5 ± 0.6 years, Mheight = 181.7 ± 4.3 cm, Mweight = 81.4 ± 7.1 kg), playing for national (n = 13) and international (n = 8) home clubs, answered the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) before training camp (T1, day 1) and prior to tournament (T2, day 11).
Results: Overall, 9 players at T1 and 7 at T2 were identified as bad sleepers (PSQI > 5), while high sleepiness (ESS > 10) was found for 6 athletes at each measurement time. Group means and standard deviations reduced descriptively for PSQI (T1 = 5.38 ± 2.31, T2 = 4.57 ± 2.36) and ESS (T1 = 9.24 ± 3.74, T2 = 8.48 ± 3.28). Tendential differences were visible for PSQI in international-based players (Z = −1.7, p = 0.09) and ESS in first-national-league players (Z = −1.73, p = 0.08) over time. Higher PSQI values for international-based players (6.25 ± 2.6) were found compared to first-national-league (5.83 ± 1.60) and lower-league players (4.00 ± 2.08), with large effect sizes for lower-league compared to international (d = 0.95) and national players (d = 0.98) at T1 and small effect sizes compared to first-league players (d = 0.24) at T2.
Conclusion: Findings emphasize great vulnerability and individuality and underline the importance of intraindividual sleep monitoring to meet the requirements needed to equally obtain health and enhance overall performance.
... The athlete's sleep may be affected by several endogenous and exogenous factors, such as body temperature, altitude, chronotype, training volume, anxiety, and precompetitive stress [6,7]. Indeed, the practice of high-level intensity exercise is usually accompanied by lifestyle changes and major disruptions in the sleep/wake cycle due to physiological and psychological demands, stress, and training and competition schedules [8,9]. ...
... In addition, the score of daytime dysfunction did not indicate problems in the practice of social life. Similarly, Tuomilehto et al. [7] found that only 4% of athletes used sleep medication from a total population of 107 players, with the drugs used consisting of zolpidem (58%), melatonin (37%), zopiclone (2.5%), and mirtazapine (2.5%), respectively. ...
Objectives
The objectives of this study were to evaluate the duration and the quality of sleep, as well as daytime sleepiness, among different levels of Arab athletes (i.e., amateur, elite) and to compare sleep quality and duration and daytime sleepiness in athletes and sedentary individuals.
Material and methods
A total of 409 participants, characterized as elite athletes (n = 78), amateur athletes (n = 231), and sedentary individuals (n = 100), participated in this study. Participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire, for the evaluation of sleep quality, and the Epworth Sleepiness Scale (ESS), for the assessment of daytime sleepiness.
Results
The total PSQI score was significantly higher in sedentary (total PSQI score = 5.74 ± 2.5) vs. amateur (total PSQI score = 5 ± 2.3) (P < 0.001) and elite athletes (total PSQI score = 4.73 ± 2.3) (P < 0.01), respectively. However, there was no significant difference between elite and amateur athletes (P > 0.05). There was no significant difference (P > 0.05) between levels of daytime sleepiness reported in amateur athletes (ESS score = 9.6 ± 4.3), elite athletes (ESS score = 10 ± 3.8), and sedentary individuals (ESS score = 10.4 ± 2.4).
Conclusion
Athletes experienced a better sleep quality compared to sedentary individuals. However, some athletes can suffer from poor sleep quality, suggesting an urgent need for the implementation of sleep hygiene education. Levels of daytime sleepiness, comparable in athletes and sedentary individuals, indicate higher normal daytime sleepiness. Thus, daily naps could be useful to prevent excessive daytime sleepiness, but future studies on this topic, efficacy, and practicality are needed.
... Further caution should be taken when monitoring sleep in athletes of contact sports. Emerging data shows that athletes from sports that require physical contact between players, such as judo [56], rugby [18,57], American football [58,59] and ice hockey [60], may experience poor sleep quality and suffer from sleep disordered breathing. These consequences are commonly attributable to excessive weight and increased neck circumference [18], or come as a result of sports-related concussions [61,62]. ...
A growing body of research focus on athletes’ sleep in order to investigate the effects of sleep in sports performance and recovery or the prevalence of sleep disorders in athletes. At the same time, several sleep monitoring tools have been developed and used in athletic populations for fulfilling these purposes. This review aimed to provide critical assessment to the most used by athletes’ methodological approaches and compared them with the gold standard approach. Advantages and disadvantages of the various sleep monitoring tools were critically discussed. Literature related to aspects of athletes’ sleep was reviewed. From the shortlisted studies, several factors that seem to affect sleep in athletes were identified using objective methods such as polysomnography/electroencephalography and actigraphy. These factors were associated to sleep (e.g. such as sleep environment, familiarization procedures and napping) and daily habits (e.g. nutrition, fluid consumption, alcohol and caffeine intake, tobacco use). The selected studies that evaluated sleep objectively were screened according the reporting rates of these variables. The majority of the screened studies were found to underreport these variables. Practical issues were addressed and recommendations about reporting sleep-related factors were made in order to improve studies’ quality assessment and allow for more robust comparisons between studies.
... Olympic and Paralympic athletes often present bad sleep quality, sleep complaints, sleep disturbances, and inadequate sleep duration [39][40][41] , particularly during periods that precede important competitions [42][43][44][45] . Besides negatively affecting the sports performance 46 , sleep restriction presumably triggers important immunological alterations 37,47 . ...
In December 2019, Wuhan, in China, attracted international attention due to a pneumonia outbreak caused by the new coronavirus (2019-nCoV). Infection by 2019-nCoV is more likely in elderly people with comorbidities or with associated chronic diseases. Due to the high transmission rate among humans, this disease is rapidly disseminated, which led to several events being canceled, including the Tokyo 2020 Olympic and Paralympic Games. The aim of this article is to discuss the risk factors for Olympic and Paralympic athletes, as well as for spectators, that justify the decision to postpone the Tokyo Games 2020. Regular physical exercise is associated with health and the prevention of chronic diseases. Although athletes generally appear to be healthy and physically fit, this may not be true. The immune system, which protects the organism from invasive microorganisms, can be affected by the duration and quality of sleep, as well as by physical exercise which influences the quality of the immune response. High volumes of high-intensity physical exercise, as well as changes in sleep patterns during the pre-competition period and the impacts of jet lag on athletes traveling for the Tokyo Games in 2020 may lead to immune system suppression, making these groups more vulnerable to infection by 2019-nCoV. Moreover, during the period planned for the games in 2020 the pandemic may be subsiding in some countries and increasing in others, and this was also taken into consideration as a risk factor. Hence, the decision taken to postpone the Tokyo 2020 Olympic and Paralympic Games until 2021 due to the 2019-nCoV was the correct one, and was extremely important to protect the health of Olympic and Paralympic athletes, as well as spectators. Level of evidence V; expert opinion .
... 3 Athletes recognize the importance of sleep for their recovery and performance. 4 Although training load and competition schedules are 2 major factors known to influence the sleep/wake behaviors of elite adult athletes, 5,6 adolescent athletes are exposed to a myriad of additional factors that may impact their sleep. Adolescents have a higher physiological need for sleep (8-10 h per night) compared with adults (7-9 h per night) and frequently experience delays in sleep onset and awakening. ...
Purpose:
To quantify the sleep/wake behaviors of adolescent, female basketball players and to examine the impact of daily training load on sleep/wake behaviors during a 14-day training camp.
Methods:
Elite, adolescent, female basketball players (N = 11) had their sleep/wake behaviors monitored using self-report sleep diaries and wrist-worn activity monitors during a 14-day training camp. Each day, players completed 1 to 5 training sessions (session duration: 114 [54] min). Training load was determined using the session rating of perceived exertion model in arbitrary units. Daily training loads were summated across sessions on each day and split into tertiles corresponding to low, moderate, and high training load categories, with rest days included as a separate category. Separate linear mixed models and effect size analyses were conducted to assess differences in sleep/wake behaviors among daily training load categories.
Results:
Sleep onset and offset times were delayed (P < .05) on rest days compared with training days. Time in bed and total sleep time were longer (P < .05) on rest days compared with training days. Players did not obtain the recommended 8 to 10 hours of sleep per night on training days. A moderate increase in sleep efficiency was evident during days with high training loads compared with low.
Conclusions:
Elite, adolescent, female basketball players did not consistently meet the sleep duration recommendations of 8 to 10 hours per night during a 14-day training camp. Rest days delayed sleep onset and offset times, resulting in longer sleep durations compared with training days. Sleep/wake behaviors were not impacted by variations in the training load administered to players.
... Moreover, in professional hockey players, OSA was present in approximately 10% of athletes. 57 It is reported that, in most cases, the OSA severity was mild but even mild OSA might cause major disturbances in sleep, 58 potentially having an impact athletic performance. ...
KEY POINTS
- Insufficient sleep and poor sleep quality are prevalent among athletes, potentially due to time demands, physical demands, and developmental needs.
-Sleep disturbances among athletes have adverse impacts on physical performance, mental performance,
injury risk and recovery, medical health, and mental health.
-Sleep interventions among athletes have been shown to improve physical strength and speed, cognitive performance and reaction time, mental health, and other domains.
-Sport organizations should incorporate sleep health promotion programs at individual, team, and system levels.
... The study also found that 63% of the population sampled reported at least 1 sleep related complaint 33 . In addition, a study by Tuomilehto et al. 34 reported that sleep problems are common in professional athletes. Table 3. Prevalence of sleep disturbance detected by polysomnography (AHI, PLM, bruxism) and clinical evaluation (insomnia). ...
Objective:
The present study aimed to investigate the gender differences for sleep complaints, patterns and disorders of elite athletes during preparation for the Rio 2016 Olympic Games.
Methods:
The study included 146 athletes from the Brazilian Olympic Team (male: n=86; 59%; female: n=60; 41%). The assessment of the Olympic athletes' sleep took place in 2015, during the preparation period for the Rio Olympic Games. The athletes underwent a single polysomnography (PSG) evaluation. Sleep specialists evaluated the athletes and asked about their sleep complaints during a clinical consultation. In this evaluation week, the athletes did not take part in any training or competitions.
Results:
The prevalence of sleep complaints was 53% of the athletes during the medical consultation, the most prevalent being insufficient sleep/waking up tired (32%), followed by snoring (21%) and insomnia (19.2%). In relation to the sleep pattern findings, the men had significantly higher sleep latency and wake after sleep onset than the women (p=0.004 and p=0.002, respectively). The sleep efficiency and sleep stages revealed that men had a lower percentage of sleep efficiency and slow wave sleep than the women (p=0.001 and p=0.05, respectively).
Conclusion:
Most athletes reported some sleep complaints, with men reporting more sleep complaints than women in the clinical evaluation. The PSG showed that 36% of all athletes had a sleep disorder with a greater reduction in sleep quality in men than in women.
... For example, more than 55% of athletes in the Bobsleigh Canada Skeleton team were flagged as being poor sleepers [9]. Poor sleep was also observed in 50% of a sample of 24 professional ballet dancers [15], 50% of 175 elite rugby and cricket athletes [16], and 25% of 107 professional Finnish hockey athletes [18]. Despite such evidence for a high prevalence of poor sleep in elite athletes, little is known about what kinds of sleep disturbances occur. ...
