Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Sports Medicine
Published in: Sports Medicine 4/2021

01-04-2021 | Systematic Review

The Association Between Poor Sleep and the Incidence of Sport and Physical Training-Related Injuries in Adult Athletic Populations: A Systematic Review

Authors: Devon A. Dobrosielski, Lisa Sweeney, Peter J. Lisman

Published in: Sports Medicine | Issue 4/2021

Login to get access

Abstract

Background

The importance of achieving an adequate amount of sleep to optimize health and athletic performance is well recognized. Yet, a systematic evidence compilation of the risk for sport-related injury in adult athletic populations due to poor sleep does not exist.

Objective

To examine the association between poor sleep and sport and physical training-related injuries in adult athletic populations.

Data Sources

Electronic databases were searched using keywords relevant to sleep quantity and quality, and musculoskeletal injury and sport-related concussion (SRC).

Eligibility Criteria for Selecting Studies

Studies were included in this systematic review if they were comprised of adult athletic populations, reported measures of sleep quantity or quality, followed participants prospectively for injury, and reported an association between sleep and incidence of sport or physical training-related injury.

Study Appraisal

The methodological quality of each study was assessed using the Newcastle–Ottawa Scale for Cohort Studies.

Results

From our review of 12 prospective cohort studies, we found limited evidence supporting an association between poor sleep and injury in adult athletic populations. Specifically, there is (a) insufficient evidence supporting the associations between poor sleep and increased risk of injury in specific groups of athletic adults, including professional or elite athletes, collegiate athletes, elite or collegiate dancers, and endurance sport athletes; and (b) limited evidence of an association between poor sleep and increased risk of SRC in collegiate athletes.

