Insomnia symptomatology is high among elite athletes, with sleep quality appearing most vulnerable prior to major competitive events, during periods of high-intensity training and following long-haul travel to competitions. |
Athlete sleep disturbances can affect training and competition directly, through fatigue, or indirectly, through sleep-related performance anxieties. |
In general, the quality of the evidence base addressing sleep quality among elite athletes is low, with poor operationalisation of sleep quality constructs and few controlled comparisons of athlete and non-athlete sleep. |
1 Introduction
1.1 Objectives
2 Methods
2.1 Search Strategy
2.2 Eligibility Criteria
2.3 Study Selection and Data Extraction
2.4 Study Quality Appraisal
2.5 Definitions of Sleep Terminology
Term | Definition |
---|---|
Sleep structure | The electrophysiological composition and organisation of sleep typically described in terms of the duration of defined sleep stages, the duration of the awake stage, the aggregated time spent in all sleep stages (i.e. TST), or latencies to sleep onset (see below) and other (e.g. rapid eye movement sleep onset latency) stages. When combined with measures of TIB, electrophysiogical measures can provide a reliable indication of SE (see below). Such electrophysiological measures require polysomnography (PSG), and are rarely used for 24-h or serial measurements |
Sleep patterns | As used in this review, ‘sleep patterns’ refer to sleep–wake distributions typically assessed over units of 24 h using wrist actigraphy (and often repeated for multiple days). When combined with measures of TIB, actigraphy can provide a reliable indication of SL and SE (see below) |
Sleep quality | An individual’s subjective experience of sleep typically focussing on problems initiating or maintaining sleep, or early morning awakening. Assessed through single items or formal psychometric evaluations, these experiences represent cardinal symptoms of insomnia. Combined with information on symptom frequency/duration and daytime symptoms (e.g. fatigue), these experiences contribute to diagnostic judgements of insomnia disorder as defined in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) [49] |
Sleep profile | Broadly, SOL, TST, and SE reported |
Time in bed (TIB) | The time elapsed between first getting into bed (with the intention of sleeping), to the final arising |
Sleep period time (SPT) | The time elapsed between the first onset of sleep and the final awakening |
Wake after sleep onset (WASO) | The amount of wakefulness accumulated between the first onset of sleep and the final awakening |
Total sleep time (TST) | The total amount of time spent asleep whilst in bed (i.e. SPT-WASO) |
Sleep efficiency (SE) | TST expressed as a percentage of TIB: TST/TIB × 100. Whether derived from instrumental measures or subjective estimates (of TST), SE provides a sensitive metric for estimating sleep quality. A SE below 85% is indicative of disorder |
Sleep onset latency (SOL) or sleep latency (SL) | The time elapsed between getting into bed or ‘lights out’ to sleep onset |
Fragmentation index | A measure of the extent to which continuous sleep is interrupted by episodes of wakefulness. Sleep fragmentation is reflected in the duration and/or frequency of episodes of WASO |