Previous research has found that elite athletes have insufficient sleep, yet the specific kinds of sleep disturbances occurring as compared to a control group are limited. Here we compare the subjective sleep quality and chronotype of elite athletes to a control group of non-athlete good sleepers. Sixty-three winter Canadian National Team athletes (mean age 26.0 ± 0.0; 32% females) completed the Pittsburgh Sleep Quality Index (PSQI) and the Athlete Morningness Eveningness Scale. They were compared to 83 healthy, non-athlete, good-sleeper controls (aged 27.3 ± 3.7; 51% females) who completed the PSQI and the Composite Scale of Morningness. The elite athletes reported poorer sleep quality (PSQI global score 5.0 ± 2.6) relative to the controls (PSQI global score 2.6 ± 1.3), despite there being no group difference in self-reported sleep duration (athletes 8.1 ± 1.0 h; controls 8.0 ± 0.7 h). Further, athletes’ chronotype distribution showed a greater skew toward morningness, despite there being no group differences in self-reported usual bedtime and wake time. These results suggest that a misalignment of sleep times with circadian preference could contribute to poorer sleep quality in elite athletes.
... Athletes experience high training load demands and stress (Tuomilehto et al., 2016) with sleep widely regarded as important for performance and recovery (Halson, 2013). Athletes often experience poorer sleep quantity in comparison to non-athletes (Driller et al., 2017a) and reports have shown that sleep is often impaired on nights following training or competition . ...
To determine the melatonin concentrations and subsequent sleep indices of elite netball athletes following a training day when compared to a control day. Ten elite female netball athletes (mean ± SD; age = 23 ± 6 yrs) provided saliva samples PRE (17:15h) and POST (22:00h) a training session, and a day with no training (CONTROL). Sleep monitoring was performed using wrist actigraphy to assess total time in bed (TTB), total sleep time (TST), sleep efficiency (SE) and sleep latency (SL). Melatonin levels were significantly lower (p < 0.05), both PRE and POST the training condition (6.2 and 17.6 pg/mL, respectively) when compared to the CONTROL (14.8 and 24.3 pg/mL, respectively). There were no significant differences observed between conditions for any of the sleep variables. However, a small reduction in TST could be observed following the training session condition compared to the CONTROL condition. The scheduling of netball training in the evening is shown to suppress salivary melatonin levels. This may have an influence on subsequent sleep following night-time exercise.
... It is an important factor for stress-recovery balance among team athletes [4]. Athletes sleep is influenced by sports-specific factors, such as competition [5,6], travel [7], training [8] and non-sports factors, such as stress, anxiety and late-night blue light, etc. [8] Sleep inadequacies, such as poor sleep quality [9], insufficient sleep [10], daytime sleepiness [9,11], sleep disturbance [9], longer sleep latency [12], and greater sleep fragmentation [13], are prevalent among athletic population. ...
... Athletes experience high training load demands and stress (Tuomilehto et al., 2016) with sleep widely regarded as important for performance and recovery (Halson, 2013). Athletes often experience poorer sleep quantity in comparison to non-athletes (Driller et al., 2017a) and reports have shown that sleep is often impaired on nights following training or competition . ...
Objective: To determine the melatonin concentrations and subsequent sleep indices of elite netball athletes following a training day when compared to a control day. Methods: Ten elite female netball athletes (mean ± SD; age = 23 ± 6 yrs) provided saliva samples PRE (17:15h) and POST (22:00h) a training session, and a day with no training (CONTROL). Sleep monitoring was performed using wrist actigraphy to assess total time in bed (TTB), total sleep time (TST), sleep efficiency (SE) and sleep latency (SL). Results: Melatonin levels were significantly lower (p < 0.05), both PRE and POST the training condition (6.2 and 17.6 pg/mL, respectively) when compared to the CONTROL (14.8 and 24.3 pg/mL, respectively). There were no significant differences observed between conditions for any of the sleep variables. However, a small reduction in TST could be observed following the training session condition compared to the CONTROL condition. Conclusion: The scheduling of netball training in the evening is shown to suppress salivary melatonin levels. This may have an influence on subsequent sleep following night-time exercise.
... The performance of elite athletes depends on neuromotor performance, efficient cortical control, intellectual, motor memory, coordination, visual cueing, balance, focus, cardiorespiratory endurance, hormonal control and efficient energy metabolism [4]. Recent literature investigates the physiological and psychological impact of sleep over sport performance [5][6][7][8]. As sleep affects cardiorespiratory endurance [9,10], neuromotor performance [11], mood, focus and metabolism, it is logical to think sports performance shall be largely affected by sleep if deprived or fragmented [12]. ...
Purpose
Sleep is basic and common biological activity in human beings. Sleep is vital for recovery for recovering or replenishments of energy loss during daily functional activities. Sports involve expending excess energy more than required for day-to-day operations. Hence extended sleep becomes mandatory for replenishment of expended energy during sporting activities. However, real time scenario depicts athletes get lesser sleep than normally required taxing the physiological system, predisposing chronic injury and hindering sports performance.
Methodology
Literature search was done through PubMed Central, CINAHL, Proquest and Cochrane Central with keywords of “Sports performance AND Sleep,” “Sleep extension OR micro-sleep OR sleep deprivation AND sports.” The full-text articles or English language were analyzed and prepared for a historical review in logical order.
Results
Sleep deprivation has a significant impact on various physiological systems such as cardiorespiratory, nervous and endocrine system. Sleep extension has benefits in sports performance despite the variety of sports.
Conclusion
Sleep quality and intensity shall be borne in mind in coaching athletes before, during and after the competitions. The sleep education should be part of coaches, psychologist and team manager's training for behavior modification and fruitful team performance.
... 1 Although both the quantity and the quality of sleep are important, sleep quality remains an area lacking research focus when evaluating recovery of highperformance athletes. 2,3 Poor sleep quality is reported as common among athletes, particularly before competitions; for example, a study by Tuomilehto et al 4 reported that sleep problems are common in professional athletes, such as altered sleepwake cycle and/or frequent late night social media usage. Such sleep restriction is thought to have a significant impact on performance, 5 as insufficient and nonrestorative sleep can reduce athletic performance, causing a decline in implementing specific skills in sports. ...
... Adequate sleep is important to postexercise recovery in athletes. [1][2][3][4][5] Factors determining the recuperative benefits of sleep include its duration, quality and circadian phase. 1 5 Poor sleep is a common complaint of athletes, [6][7][8][9][10] and inadequate or unsatisfactory sleep may negatively affect physical performance, [11][12][13] competition outcomes, [14][15][16] cognitive function, 17 18 mood state, 14 15 immune function, 19 20 glucose metabolism 21 22 and the risk of injuries. [21][22][23] The sleep-wake pattern of athletes may be disrupted by late-night competitions, [24][25][26][27][28] nightmares before competition, 29 30 early morning training, 31 32 high training loads, 33 34 high altitude exposure 35 and jet lag. ...
Objective
To evaluate the effect of observing Ramadan on athletes’ sleep patterns.
Design
Systematic review and meta-analysis.
Data sources
The entire content of PubMed/MEDLINE and Web of Science.
Eligibility criteria for selecting studies
Single-group, prepost and cross-over design studies conducted in athletes aged ≥18 years, training at least twice a week and published in English before 12 July 2018 were included. Studies assessing sleep quantity, quality, daytime sleepiness and/or daily naps based on objective or subjective methods were deemed eligible.
Study appraisal
The methodological quality was assessed using ‘QualSyst’.
Results
Of 13 selected articles, 7 were of strong quality, 3 were moderate and 3 were weak. 11 studies evaluated total sleep time (TST); this decreased during Ramadan in 4 studies, increased in 1 and remained unchanged in 6. Pooled TST findings indicated a moderate effect size (− 0.97, SE=0.37, 95% CI −1.69 to −0.25, t=−2.64, p=0.01) with significant heterogeneity but no publication bias. Meta-regressions showed no effects of study year, age, sample size, type of sport or competition level, but there were effects of country (with France and Tunisia being the most affected countries and Turkey the least affected, Q=32.14, p<0.0001) and study design (Q=7.74, p=0.02). Four studies measured self-reported sleep quality and it decreased in three studies. One study of sleep architecture reported more frequent waking and more light sleep during Ramadan. Daily nap duration was increased in two studies, but daytime sleepiness remained unchanged in four studies.
Conclusion
When athletes continue to train at least two times/week while observing Ramadan, TST is decreased compared with athletes’ baseline levels.
... Sleep disturbances and inadequate sleep duration have been reported in athletic populations. Assessment of the sleep patterns of professional male ice hockey players (n = 23) using polysomnography (PSG), demonstrated mean total sleep duration was 6.92 h; 95% CI 6.3-7.5 h [32]. Similarly, sleep was self-reported as the most important recovery modality utilised by South African athletes (n = 890; international n = 183, national n = 474, club n = 233) [15]. ...
This narrative review explores the relationship between sleep and nutrition. Various nutritional interventions have been shown to improve sleep including high carbohydrate, high glycaemic index evening meals, melatonin, tryptophan rich protein, tart cherry juice, kiwifruit and micronutrients. Sleep disturbances and short sleep duration are behavioural risk factors for inflammation, associated with increased risk of illness and disease, which can be modified to promote sleep health. For sleep to have a restorative effect on the body, it must be of adequate duration and quality; particularly for athletes whose physical and mental recovery needs may be greater due to the high physiological and psychological demands placed on them during training and competition. Sleep has been shown to have a restorative effect on the immune system, the endocrine system, facilitate the recovery of the nervous system and metabolic cost of the waking state and has an integral role in learning, memory and synaptic plasticity, all of which can impact both athletic recovery and performance. Functional food-based interventions designed to enhance sleep quality and quantity or promote general health, sleep health, training adaptations and/or recovery warrant further investigation.
... 75-77 114 115 Mild sleep-disordered breathing has been found to occur in 8% of college American footballers 76 and 19% of professional American footballers. 114 One in four professional ice hockey players has significant problems sleeping, 77 while a study examining rugby and cricket players found 38% defined themselves as snorers. 115 Athletes with high body mass index, large neck circumference or high levels of adiposity may be at a heightened risk of developing a sleep disorder. ...
Objectives
To characterise the sleep of elite athletes and to identify factors associated with training and competition that negatively affect sleep.
Design
Prognosis systematic review.
Data sources
Three databases (PubMed, SCOPUS and SPORTDiscus) were searched from inception to 26 February 2018.
Eligibility criteria for selecting studies
Included studies objectively reported total sleep time (TST) and/or sleep efficiency (SE) in elite athletes. Studies were required to be observational or to include an observational trial.
Results
Fifty-four studies were included. During training, many studies reported athletes were unable to achieve TST (n=23/41) and/or SE (n=16/37) recommendations. On the night of competition, most studies reported athletes were unable to achieve TST (n=14/18) and/or SE (n=10/16) recommendations. TST was shorter (60 min) the night of competition compared with previous nights. SE was lower (1%) the night of competition compared with the previous night. TST was shorter the night of night competition (start ≥18:00; 80 min) and day competition (20 min) compared with the previous night. SE was lower (3%–4%) the night of night competition but unchanged the night of day competition compared with previous nights. Early morning training (start <07:00), increases in training load (>25%), late night/early morning travel departure times, eastward air travel and altitude ascent impaired sleep.