Conclusions

The current evidence does not support poor sleep as an independent risk factor for increased risk of sport or physical training-related injuries in adult athletic populations. Given the methodological heterogeneity and limitations across previous studies, more prospective studies are required to determine the association between sleep and injury in this population.
Literature
1.
Sheu Y, Chen LH, Hedegaard H. Sports- and recreation-related injury episodes in the United States, 2011–2014. Natl Health Stat Report. 2016;99:1–12.
2.
Kerr ZY, Marshall SW, Dompier TP, Corlette J, Klossner DA, Gilchrist J. College sports-related injuries—United States, 2009–10 through 2013–14 academic years. MMWR Morb Mortal Wkly Rep. 2015;64:1330–6.PubMedCrossRef
3.
Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42:311–9.PubMedPubMedCentral
4.
Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009–2010 to 2013–2014: incidence, recurrence, and mechanisms. Am J Sports Med. 2015;43:2654–62.PubMedCrossRef
5.
Herzog MM, Mack CD, Dreyer NA, Wikstrom EA, Padua DA, Kocher MS, et al. Ankle sprains in the National Basketball Association, 2013–2014 through 2016–2017. Am J Sports Med. 2019;47:2651–8.PubMedCrossRef
6.
Lawrence DW, Hutchison MG, Comper P. Descriptive epidemiology of musculoskeletal injuries and concussions in the National Football League, 2012–2014. Orthop J Sports Med. 2015;3:2325967115583653.PubMedPubMedCentralCrossRef
7.
Hauret KG, Jones BH, Bullock SH, Canham-Chervak M, Canada S. Musculoskeletal injuries description of an under-recognized injury problem among military personnel. Am J Prev Med. 2010;38:S61-70.PubMedCrossRef
8.
Hauschild VD, Lee T, Barnes S, Forrest L, Hauret K, Jones BH. The etiology of injuries in US Army initial entry training. US Army Med Dep J. 2018;22–29.
9.
Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016;50:145–8.PubMedCrossRef
10.
Williams S, Trewartha G, Kemp SP, Brooks JH, Fuller CW, Taylor AE, et al. Time loss injuries compromise team success in elite Rugby Union: a 7-year prospective study. Br J Sports Med. 2016;50:651–6.PubMedCrossRef
11.
Andrew N, Wolfe R, Cameron P, Richardson M, Page R, Bucknill A, et al. The impact of sport and active recreation injuries on physical activity levels at 12 months post-injury. Scand J Med Sci Sports. 2014;24:377–85.PubMedCrossRef
12.
Filbay S, Pandya T, Thomas B, McKay C, Adams J, Arden N. Quality of life and life satisfaction in former athletes: a systematic review and meta-analysis. Sports Med. 2019;49:1723–38.PubMedPubMedCentralCrossRef
13.
Gouttebarge V, Inklaar H, Backx F, Kerkhoffs G. Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature. Rheumatol Int. 2015;35:405–18.PubMedCrossRef
14.
Bullock SH, Jones BH, Gilchrist J, Marshall SW. Prevention of physical training-related injuries recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med. 2010;38:S156–81.PubMedCrossRef
15.
Lovalekar M, Sharp MA, Billing DC, Drain JR, Nindl BC, Zambraski EJ. International consensus on military research priorities and gaps—Survey results from the 4th International Congress on Soldiers’ Physical Performance. J Sci Med Sport. 2018;21:1125–30.PubMedCrossRef
16.
Kroshus E, Wagner J, Wyrick D, Athey A, Bell L, Benjamin HJ, et al. Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness. Br J Sports Med. 2019;53:731–6.PubMedCrossRef
17.
Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53:667–99.PubMedCrossRef
18.
Leeder J, Glaister M, Pizzoferro K, Dawson J, Pedlar C. Sleep duration and quality in elite athletes measured using wristwatch actigraphy. J Sports Sci. 2012;30:541–5.PubMedCrossRef
19.
Lastella M, Roach GD, Halson SL, Sargent C. Sleep/wake behaviours of elite athletes from individual and team sports. Eur J Sport Sci. 2015;15:94–100.PubMedCrossRef
20.
Turner RW, 2nd, Vissa K, Hall C, Poling K, Athey A, Alfonso-Miller P, et al. Sleep problems are associated with academic performance in a national sample of collegiate athletes. J Am Coll Health. 2019;1–8.
21.
Drew M, Vlahovich N, Hughes D, Appaneal R, Burke LM, Lundy B, et al. Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games. Br J Sports Med. 2018;52:47–53.PubMedCrossRef
22.
Hoshikawa M, Uchida S, Hirano Y. A subjective assessment of the prevalence and factors associated with poor sleep quality amongst elite Japanese athletes. Sports Med Open. 2018;4:10.PubMedPubMedCentralCrossRef
23.
Mah CD, Kezirian EJ, Marcello BM, Dement WC. Poor sleep quality and insufficient sleep of a collegiate student-athlete population. Sleep Health. 2018;4:251–7.PubMedCrossRef