3 Results
3.1 Study Selection
3.2 Characteristics of Included Studies
3.3 ‘Eliteness’ of Athletes
3.4 Evidence Quality Appraisal
3.5 Sleep Structure and Patterns
Study | Sport | Level of performance description |
n
| Sex | Nights recorded | Mean values (SD) | |||
---|---|---|---|---|---|---|---|---|---|
Age, y | TST, h | SE, % | SOL, min | ||||||
Actigraphy | |||||||||
Leeder et al. [50] | Multi-sports | GB squad | 46 | M + F | 4 | NR | 6.9 (0.7) | 81 (6) | 18 (17) |
Lastella et al. [51] | Multi-sports | Elite | 124 | M + F | 12 | 22.2 (3.0) | 6.8 (1.2) | 86 (6) | 19 (24) |
Richmond et al. [40] | ARF | Professional | 19 | M | 4 | 24.1 (3.3) | 8.9 (0.1) | 93 (1) | NR |
Richmond et al. [39] | ARF | Professional | 10 | M | 5 | 23.0 (2) | 8.4 (0.3) | 88 (4) | NR |
Romyn et al. [52] | Netball | State level | 8 | F | 7 | 19.6 (1.5) | 8.2 (0.5) | 85 (4) | 28 (26) |
Schaal et al. [53] | SS | International | 10 | F | 7 | 20.4 (0.4) | 7.2 (0.2) | 85 (1) | 17 (2) |
Sargent et al. [32] | Multi-sports | Elite | 70 | M + F | 14 | 20.3 (2.9) | 6.5 (1.5) | 86 (7) | NR |
Robey et al. [54] | Football | Elite youth | 12 | M | 12 | 18.5 (1.4) | 7.2 (0.7) | 89 (6) | 21 (11) |
Sargent et al. [55] | Cycling | National | 16 | M | 8a,b
| 19.3 (1.5) | 7.6 (0.6) | 85 (5) | 17 (14) |
Shearer et al. [56] | Rugby Union | Elite | 28 | M | 4 | 24.4 (2.9) | 7.1 (1.0) | 79 (9) | 34 (40) |
Lastella et al. [57] | Football | Elite | 16 | M | 3 | 18.8 (0.9) | 7.5 (1.3) | 85 (NR) | NR |
Mean | 7 (4) | 21.0 (2.2) | 7.5 (0.7) | 86 (5) | 22 (7) | ||||
Sleep diary | |||||||||
Fullagar et al. [58] | Football | Elite | 15 | M | 3 | 25.5 (4.9) | 8.5 (1.2) | 92 (4) | 20 (17) |
Fullagar et al. [59] | Football | Elite | 16 | M | NR | 25.9 (7.5) | 8.7 (0.7) | 96 (NR) | 16 (7) |
Kölling et al. [60] | Rowing | National | 55 | M + F | 6 | 17.7 (0.6) | 6.9 (0.4) | 93 (4) | 26 (17) |
Fowler et al. [42] | Rugby league | Professional | 18 | M | 1 | 24.2 (3.3) | 7.9 (1.0) | NR | NR |
Mean | 23.3 (3.8) | 8.0 (0.8) | 94 (2) | 21 (5) | |||||
Polysomnography | |||||||||
Sargent et al. [55] | Cycling | National | 16 | M | 8a
| 19.3 (1.5) | 8.5 (0.4) | 90 (5) | 18 (13) |
Netzer et al. [61] | Cycling | National | 13 | M | 1 | 23.9 (NR) | NR | 93 (3) | 19 (16) |
Mean | 21.6 (3.3) | 8.5 (NA) | 92 (2) | 19 (1) | |||||
Questionnairec
| |||||||||
Tsunoda et al. [62] | WCB | Elite | 14 | M | NA | 29.5 (5.2) | 6.5 (0.9) | 88 (9) | 25 (22) |
Swinbourne et al. [63] | Team sports | National | 175 | M + F | NA | 21.9 (2.6) | 7.9 (1.3) | NR | NR |
Bleyer et al. [64] | Multi-sports | Elite | 452 | M + F | NA | 21.2 (5.8) | 7.9 (1.5) | NR | NR |
Durán et al. [65] | Multi-sports (Paralympic) | Elite | 33 | M + F | NA | 26.4 (9.8) | 6.9 (1.4) | 83 (NR) | 44 (46) |
Mean | 25.7 (3.7) | 7.3 (0.7) | 86 (4) | 35 (13) |
3.6 Summary of Sleep Structure and Patterns
3.7 Sleep Quality and Insomnia Symptomatology
Study | Symptoms assessed | Sport | Level of performance |
n
| Sex | Mean age, y (SD) | Prevalence of symptoms,% | ||
---|---|---|---|---|---|---|---|---|---|
Total | M | F | |||||||
Venter et al. [73] | Experience of sleep problems | Team sports | National | 890 | M + F | 22.3 (3.4) | 41 | NR | NR |
Schaal et al. [69] | Ongoing sleep problemsa
| Multi-sports | National | 2067 | M + F | 23.5 (NR) | 22 | 20 | 24 |