Conclusion
Athletes were often unable to achieve sleep recommendations during training or competition periods. Sleep was impaired the night of competition compared with previous nights. Early morning training, increases in training load, travel departure times, jet lag and altitude can impair athletes’ sleep.
PROSPERO registration number
CRD42017074367.
... 1 Although both the quantity and the quality of sleep are important, sleep quality remains an area lacking research focus when evaluating recovery of highperformance athletes. 2,3 Poor sleep quality is reported as common among athletes, particularly before competitions; for example, a study by Tuomilehto et al 4 reported that sleep problems are common in professional athletes, such as altered sleepwake cycle and/or frequent late night social media usage. Such sleep restriction is thought to have a significant impact on performance, 5 as insufficient and nonrestorative sleep can reduce athletic performance, causing a decline in implementing specific skills in sports. ...
Purpose:
To investigate the relationship between sleep quality and quantity and injuries in elite soccer players and to compare sleep-wake variables and injury characteristics.
Methods:
The current investigation was a prospective cohort study of 23 elite male soccer players competing for 2 teams over 6 mo in the highest-level Brazilian competition. The players' sleep behavior was monitored for 10 d in the preseason using self-reporting sleep diaries and wrist activity monitors to determine sleep duration and quality. Furthermore, injuries were recorded by the respective club's medical teams into a specific database. Details of injuries recorded included the type, location, and severity of each injury. The results were expressed as descriptive statistics, and the significance level was set at 5%. The Mann-Whitney U test was performed to compare the sleep variables between groups. Spearman correlation coefficient and linear-regression analysis were used.
Results:
The results indicated a moderate negative correlation between sleep efficiency and particular injury characteristics, including absence time, injury severity, and amount of injuries. The linear-regression analysis indicated that 44% of the total variance in the number of injuries can be explained by sleep efficiency, 24% of the total variance in the absence time after injury (days) can be explained by sleep efficiency, and 47% of the total variance in the injury severity can be explained by sleep efficiency.
Conclusions:
Soccer players who exhibit lower sleep quality or nonrestorative sleep show associations with increased number and severity of musculoskeletal injuries.
... 10,11 These sleep complaints range from athletes sleeping inadequate amounts to complaints of poor quality of sleep described variously as unrefreshing sleep and dissatisfaction with sleep. 12,13 Additionally, athletes with poor quality and inadequate amount of sleep also complain of accompanying daytime sleepiness and fatigue. 10,14 The question of whether participation in sports itself results in degraded sleep has been explored. ...
None:
Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) teams during the season, often results in accompanying sleep disturbances related to sleep length, sleep quality and sleep timing (with highly harmful impacts on health, both physical and mental). These issues are not only problematic for NBA players, but also the coaches, training staff and management support. In this narrative review, we summarize the detrimental effects that this travel and game schedule could have on NBA team member's sleep, as well as their physical and mental health. Multiple peer-reviewed articles address the role of sleep in athletic performance and health, however, to date, the literature focused on sleep-related issues that are unique to the NBA schedule is scarce. Firstly, this review addresses the impact of the NBA schedule, outlining the number of games, and the travel involved (number of flights, the timing of flights, timings of arrival at destination and hotel), we also outline a typical daily NBA travel schedule, providing the reader a glimpse of what this encompasses. Secondly, we provide a brief overview of sleep science and discuss specific applications related to the NBA. Finally, we provide comment on the unique current situation of the NBA "bubble". Based on this review, there appears to be considerable scope for further investigation of the acute and chronic effects of sleep disturbances concerning the NBA travel and game schedule. Sleep science recommendations need to inform practice, target sleep interventions and personalized protocols designed to enhance sleep health that can be incorporated at the organizational level.
... A reduction in sleep quality has been associated with increased incidence of fatigue-related injury [1], reductions in the skeletal muscle remodeling [10], and disturbs cellular maintenance processes [6,7]. Despite evidence affirming the importance of restorative sleep [11], elite athletes appear to experience more sleep disturbances than the general population [1,8]. Behavioral and lifestyle strategies that promote sleep and sports performance will be welcomed by athletes and coaches. ...
Athletes often experience sleep disturbances and poor sleep as a consequence of extended travel, the timing of training and competition (i.e., early morning or evening), and muscle soreness. Nutrition plays a vital role in sports performance and recovery, and a variety of foods, beverages, and supplements purportedly have the capacity to improve sleep quality and quantity. Here, we review and discuss relevant studies regarding nutrition, foods, supplements, and beverages that may improve sleep quality and quantity. Our narrative review was supported by a semi-systematic approach to article searching, and specific inclusion and exclusion criteria, such that articles reviewed were relevant to athletes and sporting environments. Six databases—PubMed, Scopus, CINAHL, EMBASE, SPORTDiscus, and Google Scholar—were searched for initial studies of interest from inception to November 2020. Given the paucity of sleep nutrition research in the athlete population, we expanded our inclusion criteria to include studies that reported the outcomes of nutritional interventions to improve sleep in otherwise healthy adults. Carbohydrate ingestion to improve sleep parameters is inconclusive, although high glycemic index foods appear to have small benefits. Tart cherry juice can promote sleep quantity, herbal supplements can enhance sleep quality, while kiwifruit and protein interventions have been shown to improve both sleep quality and quantity. Nutritional interventions are an effective way to improve sleep quality and quantity, although further research is needed to determine the appropriate dose, source, and timing in relation to training, travel, and competition requirements.
... ("never," "only a little," "occasionally," "almost every night," or "every night"). The questions that referred to sleep-related problems were also used in a previous study [29] and were derived from a previously validated questionnaire (Basic Nordic Sleep Questionnaire [30]. Small amendments were made related to the target population, i.e., musicians. ...
Objective: This study aimed to evaluate whether self-reported sleep bruxism among musicians is associated with sleep-related problems and/or psychological stress.
Methods: Eight hundred-thirty-one Finnish orchestra musicians completed a questionnaire that covered, among others, indicators of sleep-related problems, possible sleep bruxism, and stress.
Results: In total, 488 questionnaires were completed. The single variable ordinal logistic regression models revealed at least moderate associations between frequency of sleep bruxism and female gender, shorter sleep duration, longer sleep latency, problems in sleeping during concert season, feeling more often tired during the daytime, restless legs, a poor self-rated sleep quality, and more stress experience. The variables that remained in the final model were sleep duration, gender, and stress.
Conclusion: Musicians who sleep 7 hours or less per night report more sleep bruxism, as compared to those who sleep 8 hours or more. Female gender and high-stress experience were associated with more sleep bruxism.
... Sleep quality may be measured with the use of standardized questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI, Buysse et al., 1989). Despite the importance of sleep for athletic functioning (Kellmann et al., 2018), athletes' reports of poor subjective sleep quality (PSQI > 5, Buysse et al., 1989), during the competitive as well as preparatory phases of the season, vary from ∼28% (Tuomilehto et al., 2017;Hoshikawa et al., 2018;Hrozanova et al., 2019) to ∼55% (Samuels, 2008;Fietze et al., 2009;Swinbourne et al., 2016). ...
On their journeys toward senior athletic status, junior endurance athletes are faced with a multitude of stressors. How athletes react to stressors plays a vital part in effective adaptation to the demanding, ever-changing athletic environment. Sleep, the most valued recovery strategy available to athletes, has the potential to influence and balance athletic stress, and enable optimal functioning. However, sleep is sensitive to disturbances by stress, which is described by the concept of sleep reactivity. Among athletes, poor sleep quality is frequently reported, but our understanding of the associations between stress and sleep in junior athletes is currently incomplete. The present study therefore investigated the themes of stress and sleep, and the associations between these variables with the use of in-depth semi-structured interviews in six junior endurance athletes (three men and three women, mean age 17.7 ± 0.5 years). Data was analyzed qualitatively based on the Grounded Theory. The qualitative material was supplemented with quantitative data on subjective sleep quality (Pittsburg Sleep Quality Index), sleep reactivity (Ford Insomnia Response to Stress Test), and mental strain (visual analog scale). The main results showed that stress could be differentiated into relevant stressors (encompassing poor performance, uncertainty in relation to training, school, daily hassles, and sleep) and reactions to stress (with sub-categories facilitative and maladaptive). Sleep could be differentiated into sleep benefits (encompassing energy levels and athletic functioning) and sleep quality (with sub-categories satisfactory and inadequate). All athletes identified relevant stressors, and all athletes were aware of the benefits of sleep for athletic functioning. However, athletes formed two distinctive categories based on the interactions between stress and sleep: three exhibited facilitative reactions to stress and good sleep quality, as well as low sleep reactivity, and low mental strain. The remaining participants exhibited maladaptive reactions to stress and poor sleep quality, as well as high sleep reactivity and high mental strain. Conceptualizing sleep quality based on the evaluation of stressors, reactions to stress, degree of mental strain, and the propensity to stress-related sleep disturbance may offer a plausible explanation for why the occurrence of stressors leads to poor sleep quality in some athletes, but not others.
... Appropriate sleep is widely accepted as an integral component of the recovery process in athletes (for review see [112]). Professional athletes have previously reported suboptimal sleep quantity [113] and quality [114]. Indeed, disturbances in sleep can be a consequence of several mechanisms including pre-game supplementation [115], the time of competition [116], implications of long-haul travel [117], and anxiety associated with competition [118][119][120][121]. ...
Cannabis is widely used for both recreational and medicinal purposes on a global scale. There is accumulating interest in the use of cannabis and its constituents for athletic recovery, and in some instances, performance. Amidst speculation of potential beneficial applications, the effects of cannabis and its two most abundant constituents, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), remain largely un-investigated. The purpose of this review was to critically evaluate the literature describing the effects of whole cannabis, THC, and CBD, on athletic performance and recovery. While investigations of whole cannabis and THC have generally shown either null or detrimental effects on exercise performance, studies of sufficient rigor and validity to conclusively declare ergogenic or ergolytic potential in athletes are lacking. The ability of cannabis and THC to perturb cardiovascular homeostasis warrants further investigation regarding mechanisms by which performance may be affected across different exercise modalities and energetic demands. In contrast to cannabis and THC, CBD has largely been scrutinized for its potential to aid in recovery. The beneficial effects of CBD on sleep quality, pain, and mild traumatic brain injury may be of particular interest to certain athletes. However, research in each of these respective areas has yet to be thoroughly investigated in athletic populations. Elucidating the effects of whole cannabis, THC, and CBD is pertinent for both researchers and practitioners given the widespread use of these products, and their potential to interact with athletes’ performance and recovery.
... It is an important factor for stress-recovery balance among team athletes [4]. Athletes sleep is influenced by sports-specific factors, such as competition [5,6], travel [7], training [8] and non-sports factors, such as stress, anxiety and late-night blue light, etc. [8] Sleep inadequacies, such as poor sleep quality [9], insufficient sleep [10], daytime sleepiness [9,11], sleep disturbance [9], longer sleep latency [12], and greater sleep fragmentation [13], are prevalent among athletic population. ...
Objective
The aim of the present study was to investigate the sleep quality and its association with mental toughness, stress, depression, anxiety, and sports anxiety of Indian male Kho Kho players.
Methods
Participants were 52 male Indian Kho Kho players (aged 23.1 ± 3.70 years) of the pre-competition phase. Self-reported sleep quality of participants was assessed using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Depression, Anxiety and Stress Scale (DASS-21) and Physical Activity and Sport Anxiety Scale (PASAS) and Mental Toughness Questionnaire-Short Form (SMTQ) questionnaires were used as tools to assess the mental health status of the athletes. Descriptive statistics and one-way ANOVA were computed to test the study hypothesis.
Results
Sleep problems (PSQI Score > 5) were prevalent among 38.5% of athletes. Poor sleep quality (PSQI Score 6–10; 21.2%) and very poor sleep quality (PSQI Score > 11; 17.3%) were observed among the athletes. Sleep quality index scores were significantly associated (p < 0.05) with sleep disturbance, daytime dysfunction, and medication. Symptoms related to depression (15.3%), anxiety (36.5%), stress (9.6%), and sports anxiety (7.7%) were also found among athletes. Stress levels were found to be significantly increased (p < 0.05) in athletes with poor sleep quality. However, anxiety, depression and sports anxiety and mental toughness did not show a significant association with sleep quality.
Conclusion
Poor sleep quality can be associated with increased stress levels, but not with depression, anxiety and sports anxiety and mental toughness among Indian male Kho Kho players.
... 29 In other athletic studies, the prevalence of OSA varies from 24% 10 to up to 45% 30 in rugby players, American football and Ice hockey. 31 We found the prevalence of OSA to significantly impacted Total Sleep Time with those with "high risk" of OSA spending an additional 21 min awake each night, and having a 5% lower Sleep Efficiency, than those with "low risk" of OSA. Although the prevalence rates were somewhat lower in our study compared with studies of other athletes, they are still troublesome, with one in five at risk. ...
Open water swimming ultra-marathon events ≥10 km have become increasingly popular amongst master athletes. However, very little is known about the timing of training sessions and the impact on sleep. This study aimed to examine sleep behaviours, sleep problems and disorders and the relationship with training timings.
This study used a longitudinal observational design for 42 nights with 24 masters' swimmers (n = 13 females), aged 39 ± 11 years, body mass index of 26 ± 3 kg/m ² during a training squad for an ocean ultra-swim (19.7 km) in Western Australia. Objective measures of sleep were obtained from a wrist-activity monitor, the Readiband™ (Fatigue Science Inc., Canada). Swimmers completed a survey instrument related to sleep problems, disorders, chronotype, anthropometric and demographic information. Generalised linear mixed models were fitted to examine relationships between predictor variables and sleep responses.
Body mass index was associated with a decline in Total Sleep Time (TST), each one-unit increase in BMI was associated with 5 min less TST (p = 0.04). Swimmers with a “high risk” of sleep apnea had 21 min more wake time (p = 0.04) and 5% lower Sleep Efficiency (p = 0.04). Sleep Offset on the morning of a morning training session was earlier by 48 min (p < 0.001) resulting in less TST by 39 min (p < 0.001).
This study provides evidence that coaches need to consider sleep behaviours and problems before designing training schedules. Swimmers need to plan and allocate an adequate sleep opportunity and those who have a suspected sleep disorder or problem should seek the support of a sleep physician.
... An arousal is defined by the National Sleep Foundation as an abrupt change in activity, which may cause a change in sleep stage from a deep stage of NREM sleep to a light stage, or from REM sleep toward wakefulness, with the possibility of awakening as the final outcome (Ohayon et al., 2017); and it is characteristic of sleep fragmentation (Ekstedt et al., 2004). The origin of an arousal is usually cortical, but it can be generated in response to sensory perturbations such as abnormal movement during sleep (Picchietti and Winkelman, 2005;Tuomilehto et al., 2017). This is supported in the present study by a significant correlation between arousals and limb movements (r = 0.43; p < 0.05; n = 34). ...
Introduction: The aim of the present study was to investigate the effect of the depth of cold water immersion (CWI) (whole-body with head immersed and partial-body CWI) after high-intensity, intermittent running exercise on sleep architecture and recovery kinetics among well-trained runners.
Methods: In a randomized, counterbalanced order, 12 well-trained male endurance runners (VO2max = 66.0 ± 3.9 ml·min−1·kg−1) performed a simulated trail (≈18:00) on a motorized treadmill followed by CWI (13.3 ± 0.2°C) for 10 min: whole-body immersion including the head (WHOLE; n = 12), partial-body immersion up to the iliac crest (PARTIAL; n = 12), and, finally, an out-of-water control condition (CONT; n = 10). Markers of fatigue and muscle damage—maximal voluntary isometric contraction (MVIC), countermovement jump (CMJ), plasma creatine kinase [CK], and subjective ratings—were recorded until 48 h after the simulated trail. After each condition, nocturnal core body temperature (Tcore) was measured, whereas sleep and heart rate variability were assessed using polysomnography.
Results: There was a lower Tcore induced by WHOLE than CONT from the end of immersion to 80 min after the start of immersion (p < 0.05). Slow-wave sleep (SWS) proportion was higher (p < 0.05) during the first 180 min of the night in WHOLE compared with PARTIAL. WHOLE and PARTIAL induced a significant (p < 0.05) decrease in arousal for the duration of the night compared with CONT, while only WHOLE decreased limb movements compared with CONT (p < 0.01) for the duration of the night. Heart rate variability analysis showed a significant reduction (p < 0.05) in RMSSD, low frequency (LF), and high frequency (HF) in WHOLE compared with both PARTIAL and CONT during the first sequence of SWS. No differences between conditions were observed for any markers of fatigue and muscle damage (p > 0.05) throughout the 48-h recovery period.
Conclusion: WHOLE reduced arousal and limb movement and enhanced SWS proportion during the first part of the night, which may be particularly useful in the athlete's recovery process after exercise. Future studies are, however, required to assess whether such positive sleep outcomes may result in overall recovery optimization.
... The quality and duration of an individual's sleep, including the quality of recovery, is an important factor, which has also been identified to influence brain performance [133]. It has been suggested that the restorative nature of good quality sleep is important for effective training and performance [134]. High quality sleep can help athletes deal with, and adjust to, the emotional, immunological, neurological, and physical stressors that they experience [135]. ...
Proper nutrition is a key factor in physical performance, but there are also indications of an impact of dietary components on the brain function. Therefore, the aim of the study was to assess the impact of macronutrients and water on cognitive performance. Assumptions of the Mediterranean diet correlate with better global cognition, episodic memory, lower risk of cognitive impairment and neurodegenerative diseases. In turn, a high-fat and high-sugar diet shows the opposite effect. Omega-3 fatty acids could be used as a preventive tool for cognitive decline, but there is still insufficient evidence if supplementation improves cognitive functions. The proper intake of protein may be important in cognitive performance. Tyrosine seems to be potentially effective in inhibition of fatigue under extreme conditions, and the influence of BCAA on cognitive performance is still unclear. An appropriate glucose level is a critical factor for brain functions. Carbohydrate supplementation before and during exercise is associated with enhanced brain activation and decreased exercise perception, as well as improved cognitive functions. Dehydration worsens cognitive performance, especially for tasks requiring attention, executive functions and coordination. Based on the review of available studies, it should be assumed that proper nutrition might play a relevant role in athletes' cognitive performance.
... [21]. It is felt that though sleep problems are common, but they require attention [25]. We had recruited 57 sportsmen after sleep awareness talk and followed them for 8 weeks which included four weeks of intervention to improve sleep. ...
Sleep problems exist in sportspersons. There is a need to find the strategies which may help in improving sleep in sports. A trial to study the effects of yoga nidra and progressive muscle relaxation intervention on sleep profile of the athletes was done. Yoga nidra was given during the morning and compared to practicing progressive muscular relaxation before sleeping at night. 57 male sportsperson from seven sports disciplines completed the study. Baseline and post-intervention data after 4 weeks of intervention was obtained using a 14-day sleep diary and overnight sleep staging in volunteers. The data of 45 athletes was analyzed. The baseline data showed 64% to have subjective sleep onset latency (SOL) more than 30 min. There was significant improvement in objective SOL (p value = 0.031). Both the interventions significantly improved all subjective sleep variables. However, during inter group comparison subjective SOL, Time in Bed (TIB) and sleep efficiency (SE) were significantly improved in yoga nidra group as compared to PMR group (p value = 0.0001). Sleep problems in sportspersons exists and sleep strategies using PMR and yoga nidra are useful in improving sleep in sportsperson.
... Possible strategies to minimize deleterious effects on performance, are to adapt their sleep/wake rhythm so timing of optimal performance is aligned with competition time and to use tools such as blue light to advance or delay circadian rhythm when appropriate131,132 .Besides chronobiological issues arising from early or late training sessions, competition elicits also mental challenges which may hamper ideal sleep and thus recovery. Anxiety, nervousness and thoughts about the competition contribute to inferior sleep the night(s) prior to competitions116,117,130,[133][134][135] . Stress can trigger an evening rise in cortisol excretion from the adrenal cortex, which usually reaches its nadir around midnight, and induces shortened TST, increased sleep fragmentation and decreased SWS 136 . ...
... In particular, the state of research in the training setting as well as in concerns of sleep interventions remains insufficiently considered. However, there is broad consensus on the need for sleep monitoring and documentation [1,10,33]. There are currently no explicit recommendations or guidelines on sleep hygiene or sleep monitoring [18,30]. ...
Background
In current sports science, the important role of sleep quality for health and peak performance is well acknowledged. More precisely, it is evident that the negative combination of stressful factors, low resources, and bad sleep habits causes short-term performance losses as well as long-term health consequences. As the maximization of human performance consisting of multiple fixed workloads is the main motivation in CrossFit® (CF), the aim of the present study was to investigate the influence of high sleep quality on performance in CrossFit® athletes (CFA) and the different training categories that are addressed in CF.
Methods
In total, 149 CFA (81 females, 68 males; 32.01 ± 7.49 years old, 2.56 ± 1.77 active years in CF) filled in the online survey comprising the Pittsburgh Sleep Quality Index (PSQI) and CF performance-specific questions.
Results
It was found that CFA with high sleep quality reported higher values in all performance-related outcomes. Especially in Hero-/Girl-Workouts (χ2 = (1, n = 83) = 9.92, p = .002, φ = 0.37) and Gymnastics (χ2 = (1, n = 129) = 8.74, p = .003, φ = 0.28), performance differed significantly between good and poor sleeping CFA. Since those CF categories are highly technical- and cognitive-demanding high sleep quality seems to play a fundamental role in complex motor skill learning and performance development.
Conclusions
These results reveal for the first time the positive effects of high sleep quality for performance in CFA and could be used as basis for future studies. Future research should also develop and empirically test suitable interventions to foster high sleep quality in CFA.
Trial Registration : The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of University of the Federal Armed Forces Munich, Germany (06/04/2018).
... A study of professional athletes found that one in every 4 athletes had a significant sleep hygiene issue. 10 In the student-athlete population, sleep is particularly important because of the demands of academic and athletic performance. This, combined with the schedule inconsistencies inherent in college life, may affect sleep in many ways. ...