Lucidi et al. [68] | Occasional sleep disturbancesb
| Multi-sports | Olympic | 103 | M + F | 23.9 (4.1) | 60 | 59 | 62 |
Rodrigues et al. [74] | Sleep dissatisfactionc
| Para-athletics | Paralympic | 40 | M + F | 30.1 (7.1) | 46 | NR | NR |
Juliff et al. [38] | General sleep disturbanced after a rest period | Multi-sports | Elite | 283 | M + F | 24.1 (5.1) | 28 | NR | NR |
Durán et al. [65] | Insomnia symptomse
| Multi-sports (Paralympic) | Elite | 33 | M + F | 26.4 (9.8) | 70 | NR | NR |
Samuels et al. [67] | Abnormal sleepf
| Multi-sports | Elite | 349 | NR | NR | 13 | NR | NR |
Study | Sport | Level of performance |
n
| Sex | Mean age, y (SD) | Mean global score (SD)a
| Prevalence, % | ||
---|---|---|---|---|---|---|---|---|---|
≥5 | >5 | >8 | |||||||
Dekker et al. [70] | Gymnastics | National | 12 | M + F | 22.9 (3.5) | 6 (NR) | NR | NR | NR |
Samuels [1] | Bobsleigh | Elite | 24 | M + F | 27.0 (NR) | 6 (1) | 78 | 57 | 26 |
Tsunoda et al. [62] | WCB | Elite | 14 | M | 29.5 (5.2) | 6 (3) | NR | 43 | NR |
Swinbourne et al. [63] | Team sports | National | 175 | M + F | 21.9 (2.6) | 6 (3) | 65 | 50 | 22 |
Bleyer et al. [64] | Multi-sports | Elite | 452 | M + F | 21.2 (5.8) | 5 (3) | NR | 38 | NR |
Durán et al. [65] | Multi-sports (Paralympic) | Elite | 33 | M + F | 26.4 (9.8) | 11 (8) | 79 | NR | NR |
Mean | 24.8 (5.4) | 7 (4) | 74 | 47 | 24 |
3.7.1 Summary of Sleep Quality and Insomnia Symptomatology
3.8 Risk Factors for Sleep Disturbance
Study | Sport | Competition (home/away) |
n
| Sex | Mean age, y (SD) | Prevalence of insomnia symptoms (%) | PSQI global mean (SD) | Δ Sleep patterns and sleep quality | |||
---|---|---|---|---|---|---|---|---|---|---|---|
SE | SOL | TST | SQ | ||||||||
Actigraphy | |||||||||||
Romyn et al. [52] | Netball | National championships | 8 | F | 19.6 (1.5) | NR | NR | ↑ | ↔ | ↔ | ↔ |
Richmond et al. [40] | ARF | AFL match (home) | 19 | M | 24.1 (3.3) | NR | NR | ↔ | NR | ↑ | ↔ |
Richmond et al. [39] | ARF | AFL match (home) | 10 | M | 23.0 (2.0) | NR | NR | ↔ | NR | ↑ | ↔ |
Shearer et al. [56] | Rugby Union | Celtic League match (home) | 28 | M | 24.4 (2.9) | NR | NR | ↔ | ↔ | ↔ | ↔ |
Fowler et al. [78] | Football | A-League match (home) | 6 | M | 23.4 (NR) | NR | NR | ↔ | ↔ | ↔ | ↔ |
Chennaoui et al. [77]a
| Swimming | National championships | 9 | M + F | 22.0 (3.0) | NR | NR | ↔ | NR | ↔ | NR |
Questionnaire | |||||||||||
Elbayoumy and Elbayoumy [79]b
| Swimming | National championships | 40 | M | 19.0 (1.0) | NR | 5 (1) | NR | NR | NR | NR |
Swinbourne et al. [63]b
| Team sports | In competition | 75 | M + F | NR | NR | 6 (3) | NR | NR | NR | NR |
Silva and Paiva [76]b,c
| Gymnastics | FIG World Cup | 67 | F | 18.7 (2.9) | 78 | 7 (3) | NR | NR | NR | ↓b
|
Rodrigues et al. [74]d
| Para-athletics | Paralympic Games | 40 | M + F | 30.1 (7.1) | 37 | NR | NR | NR | NR | NR |
Silva et al. [80]d
| Para-athletics | Paralympic Games | 27 | M + F | 28.0 (6.0) | 70 | NR | NR | NR | NR | NR |
Erlacher et al. [37]e
| Multi-sports | Important competition | 632 | M + F | 21.9 (6.8) | 66 | NR | NR | NR | NR | NR |
Juliff et al. [38]b,e
| Multi-sports | Olympic Games | 283 | M + F | 24.0 (5.0) | 64 | NR | NR | NR | NR | NR |
Study | Sport | Competition (home/ away) |
n