... Sleep is essential to optimal health and restorative function [1], especially in athletes [2]. Thus, athletes and coaches recognize the relevance of sleep for supporting performance and recovery [3]. In an era of data monitoring, controlling the training process and factors affecting performance is crucial [4]. ...
The purpose of this systematic review was to summarize available evidence regarding the relationships between sleep and (i) athletic and match performance, (ii) training load, and (iii) injuries in soccer players. A systematic review of EBSCOhost (SPORTDiscus), PubMed, Cochrane Library , FECYT (Web of Sciences, CCC, DIIDW, KJD, MEDLINE, RSCI, and SCIELO) databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 297 titles were identified, of which 32 met the eligibility criteria. Results revealed that soccer players are no exception for sleep inadequacy. Although there was inconsistency in the findings, some studies suggested that sleep restrictions in soccer negatively affected athletic and match performance while also increasing the number and severity of musculo-skeletal injuries. On the other hand, inconsistent results were found between sleep and athletic and match performance, and training load in soccer players. Physiological responses (and their intensity) during drill-based games were not influenced by changes in sleep. The available evidence is inconsistent; however, it appears to suggest that poor sleep affects soccer players' performance and increases the risk of injury. However, it remains important to study this complex relationship further .
Although the link between sleep, health, and performance has been well documented, research on this link in collegiate student-athletes is still in its infancy. A large body of evidence indicates that collegiate student-athletes are not obtaining enough sleep, but less is known about their sleep quality, patterns, and the impact on health and performance. Consequently, short sleep negatively affects physical and mental health, as well as several domains of performance (ie, aerobic, anaerobic, sport-specific, cognitive). The majority of studies examining the links between short sleep, health, and performance have been conducted with healthy adults or noncollegiate athlete samples; however, collegiate student-athletes have demands unlike those of their nonathlete or noncollegiate athlete counterparts. Poor sleep health and sleep disorders are of increasing concern among the college athlete population and have recently been recognized by national and international sports governing bodies. The purpose of this review was to summarize the available literature on sleep and its impact on health and performance among athletes, specifically addressing gaps where no data are available on collegiate student-athletes. Consideration is also given to sleep interventions that have been used with athletes, as well as recommendations for future research and intervention development.
Background
Sleep quality is an essential component of athlete’s recovery. However, a better understanding of the parameters to adequately quantify sleep quality in team sport athletes is clearly warranted.
Objective
To identify which parameters to use for sleep quality monitoring in team sport athletes.
Methods
Systematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus, SPORTDiscus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. For the meta-analysis, effect sizes with 95% CI were calculated and heterogeneity was assessed using a random-effects model. The coefficient of variation (CV) with 95% CI was also calculated to assess the level of instability of each parameter.
Results
In general, 30 measuring instruments were used for monitoring sleep quality. A meta-analysis was undertaken on 15 of these parameters. Four objective parameters inferred by actigraphy had significant results (sleep efficiency with small CV and sleep latency, wake episodes and total wake episode duration with large CV). Six subjective parameters obtained from questionnaires and scales also had meaningful results (Pittsburgh Sleep Quality Index (sleep efficiency), Likert scale (Hooper), Likert scale (no reference), Liverpool Jet-Lag Questionnaire, Liverpool Jet-Lag Questionnaire (sleep rating) and RESTQ (sleep quality)).
Conclusions
These data suggest that sleep efficiency using actigraphy, Pittsburgh Sleep Quality Index, Likert scale, Liverpool Jet-Lag Questionnaire and RESTQ are indicated to monitor sleep quality in team sport athletes.
PROSPERO registration number
CRD42018083941.
Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes’ sleep.
Professional sport belongs to those types of activities that are accompanied by high energy costs and requires more than a person needs on average, the amount of sleep. Sleep of professional athletes is important for restoring the brain’s energy expenditure, as well as for the normal functioning of memory and attention, and, consequently, for achieving high sports results. The article analyzes the literature devoted to the study of the role of sleep for athletes, scientific information about the representation, nature and consequences of its violations, summarizes and structures data related to the strategy for optimizing sleep in this population group.
In diesem Kapitel soll das Schlafverhalten von Athletinnen und Athleten in den verschiedenen Sportarten näher betrachtet werden. Das Schlafverhalten wurde in der Sportpraxis überwiegend durch die Aktigraphie erhoben. Die methodischen Besonderheiten der Aktigraphie (z. B. Unter-/Überschätzung von Wachzeiten) werden deshalb gesondert diskutiert. Anschließend sollen die Begriffe Schläfrigkeit, Müdigkeit und Erschöpfbarkeit im Kontext der Schlafmedizin und Sportpraxis differenziert betrachtet werden. Die Schlafdauer und Schlafqualität scheint durch die Anforderungen der einzelnen Sportarten beeinflusst – vor allem die geringen Schlafzeiten in trainingsintensiven Individualsportarten überrascht. Verschiedene Trainingsfaktoren interferieren dabei mit dem Schlafverhalten, wodurch sich einige konkrete Empfehlung für die Sportpraxis ableiten lassen.
El objetivo de la presente investigación es describir y analizar los patrones de sueño de hombres y mujeres deportistas universitarios practicantes de fútbol, baloncesto, voleibol, atletismo, natación y taekwondo. Participaron 114 deportistas (56 hombres, 58 mujeres), quienes durante 7 días utilizaron un acelerómetro modelo wGT3X-BT al momento de dormir. Todas las mediciones fueron realizadas al inicio del periodo de preparación de los deportistas. Se presentaron interacciones entre el sexo y el deporte para la eficiencia de sueño (p = 0.006), el tiempo en despertar (p = 0.016), el tiempo en cama (p = 0.048) y el tiempo de sueño (p = 0.006). La latencia, así como la cantidad y la duración de los despertares, no difieren según el sexo ni el deporte practicado. Independientemente del deporte, los hombres presentan una mayor cantidad (p = 0.046) y duración (p =0.002) de despertares que las mujeres. Se observaron valores de eficiencia y duración de sueño inferiores a los deseados. Se recomienda vigilar los patrones de sueño de los deportistas universitarios, ya que las obligaciones académicas podrían afectar sus hábitos de sueño.
ABSTRACT
Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1–3 nights, a more real-world scenario, remains unclear. Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health. Studies in the wider population show that habitually sleeping <7 hours/night increases susceptibility to respiratory infection. Fortunately, much is known about the salient risk factors
for sleep inadequacy in athletes, enabling targeted interventions. For example, athlete sleep is influenced by sport-specific factors (relating to training, travel and competition) and non-sport factors (eg, female gender, stress and anxiety). This expert consensus culminates with a sleep toolbox for practitioners (eg, covering sleep education and screening) to mitigate these risk factors and optimise athlete sleep. A one-size-fits-all approach to athlete sleep recommendations (eg, 7–9 hours/night) is unlikely ideal for health and performance. We recommend an individualised approach that should consider the athlete’s perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).
Although optimizing sleep with the goal of optimizing athletic performance is gaining support among the athletic community, sleep and its disorders remain under-recognized and underappreciated. This is critically important as athletic performance is impaired by the presence of inadequate sleep and untreated sleep disorders. Athletes are uniquely at a higher risk for certain sleep disorders such as obstructive sleep apnea, including those in collision sports where athletes with larger body mass and neck size have a distinct advantage.
Objectives
Limited data suggest that swimmers might be affected by poor quality of sleep significantly. The aim was to explore the prevalence of sleep disturbances in swimmers and possible link between rhinitis and sleep disturbance.
Methods
Study 1 was an observational case–control, questionnaire-based study involving 157 elite and non-elite swimmers, 36 non-swimming athletes and 50 controls. In study 2, we measured sleep quality and duration using actigraphy in 20 elite swimmers. We also looked for presence of sleep-disordered breathing using overnight pulse oximetry monitor.
Results
In study 1, we observed a significant difference in prevalence of excessive daytime sleepiness between groups of elite swimmers and controls. Pittsburgh Sleep Quality Index (PSQI) scores do not suggest that quality of sleep in group of swimmers is impaired. In study 2, we found that prevalence of obstructive sleep apnoea (OSA) in elite swimmers defined as oxygen desaturation index ≥5 was 30%. Analysis of actigraphy data revealed that on nights prior to training days, ‘going to’ bed time was significantly earlier and total sleep time was significantly reduced.
Conclusion
Swimmers and non-swimming athletes suffer significantly more with excessive daytime sleepiness than healthy controls. In elite swimmers, this is likely linked to high prevalence of OSA. PSQI scores do not suggest that quality of sleep in group of swimmers is impaired, but actigraphy shows great variations between sleep pattern preceding training and rest day. This seems to be associated with early-morning sessions which can be a disruptive element of weekly sleep patterns.
Purpose
To explore the prevalence of obstructive sleep apnea (OSA) within a professional rugby league team and determine associations of OSA with ethnicity, positional group, and physical characteristics.
Methods
22 professional rugby league athletes underwent one night of home-based polysomnography with apnea-hypopnea index (AHI), rapid eye movement (REM)AHI, non-REMAHI and supineAHI determined to indicate OSA. Linear models were used to assess if playing position (back or forward) or ethnicity (European-Australian or Polynesian) influenced AHI, REMAHI, non-REMAHI and supineAHI. Models were also built to determine differences according to body composition.
Results
Seven athletes were classified with mild OSA (6 forwards and 1 back, 3 European-Australians, and 4 Polynesians) and three with moderate OSA (2 forwards and 1 back, 3 Polynesians). When considering ethnicity, differences were observed between Polynesians and European-Australians for REMAHI (ES = 0.90, p = 0.02). Increased body mass index (BMI) was associated with a moderate increase in AHI (r = 0.38, p = 0.04) and non-REMAHI (r = 0.36, p = 0.05), while higher skinfold thickness moderately related to a higher AHI (r = 0.40, p = 0.05) non-REMAHI (r = 0.47, p = 0.02), and supineAHI (r = 0.41, p = 0.04.
Conclusions
This exploratory study found 10 cases of OSA. Polynesian athletes and athletes classified as forwards constituted the majority of reported cases, suggesting their susceptibility to OSA. Furthermore, the data suggests that athletes with greater BMI and skinfold thickness may be predisposed to OSA.
Study objectives:
The objective of this study was to characterize sleep health in a large, diverse population of college athletes utilizing the Athletic Sleep Screening Questionnaire (ASSQ), a clinically validated questionnaire, designed to screen athletes for clinically significant degree of poor sleep health, and determine if they require further intervention.
Methods:
College athletes from 4 different NCAA institutions were surveyed using the Athletic Sleep Screening Questionnaire (ASSQ). Descriptive information including gender, sport, and college year was also collected. The ASSQ was scored according to prior clinically validated methods to determine sleep difficulty score (SDS), clinical sleep problem category (none, mild, moderate, or severe), and need for assessment by a physician due to poor sleep health.
Results:
1055 surveys were collected with a 95% response rate. Respondents were 36% female, 64% male, and included athletes competing in 15 different sports. Approximately 25% of participants were found to have a clinically meaningful problem with their sleep. Athletes entering their second or higher year of college were more likely to report worse sleep compared to those entering their first year (one-way ANOVA, kruskall-wallis p<0.001).
Conclusions:
A substantial portion of college athletes experience poor sleep health, and would benefit from interventions aimed at improving sleep. The ASSQ appears to be a cost and time efficient way to evaluate sleep health in a large athletic population.
Sleep is a physiological state and it is fundamental for physical and cognitive recovery of athletes. Due to strenuous training and competitions, athletes may present sleep complaints compromising good quality and quantity of sleep. Studies have related sleep debt to the occurrence of musculoskeletal injuries in athletes, but the mechanisms that can lead to this are not entirely clear. Studies involving animals and humans have shown that poor sleep quality can cause significant changes in hormones and cytokines. Demonstrating that this hormones changes lead to a decrease of testosterone and growth hormone levels and increased cortisol levels, important hormones in the process of protein synthesis and degradation. In athletes, the sport itself is a risk factor of injuries, and sleep debt may result in overtraining syndrome associated with inflammatory markers and ultimately to immune system dysfunction. Thus, we hypothesize that athletes who have sleep debt are more susceptible to musculoskeletal injuries due to increased catabolic pathway signaling, i.e. protein degradation and decreased anabolic pathway signaling, compromising muscle integrity. In this sense, we indicate the relationship between musculoskeletal injuries and sleep debt involving new targets for immunological signaling pathways that start the reduction of the muscle recovery process.
Sleep health is an important consideration for athletic performance. Athletes are at high risk of insufficient sleep duration, poor sleep quality, daytime sleepiness and fatigue, suboptimal sleep schedules, irregular sleep schedules, and sleep and circadian disorders. These issues likely have an impact on athletic performance via several domains. Sleep loss and/or poor sleep quality can impair muscular strength, speed, and other aspects of physical performance. Sleep issues can also increase risk of concussions and other injuries and impair recovery after injury. Cognitive performance is also impacted in several domains, including vigilance, learning and memory, decision making, and creativity.
In elite soccer, players are frequently exposed to various situations and conditions that can interfere with sleep (e.g., playing night matches interspersed with 3 days; performing activities demanding high levels of concentration close to bedtime; use of products containing caffeine or alcohol in the period preceding bedtime; regular daytime napping throughout the week; variable wake-up times or bedtime), potentially leading to sleep deprivation. We outline simple, practical, and pharmaceutical-free sleep strategies that are coordinated to the constraints of elite soccer in order to promote sleep. Sleep deprivation is best alleviated by sleep extension; however, sleep hygiene strategies (i.e., consistent sleep pattern, appropriate napping, and active daytime behaviors) can be utilized to promote restorative sleep. Light has a profound impact on sleep, and sleep hygiene strategies that support the natural environmental light-dark cycle (i.e., red-light treatment prior to sleep, dawn-simulation therapy prior to waking) and prevent cycle disruption (i.e., filtering short wavelengths prior to sleep) may be beneficial to elite soccer players. Under conditions of inordinate stress, techniques such as brainwave entrainment and meditation are promising sleep-promoting strategies, but future studies are required to ascertain the applicability of these techniques to elite soccer players. Consuming high-electrolyte fluids such as milk, high-glycemic index carbohydrates, some forms of protein immediately prior to sleep, as well as tart cherry juice concentrate and tryptophan may promote rehydration, substrate stores replenishment, muscle-damage repair and/or restorative sleep. The influence of cold water immersion performed close to bedtime on subsequent sleep is still debated. Conversely, the potential detrimental effects of sleeping medication must be recognized. Sleep initiation is influenced by numerous factors, reinforcing the need for future research to identify such factors. Efficient and individualized sleep hygiene strategies may consequently be proposed.
Although its true function remains unclear, sleep is considered critical to human physiological and cognitive function. Equally, since sleep loss is a common occurrence prior to competition in athletes, this could significantly impact upon their athletic performance. Much of the previous research has reported that exercise performance is negatively affected following sleep loss; however, conflicting findings mean that the extent, influence, and mechanisms of sleep loss affecting exercise performance remain uncertain. For instance, research indicates some maximal physical efforts and gross motor performances can be maintained. In comparison, the few published studies investigating the effect of sleep loss on performance in athletes report a reduction in sport-specific performance. The effects of sleep loss on physiological responses to exercise also remain equivocal; however, it appears a reduction in sleep quality and quantity could result in an autonomic nervous system imbalance, simulating symptoms of the overtraining syndrome. Additionally, increases in pro-inflammatory cytokines following sleep loss could promote immune system dysfunction. Of further concern, numerous studies investigating the effects of sleep loss on cognitive function report slower and less accurate cognitive performance. Based on this context, this review aims to evaluate the importance and prevalence of sleep in athletes and summarises the effects of sleep loss (restriction and deprivation) on exercise performance, and physiological and cognitive responses to exercise. Given the equivocal understanding of sleep and athletic performance outcomes, further research and consideration is required to obtain a greater knowledge of the interaction between sleep and performance.
In any sport, successful performance requires a planned approach to training and recovery. While sleep is recognized as an essential component of this approach, the amount and quality of sleep routinely obtained by elite athletes has not been systematically evaluated. Data were collected from 70 nationally ranked athletes from seven different sports. Athletes wore wrist activity monitors and completed self-report sleep/training diaries for 2 weeks during normal training. The athletes also recorded their fatigue level prior to each training session using a 7-point scale. On average, the athletes spent 08:18 ± 01:12 h in bed, fell asleep at 23:06 ± 01:12 h, woke at 6:48 ± 01:30 h and obtained 06:30 ± 01:24 h of sleep per night. There was a marked difference in the athletes' sleep/wake behaviour on training days and rest days. Linear mixed model analyses revealed that on nights prior to training days, time spent in bed was significantly shorter (p ¼ 0.001), sleep onset and offset times were significantly earlier (p50.001) and the amount of sleep obtained was significantly less (p ¼ 0.001), than on nights prior to rest days. Moreover, there was a significant effect of sleep duration on pre-training fatigue levels (p 0.01). Specifically, shorter sleep durations were associated with higher levels of pre-training fatigue. Taken together, these findings suggest that the amount of sleep an elite athlete obtains is dictated by their training schedule. In particular, early morning starts reduce sleep duration and increase pre-training fatigue levels. When designing schedules, coaches should be aware of the implications of the timing of training sessions for sleep and fatigue. In cases where early morning starts are unavoidable, countermeasures for minimizing sleep loss – such as strategic napping during the day and correct sleep hygiene practices at night – should be considered.
Study Objective: To examine recent national trends in outpatient visits for sleep related difficulties in the United States and prescriptions for sleep medications.
Design: Trend analysis.
Setting: Data from the National Ambulatory Medical Care Survey from 1999 to 2010.
Participants: Patients age 20 y or older.
Measurements and Results: The number of office visits with insomnia as the stated reason for visit increased from 4.9 million visits in 1999 to 5.5 million visits in 2010 (13% increase), whereas the number with any sleep disturbance ranged from 6,394,000 visits in 1999 to 8,237,000 visits in 2010 (29% increase). The number of office visits for which a diagnosis of sleep apnea was recorded increased from 1.1 million visits in 1999 to 5.8 million visits in 2010 (442% increase), whereas the number of office visits for which any sleep related diagnosis was recorded ranged from 3.3 million visits in 1999 to 12.1 million visits in 2010 (266% increase). The number of prescriptions for any sleep medication ranged from 5.3 in 1999 to 20.8 million in 2010 (293% increase). Strong increases in the percentage of office visits resulting in a prescription for nonbenzodiazepine sleep medications (∼350%), benzodiazepine receptor agonists (∼430%), and any sleep medication (∼200%) were noted.
Conclusions: Striking increases in the number and percentage of office visits for sleep related problems and in the number and percentage of office visits accompanied by a prescription for a sleep medication occurred from 1999-2010.
Sleep and exercise influence each other through complex, bilateral interactions that involve multiple physiological and psychological pathways. Physical activity is usually considered as beneficial in aiding sleep although this link may be subject to multiple moderating factors such as sex, age, fitness level, sleep quality and the characteristics of the exercise (intensity, duration, time of day, environment). It is therefore vital to improve knowledge in fundamental physiology in order to understand the benefits of exercise on the quantity and quality of sleep in healthy subjects and patients.
Conversely, sleep disturbances could also impair a person’s cognitive performance or their capacity for exercise and increase the risk of exercise-induced injuries either during extreme and/or prolonged exercise or during team sports.
This review aims to describe the reciprocal fundamental physiological effects linking sleep and exercise in order to improve the pertinent use of exercise in sleep medicine and prevent sleep disorders in sportsmen.
Abstract Sleep is an essential component for athlete recovery due to its physiological and psychological restorative effects, yet few studies have explored the habitual sleep/wake behaviour of elite athletes. The aims of the present study were to investigate the habitual sleep/wake behaviour of elite athletes, and to compare the differences in sleep between athletes from individual and team sports. A total of 124 (104 male, 20 female) elite athletes (mean ± s: age 22.2 ± 3.0 years) from five individual sports and four team sports participated in this study. Participants' sleep/wake behaviour was assessed using self-report sleep diaries and wrist activity monitors for a minimum of seven nights (range 7-28 nights) during a typical training phase. Mixed-effects analyses of variances were conducted to compare the differences in the sleep/wake behaviour of athletes from two sport types (i.e. individual and team). Overall, this sample of athletes went to bed at 22:59 ± 1.3, woke up at 07:15 ± 1.2 and obtained 6.8 ± 1.1 h of sleep per night. Athletes from individual sports went to bed earlier, woke up earlier and obtained less sleep (individual vs team; 6.5 vs 7.0 h) than athletes from team sports. These data indicate that athletes obtain well below the recommended 8 h of sleep per night, with shorter sleep durations existing among athletes from individual sports.
Sleep has numerous important physiological and cognitive functions that may be particularly important to elite athletes. Recent evidence, as well as anecdotal information, suggests that athletes may experience a reduced quality and/or quantity of sleep. Sleep deprivation can have significant effects on athletic performance, especially submaximal, prolonged exercise. Compromised sleep may also influence learning, memory, cognition, pain perception, immunity and inflammation. Furthermore, changes in glucose metabolism and neuroendocrine function as a result of chronic, partial sleep deprivation may result in alterations in carbohydrate metabolism, appetite, food intake and protein synthesis. These factors can ultimately have a negative influence on an athlete's nutritional, metabolic and endocrine status and hence potentially reduce athletic performance. Research has identified a number of neurotransmitters associated with the sleep-wake cycle. These include serotonin, gamma-aminobutyric acid, orexin, melanin-concentrating hormone, cholinergic, galanin, noradrenaline, and histamine. Therefore, nutritional interventions that may act on these neurotransmitters in the brain may also influence sleep. Carbohydrate, tryptophan, valerian, melatonin and other nutritional interventions have been investigated as possible sleep inducers and represent promising potential interventions. In this review, the factors influencing sleep quality and quantity in athletic populations are examined and the potential impact of nutritional interventions is considered. While there is some research investigating the effects of nutritional interventions on sleep, future research may highlight the importance of nutritional and dietary interventions to enhance sleep.
Objectives
Anecdotally many athletes report worse sleep in the nights prior to important competitions. Despite sleep being acknowledged as an important factor for optimal athletic performance and overall health, little is understood about athlete sleep around competition. The aims of this study were to identify sleep complaints of athletes prior to competitions and determine whether complaints were confined to competition periods.