| Sex | Mean age, y (SD) | Prevalence of insomnia symptoms (%) | Δ Sleep patterns and sleep quality | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
BT | SE | SOL | TST | SQ | |||||||
Actigraphy | |||||||||||
Shearer et al. [56] | Rugby Union | Celtic League match (home) | 28 | M | 24.4 (2.9) | NR | ↑ | ↔ | ↔ | ↓ | NR |
Fowler et al. [78] | Football | A-League (home) | 6 | M | 23.4 (NR) | NR | ↑ | ↔ | ↔ | ↓ | ↓ |
Fowler et al. [41] | Football | Pre-season tour (away) | 16 | M | 27.0 (NR) | NR | NR | NR | NR | ↓ | ↓ |
Fullagar et al. [58] | Football | Pre-FIFA World Cup (away) | 15 | M | 25.5 (4.9) | NR | ↑ | ↔ | ↔ | ↓ | ↔ |
Richmond et al. [39] | ARF | AFL (home) | 10 | M | 23.0 (2.0) | NR | NR | ↔ | NR | ↓ | ↓↓ |
Sleep diaries | |||||||||||
Fullagar et al. [59] | Football | Bundesliga/Eredevisie (home and away) | 16 | M | 25.9 (7.5) | NR | ↑ | NR | ↑ | ↓ | ↓ |
Polysomnography | |||||||||||
Netzer et al. [61] | Cycling | German First Division | 13 | M | 23.9 (NR) | NR | NR | ↔ | ↔ | NR | NR |
Questionnaire | |||||||||||
Juliff et al. [38]a
| Multi-sports | Olympic Games | 283 | M + F | 24.0 (5.0) | 53 | NR | NR | NR | NR | NR |
Study | Sport | Flight type (Δ time zone W/E) |
n
| Sex | Mean age, y (SD) | Δ Sleep patterns, sleep quality and JL | ||||
---|---|---|---|---|---|---|---|---|---|---|
SE | SOL | TST | SQ | JL | ||||||
Long-haul | ||||||||||
Actigraphy | ||||||||||
Fullagar et al. [58]a
| Football | International (4 h W) | 15 | M | 25.5 (4.9) | ↔ | ↔ | ↔ | ↔ | ↑ |
Fowler et al. [41]a
| Football | International (1 h W) | 16 | M | 27.0 (NR) | NR | NR | ↔ | ↔ | ↑ |
Lastella et al. [57]a,b
| Football | International (8 h E) | 16 | M | 18.8 (0.9) | ↔ | NR | ↓ | ↔ | NR |
Sleep diary | ||||||||||
Fowler et al. [42]a
| Rugby league | International (11 h W) | 18 | M | 24.2 (3.3) | NR | ↔ | ↑ | ↔ | ↑↑ |
Short-haul | ||||||||||
Actigraphy | ||||||||||
Fowler et al. [78]c
| Football | Domestic (2 h E and W) | 6 | M | 23.4 (NR) | ↔ | ↔ | ↔ | ↔ | NR |
Richmond et al. [39]c
| ARF | Domestic (2 h E) | 10 | M | 23.0 (2.0) | ↔ | NR | ↔ | ↔ | NR |
Richmond et al. [40]c
| ARF | Domestic (2 h E) | 19 | M | 24.1 (3.3) | ↔ | NR | ↔ | ↓ | NR |
Study | Sport | Training |
n
| Sex | Mean age, y (SD) | Prevalence of insomnia symptoms (%) | Δ Sleep patterns and sleep quality | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
RT | SE | SOL | TST | SQ | |||||||
Training vs rest days | |||||||||||
Actigraphy | |||||||||||
Sargent et al. [33] | Swimming | Olympic preparation | 7 | M + F | 22.5 (1.7) | NR | ↓↓ | ↔ | ↔ | ↓↓ | NR |
Sargent et al. [32] | Multi-sport | Normal training | 70 | M + F | 20.3 (2.9) | NR | ↓↓ | ↔ | NR | ↓↓ | NR |
Kölling et al. [60] | Rowing | World Cup preparation | 18 | M + F | 17.7 (0.6) | NR | ↓↓ | ↔ | ↔ | ↓↓ | ↓↓ |
Questionnaire | |||||||||||
Juliff et al. [38]a
| Multi-sport | Following a rest day | 283 | M + F | 24.0 (5.0) | 28 | NR | NR | NR | NR | NR |
Intensified vs normal training | |||||||||||
Actigraphy | |||||||||||
Schaal et al. [53] | SS | Olympic preparation | 14 | F | 20.4 (0.4) | NR | ↑↑ | ↓ | ↑ | ↓ | ↔ |
Kölling et al. [60] | Rowing | World Cup preparation | 18 | M + F | 17.7 (0.6) | NR | ↔ | ↔ | ↔ | ↓ | ↓ |
Questionnaire | |||||||||||
Juliff et al. [38]a
| Multi-sport | Heavy training period | 283 | M + F | 24.0 (5.0) | 28 | NR | NR | NR | NR | NR |