Design
Cross-sectional study.
Methods
A sample of 283 elite Australian athletes (129 male, 157 female, age 24 ± 5 yr) completed two questionnaires; Competitive Sport and Sleep questionnaire and the Pittsburgh Sleep Quality Index.
Results
64.0% of athletes indicated worse sleep on at least one occasion in the nights prior to an important competition over the past 12 months. The main sleep problem specified by athletes was problems falling asleep (82.1%) with the main reasons responsible for poor sleep indicated as thoughts about the competition (83.5%) and nervousness (43.8%). Overall 59.1% of team sport athletes reported having no strategy to overcome poor sleep compared with individual athletes (32.7%, p = 0.002) who utilised relaxation and reading as strategies. Individual sport athletes had increased likelihood of poor sleep as they aged. The poor sleep reported by athletes prior to competition was situational rather than a global sleep problem.
Conclusion
Poor sleep is common prior to major competitions in Australian athletes, yet most athletes are unaware of strategies to overcome the poor sleep experienced. It is essential coaches and scientists monitor and educate both individual and team sport athletes to facilitate sleep prior to important competitions.
Epidemiological studies have shown that short or insufficient sleep is associated with increased risk for metabolic diseases and mortality. To elucidate mechanisms behind this connection, we aimed to identify genes and pathways affected by experimentally induced, partial sleep restriction and to verify their connection to insufficient sleep at population level. The experimental design simulated sleep restriction during a working week: sleep of healthy men (N = 9) was restricted to 4 h/night for five nights. The control subjects (N = 4) spent 8 h/night in bed. Leukocyte RNA expression was analyzed at baseline, after sleep restriction, and after recovery using whole genome microarrays complemented with pathway and transcription factor analysis. Expression levels of the ten most up-regulated and ten most down-regulated transcripts were correlated with subjective assessment of insufficient sleep in a population cohort (N = 472). Experimental sleep restriction altered the expression of 117 genes. Eight of the 25 most up-regulated transcripts were related to immune function. Accordingly, fifteen of the 25 most up-regulated Gene Ontology pathways were also related to immune function, including those for B cell activation, interleukin 8 production, and NF-κB signaling (P<0.005). Of the ten most up-regulated genes, expression of STX16 correlated negatively with self-reported insufficient sleep in a population sample, while three other genes showed tendency for positive correlation. Of the ten most down-regulated genes, TBX21 and LGR6 correlated negatively and TGFBR3 positively with insufficient sleep. Partial sleep restriction affects the regulation of signaling pathways related to the immune system. Some of these changes appear to be long-lasting and may at least partly explain how prolonged sleep restriction can contribute to inflammation-associated pathological states, such as cardiometabolic diseases.
Aims/hypothesis:
Subclinical inflammation confers an increased risk of type 2 diabetes, cardiovascular disease, neurodegenerative disorders and other age-related chronic diseases. Physical activity and diet can attenuate systemic immune activation, but it is not known which individual components of a comprehensive lifestyle intervention are most effective in targeting subclinical inflammation.
Methods:
We used data from the baseline examination and the 1 year follow-up of a subsample of 406 of 522 participants of the Finnish Diabetes Prevention Study (DPS) to estimate the effect of individual components of lifestyle intervention on C-reactive protein (CRP) and IL-6 levels, which represent the best characterised proinflammatory risk factors for type 2 diabetes. Changes in metabolic markers, dietary patterns and exercise were analysed to determine which were most strongly associated with the anti-inflammatory effect of lifestyle changes.
Results:
Lifestyle intervention reduced circulating levels of CRP (p < 0.001) and IL-6 (p = 0.060). Increases in fibre intake and moderate to vigorous leisure time physical activity (LTPA), but not total LTPA, predicted decreases in CRP and/or IL-6 and remained associated even after adjustment for baseline BMI or changes in BMI during the first year of the study. Changes in carbohydrate or fat intake were either weakly or not linked to reductions in CRP and IL-6.
Conclusions/interpretation:
The present study assessed the individual effects of dietary and physical activity measures on low-grade inflammation in individuals at high cardiometabolic risk. Our results underline the importance of moderate to vigorous LTPA and a diet rich in natural fibre, and this should be emphasised in lifestyle recommendations.
Our aim was to estimate heritability in phenotypic insomnia and the association between insomnia and mortality.
Representative follow-up study.
1990 survey of the Finnish Twin Cohort (N = 12502 adults; 1554 monozygotic and 2991 dizygotic twin pairs).
Current insomnia-related symptoms (insomnia in general, difficulty in initiating sleep, sleep latency, nocturnal awakening, early morning awakening, and non-restorative sleep assessed in the morning and during the day) were asked. Latent class analysis was used to classify subjects into different sleep quality classes. Quantitative genetic modelling was used to estimate heritability. Mortality data was obtained from national registers until end of April 2009.
The heritability estimates of each symptom were similar in both genders varying from 34% (early morning awakening) to 45% (nocturnal awakening). The most parsimonious latent class analysis produced 3 classes: good sleepers (48%), average sleepers (up to weekly symptoms, 40%), and poor sleepers (symptoms daily or almost daily, 12%). The heritability estimate for the cluster was 46% (95% confidence interval 41% to 50%). In a model adjusted for smoking, BMI, and depressive symptoms, the all-cause mortality of poor sleepers was elevated (excess mortality 55% in men and 51% in women). Further adjustment for sleep length, use of sleep promoting medications, and sleep apnea-related symptoms did not change the results.
Insomnia-related symptoms were common in both genders. The symptoms and their clusters showed moderate heritability estimates. A significant association was found between poor sleep and risk of mortality, especially in those with somatic disease.
To investigate the effects of sleep extension over multiple weeks on specific measures of athletic performance as well as reaction time, mood, and daytime sleepiness.
Stanford Sleep Disorders Clinic and Research Laboratory and Maples Pavilion, Stanford University, Stanford, CA.
Eleven healthy students on the Stanford University men's varsity basketball team (mean age 19.4 ± 1.4 years).
Subjects maintained their habitual sleep-wake schedule for a 2-4 week baseline followed by a 5-7 week sleep extension period. Subjects obtained as much nocturnal sleep as possible during sleep extension with a minimum goal of 10 h in bed each night. Measures of athletic performance specific to basketball were recorded after every practice including a timed sprint and shooting accuracy. Reaction time, levels of daytime sleepiness, and mood were monitored via the Psychomotor Vigilance Task (PVT), Epworth Sleepiness Scale (ESS), and Profile of Mood States (POMS), respectively.
Total objective nightly sleep time increased during sleep extension compared to baseline by 110.9 ± 79.7 min (P < 0.001). Subjects demonstrated a faster timed sprint following sleep extension (16.2 ± 0.61 sec at baseline vs. 15.5 ± 0.54 sec at end of sleep extension, P < 0.001). Shooting accuracy improved, with free throw percentage increasing by 9% and 3-point field goal percentage increasing by 9.2% (P < 0.001). Mean PVT reaction time and Epworth Sleepiness Scale scores decreased following sleep extension (P < 0.01). POMS scores improved with increased vigor and decreased fatigue subscales (P < 0.001). Subjects also reported improved overall ratings of physical and mental well-being during practices and games.
Improvements in specific measures of basketball performance after sleep extension indicate that optimal sleep is likely beneficial in reaching peak athletic performance.
Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.
We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea-hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0-14.9 events/h), moderate (AHI: 15.0-29.9 events/h), and severe (AHI: >or=30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80-1.08), 1.17 (95% CI: 0.97-1.42), and 1.46 (95% CI: 1.14-1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40-70 y (hazard ratio: 2.09; 95% CI: 1.31-3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease-related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality.
Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40-70 y with severe sleep-disordered breathing. Please see later in the article for the Editors' Summary.
Both short and long sleep duration have frequently been found to be associated with an increased risk for diabetes. The aim of the present exploratory analysis was to examine the association between sleep duration and type 2 diabetes after lifestyle intervention in overweight individuals with impaired glucose tolerance in a 7-year prospective follow-up.
A total of 522 individuals (aged 40-64 years) were randomly allocated either to an intensive diet-exercise counseling group or to a control group. Diabetes incidence during follow-up was calculated according to sleep duration at baseline. Sleep duration was obtained for a 24-h period. Physical activity, dietary intakes, body weight, and immune mediators (C-reactive protein and interleukin-6) were measured.
Interaction between sleep duration and treatment group was statistically significant (P = 0.003). In the control group, the adjusted hazard ratios (HRs) (95% CI) for diabetes were 2.29 (1.38-3.80) and 2.74 (1.67-4.50) in the sleep duration groups 9-9.5 h and >or=10 h, respectively, compared with for that of the 7-8.5 h group. In contrast, sleep duration did not influence the incidence of diabetes in the intervention group; for sleep duration groups 9-9.5 h and >or=10 h, the adjusted HRs (95% CI) were 1.10 (0.60-2.01) and 0.73 (0.34-1.56), respectively, compared with that in the reference group (7-8.5 h sleep). Lifestyle intervention resulted in similar improvement in body weight, insulin sensitivity, and immune mediator levels regardless of sleep duration.
Long sleep duration is associated with increased type 2 diabetes risk. Lifestyle intervention with the aim of weight reduction, healthy diet, and increased physical activity may ameliorate some of this excess risk.
Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA.
The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA.
Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements.
The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference.
VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.
Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks.
In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications.
Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia.
Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.
The purpose of this study is to assess the prevalence of insomnia symptoms and diagnoses in the general population of Finland. A total of 982 participants, aged 18 years or older and representative of the general population of Finland, were interviewed by telephone using the Sleep-EVAL system. The participation rate was 78%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and International Classification of Sleep Disorders (ICSD), associated and sleep/mental disorders and daytime consequences. The overall prevalence of insomnia symptoms occurring at least three nights per week was 37.6%. Difficulty initiating sleep were mentioned by 11.9% of the sample, difficulty maintaining sleep by 31.6%, early morning awakenings by 11.0% and non-restorative sleep by 7.9% of the sample. Global dissatisfaction with sleep was found in 11.9% of the sample. Daytime consequences (fatigue, mood changes, cognitive difficulties or daytime sleepiness) were reported by 39.9% of participants with insomnia symptoms and 87.6% of those with sleep dissatisfaction. A deterioration of sleep in summer or winter was associated with more complaints of sleep dissatisfaction. Prevalence of any DSM-IV insomnia diagnosis was 11.7%. More specifically, DSM-IV diagnosis of primary insomnia had a prevalence of 1.6% and DSM-IV diagnosis of insomnia related to another mental disorder was at 2.1%. Insomnia was a symptom of another sleep disorder in about 16% of cases and of a mental disorder in about 17% of cases. As reported in other Nordic studies, sleep quality was worse in summer. Insomnia symptomatology was common and was reported by more than a third of Finnish participants. Compared with other European countries studied with the same methodology (France, the UK, Germany, and Italy), the prevalence of DSM-IV insomnia diagnosis was 1.5 to two times higher in Finland.
To assess the clinical and cost-effectiveness of zaleplon, zolpidem and zopiclone (Z-drugs) compared with benzodiazepines.
Electronic databases, reference lists of retrieved articles and pharmaceutical company submissions.
Randomised controlled trials (RCTs) that compared either benzodiazepines to the Z-drugs or any two of the non-benzodiazepine drugs in patients with insomnia were included in the review. Data on the following outcome measures were considered: sleep onset latency, total sleep duration, number of awakenings, quality of sleep, adverse effects and rebound insomnia. A search was also undertaken for any study designs that evaluated issues related to adverse events (e.g. dependency and withdrawal symptoms). Full economic evaluations that compared two or more options and considered both costs and consequences including cost-effectiveness, cost-utility analysis or cost-benefit analysis undertaken in the context of high-quality RCTs were considered for inclusion in the review.
Twenty-four studies, involving a total study population of 3909 patients, met the inclusion criteria. These included 17 studies comparing a Z-drug with a benzodiazepine and seven comparing a Z-drug with another Z-drug. The diversity of possible comparisons and the range of outcome measures in the review may be confusing. Outcomes were rarely standardised and, even when reported, differed in interpretation. In addition, variations in assessment and variety in the level of information provided make study comparisons difficult. As a result, meta-analysis has been possible on only a small number of outcomes. However, some broad conclusions might be reached based on the limited data provided. The existing published economic literature in this area is very limited. No relevant economic evaluations were identified for inclusion in the review. The industry submissions did not include detailed evidence of cost-effectiveness. Given the lack of robust clinical evidence, no economic model describing the costs and benefits of the newer hypnotic drugs for insomnia was developed. The systematic review provided in this report suggests that an agnostic approach to cost-effectiveness is required at this stage. In the short-term, no systematic evidence is available concerning significant outcome variations between either the different classes of drugs or between individual drugs within each class. Within this short-term horizon, the one element that does vary significantly is the acquisition cost of the individual drugs.
The short-acting drugs seem equally effective and safe with minor differences that may lead a prescriber to favour one over another in different patients. There is no evidence that one is more cost-effective than any other. Analysis of the additional costs to the NHS, depending on the rate of change from benzodiazepine prescriptions to Z-drug prescriptions, at current levels of hypnotic prescribing, range from GBP2 million to GBP17 million per year. There are clear research needs in this area; in particular, none of the existing trials adequately compare these medications. It is suggested that further consideration should be given to a formal trial to allow head-to-head comparison of some of the key drugs in a double-blind RCT lasting at least 2 weeks, and of sufficient size to draw reasonable conclusions. We would also recommend that any such trial should include a placebo arm. It should also collect good-quality data around sleep outcomes and in particular quality of life and daytime drowsiness. We do not believe that any formal study of risk of dependency is feasible at present. Finally, the management of long-term insomnia is suggested for further investigation: considering the frequency of this symptom and its recurring course, the short-term trial of medication and lack of long-term follow-up undermine attempts to develop evidence-based guidelines for the use of hypnotics in this condition, or indeed for its whole management.
To review the literature on restless legs syndrome (RLS), periodic limb movements in sleep, and depression.
Literature review. SETTING, PARTICIPANTS, AND INTERVENTIONS: N/A.
We conducted a comprehensive review of the literature searching for publications that included data on depression or antidepressants and RLS or periodic limb movements in sleep. Sixty-two relevant literature references were found and reviewed. Four population-based studies and 9 clinical studies reported significantly higher rates of depression symptoms in individuals with RLS than in controls. Conversely, the prevalence of RLS in patients presenting with depression was reported as elevated in 2 studies. Conflicting data were found regarding the effect of antidepressants on the sensory symptoms of RLS. In contrast, several studies have found that selective serotonin reuptake inhibitor antidepressant use is associated with increased periodic limb movements in sleep.
Depression symptoms are common in adults with RLS. However, the relationship appears complex, with overlap between RLS- and depression-related symptoms confounding the issue. Given what is known at this time, we propose a specific treatment approach to patients with RLS and depression symptoms.
Chronic sleep loss as a consequence of voluntary bedtime restriction is an endemic condition in modern society. Although sleep exerts marked modulatory effects on glucose metabolism, and molecular mechanisms for the interaction between sleeping and feeding have been documented, the potential impact of recurrent sleep curtailment on the risk for diabetes and obesity has only recently been investigated. In laboratory studies of healthy young adults submitted to recurrent partial sleep restriction, marked alterations in glucose metabolism including decreased glucose tolerance and insulin sensitivity have been demonstrated. The neuroendocrine regulation of appetite was also affected as the levels of the anorexigenic hormone leptin were decreased, whereas the levels of the orexigenic factor ghrelin were increased. Importantly, these neuroendocrine abnormalities were correlated with increased hunger and appetite, which may lead to overeating and weight gain. Consistent with these laboratory findings, a growing body of epidemiological evidence supports an association between short sleep duration and the risk for obesity and diabetes. Chronic sleep loss may also be the consequence of pathological conditions such as sleep-disordered breathing. In this increasingly prevalent syndrome, a feedforward cascade of negative events generated by sleep loss, sleep fragmentation, and hypoxia are likely to exacerbate the severity of metabolic disturbances. In conclusion, chronic sleep loss, behavioral or sleep disorder related, may represent a novel risk factor for weight gain, insulin resistance, and Type 2 diabetes.
Sleep disturbances are a hallmark sign after a sport-related concussion (SRC). Poor sleep has been shown to adversely affect baseline neurocognitive test scores, but it is not comprehensively understood how neurocognitive function is affected by disrupted sleep during recovery from a concussion.
To identify the correlation between adolescent athletes' neurocognitive function and their self-reported sleep quantity and sleep disturbance symptoms during recovery from SRC.
Cross-sectional study; Level of evidence, 3.
Immediate Post-Concussion Assessment and Cognition Testing (ImPACT) data were retrospectively collected for 545 adolescent athletes treated for SRC at a sports medicine concussion clinic. Patients were stratified into groups based on 2 criteria: self-reported sleep duration and self-reported sleep disturbance symptoms during postinjury ImPACT testing. Sleep duration was classified as short (<7 hours), intermediate (7-9 hours), and long (>9 hours). Sleep disturbance symptoms were self-reported as part of the Post-Concussion Symptom Scale (PCSS) as either sleeping less than normal, sleeping more than normal, or having trouble falling asleep. One-way analyses of variance were conducted to examine the effects that sleep duration as well as self-reported sleep disturbance symptoms had on composite scores. A total of 1067 ImPACT tests were analyzed: test 1, 545; test 2, 380; and test 3, 142.
Sleeping fewer than 7 hours the night before testing correlated with higher PCSS scores (P < .001), whereas sleeping longer than 9 hours correlated with worse visual memory (P = .01), visual motor speed (P <.001), and reaction time (P = .04) composite scores. With regard to self-reported sleep disturbance symptoms, patients demonstrated worse composite scores during ImPACT testing when they self-reported sleeping more than normal (ImPACT test 1: verbal memory, P < .001; visual motor speed, P = .05; reaction time, P = .01; ImPACT test 2: verbal memory, P < .001; visual memory, P < .001; visual motor speed, P < .001; reaction time, P = .01). Adolescent patients recovering from SRC demonstrated higher (worse) PCSS scores (P < .001) when they sensed that their sleep had been disrupted.
Adolescent patients who perceive that their sleep is somehow disrupted after SRC may report a greater number of concussion symptoms during their recovery. In addition, the study results suggest that sleeping more than normal may identify an individual who continues to be actively recovering from concussion, given the correlation between lower neurocognitive function and this self-reported symptom.
© 2014 The Author(s).
Background
Obstructive sleep apnea (OSA) is a chronic progressive disease, and it is well-documented that severe OSA is associated with an increased cardiovascular morbidity and mortality. Weight reduction has been shown to improve OSA; however, we need further evidence to determine if it may prevent the progression of OSA in the long term. The aim of our study was to assess the impact of weight change during a 5-year observational follow-up of an original 1-year randomized controlled trial.
Methods
The participants were divided into the 2 groups according to the weight change at 5-year follow-up using the 5% weight loss as a cutoff point, which was later referred to as the successful (n=20) or unsuccessful groups (n=27). The change in apnea-hypopnea index (AHI) was the main objective outcome variable.
Results
Fifty-seven patients participated in the 5-year follow-up. At 5 years from the baseline, the change in AHI between the groups was significant in the successful group (−3.5 [95% confidence interval {CI}, −6.1 to −0.9) compared with the unsuccessful group (5.0 [95% CI, 2.0–8.5]) (P=.002). Successful weight reduction achieved an 80% reduction in the incidence of progression of OSA compared to the unsuccessful group (log-rank test, P=.016).
Conclusions
A moderate but sustained weight reduction can prevent the progression of the disease or even cure mild OSA in obese patients.
Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS.
Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated.
The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ≤ 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting.
Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.
A commentary on this article appears in this issue on page 1243.
Benton ML; Friedman NS. Treatment of obstructive sleep apnea syndrome with nasal positive airway pressure improves golf performance. J Clin Sleep Med 2013;9(12):1237-1242.
Background
The management of sports-related concussions (SRCs) utilizes serial neurocognitive assessments and self-reported symptom inventories to assess recovery and safety for return to play (RTP). Because postconcussive RTP goals include symptom resolution and a return to neurocognitive baseline levels, clinical decisions rest in part on understanding modifiers of this baseline. Several studies have reported age and sex to influence baseline neurocognitive performance, but few have assessed the potential effect of sleep. We chose to investigate the effect of reported sleep duration on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance and the number of patient-reported symptoms.
Hypothesis
We hypothesized that athletes receiving less sleep before baseline testing would perform worse on neurocognitive metrics and report more symptoms.
Study Design
Cross-sectional study; Level of evidence, 3.
Methods
We retrospectively reviewed 3686 nonconcussed athletes (2371 male, 1315 female; 3305 high school, 381 college) with baseline symptom and ImPACT neurocognitive scores. Patients were stratified into 3 groups based on self-reported sleep duration the night before testing: (1) short, <7 hours; (2) intermediate, 7-9 hours; and (3) long, ≥9 hours. A multivariate analysis of covariance (MANCOVA) with an α level of .05 was used to assess the influence of sleep duration on baseline ImPACT performance. A univariate ANCOVA was performed to investigate the influence of sleep on total self-reported symptoms.
Results
When controlling for age and sex as covariates, the MANCOVA revealed significant group differences on ImPACT reaction time, verbal memory, and visual memory scores but not visual-motor (processing) speed scores. An ANCOVA also revealed significant group differences in total reported symptoms. For baseline symptoms and ImPACT scores, subsequent pairwise comparisons revealed these associations to be most significant when comparing the short and intermediate sleep groups.
Conclusion
Our results indicate that athletes sleeping fewer than 7 hours before baseline testing perform worse on 3 of 4 ImPACT scores and report more symptoms. Because SRC management and RTP decisions hinge on the comparison with a reliable baseline evaluation, clinicians should consider sleep duration before baseline neurocognitive testing as a potential factor in the assessment of athletes’ recovery.
Effect size helps readers understand the magnitude of differences found, whereas statistical significance examines whether the findings are likely to be due to chance. Both are essential for readers to understand the full impact of your work. Report both in the Abstract and Results sections.