24.
Silva A, Narciso FV, Rosa JP, Rodrigues DF, Cruz A, Tufik S, et al. Gender differences in sleep patterns and sleep complaints of elite athletes. Sleep Sci. 2019;12:242–8.PubMedPubMedCentral
25.
George CF, Kab V, Levy AM. Increased prevalence of sleep-disordered breathing among professional football players. N Engl J Med. 2003;348:367–8.PubMedCrossRef
26.
Dobrosielski DA, Nichols D, Ford J, Watts A, Wilder JN, Douglass-Burton T. Estimating the prevalence of sleep-disordered breathing among collegiate football players. Respir Care. 2016;61:1144–50.PubMedCrossRef
27.
Fagundes SB, Fagundes DJ, Luna AA, Bacci A, Waisberg M. Prevalence of restless legs syndrome in runners. Sleep Med. 2012;13:771.PubMedCrossRef
28.
Rosa JP, Rodrigues DF, Silva A, de Moura Simim MA, Costa VT, Noce F, et al. 2016 Rio Olympic Games: Can the schedule of events compromise athletes’ performance? Chronobiol Int. 2016;33:435–40.PubMedCrossRef
29.
30.
31.
Van Cauter E, Copinschi G. Interrelationships between growth hormone and sleep. Growth Horm IGF Res. 2000;10(Suppl B):S57–62.PubMedCrossRef
32.
Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20:865–70.PubMed
33.
Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev. 2011;15:259–67.PubMedCrossRef
34.
Sprague AL, Smith AH, Knox P, Pohlig RT, Gravare SK. Modifiable risk factors for patellar tendinopathy in athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;52:1575–85.PubMedPubMedCentralCrossRef
35.
Griffin A, Kenny IC, Comyns TM, Lyons M. The association between the acute:chronic workload ratio and injury and its application in team sports: a systematic review. Sports Med. 2020;50:561–80.PubMedCrossRef
36.
Mougin F, Simon-Rigaud ML, Davenne D, Renaud A, Garnier A, Kantelip JP, et al. Effects of sleep disturbances on subsequent physical performance. Eur J Appl Physiol Occup Physiol. 1991;63:77–82.PubMedCrossRef
37.
Skein M, Duffield R, Edge J, Short MJ, Mundel T. Intermittent-sprint performance and muscle glycogen after 30 h of sleep deprivation. Med Sci Sports Exerc. 2011;43:1301–11.PubMedCrossRef
38.
Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab. 2010;24:687–702.PubMedPubMedCentralCrossRef
39.
Smith CD, Cooper AD, Merullo DJ, Cohen BS, Heaton KJ, Claro PJ, et al. Sleep restriction and cognitive load affect performance on a simulated marksmanship task. J Sleep Res. 2019;28:e12637.PubMedCrossRef
40.
Heaton KJ, Maule AL, Maruta J, Kryskow EM, Ghajar J. Attention and visual tracking degradation during acute sleep deprivation in a military sample. Aviat Space Environ Med. 2014;85:497–503.PubMedCrossRef
41.
Gao B, Dwivedi S, Milewski MD, Cruz AI Jr. Lack of sleep and sports injuries in adolescents: a systematic review and meta-analysis. J Pediatr Orthop. 2019;39:e324–33.PubMedCrossRef
42.
43.
Berkman ND, Lohr KN, Ansari M, McDonagh M, Balk E, Whitlock E, et al. Grading the strength of a body of evidence when assessing health care interventions for the effective health care program of the Agency for Healthcare Research and Quality: an update. In: Methods guide for effectiveness and comparative effectiveness reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013.
44.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–47.PubMedCrossRef
45.
46.
Bulzacchelli MT, Sulsky SI, Rodriguez-Monguio R, Karlsson LH, Hill MO. Injury during U.S. Army basic combat training: a systematic review of risk factor studies. Am J Prev Med. 2014;47:813–22.PubMedCrossRef
47.
48.
van Ierssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5–18 years? A systematic review and meta-analysis. Br J Sports Med. 2020;bjsports-2020-102967.
49.
Burke TM, Lisman PJ, Maguire K, Skeiky L, Choynowski JJ, Capaldi VF 2nd, et al. Examination of sleep and injury among college football athletes. J Strength Cond Res. 2020;34:609–16.PubMedCrossRef
50.
Sampson JA, Murray A, Williams S, Sullivan A, Fullagar HHK. Subjective wellness, acute: chronic workloads, and injury risk in college football. J Strength Cond Res. 2019;33:3367–73.PubMedCrossRef
51.
Dennis J, Dawson B, Heasman J, Rogalski B, Robey E. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2016;19:113–6.PubMedCrossRef
52.
Hayes LE, Boulos A, Cruz AI Jr. Risk factors for in-season injury in varsity collegiate cross-country athletes: an analysis of one season in 97 athletes. J Sports Med Phys Fitness. 2019;59:1536–43.PubMedCrossRef
53.
Jones CM, Griffiths PC, Towers C, Claxton J, Mellalieu SD. Pre-season injury and illness associations with perceptual wellness, neuromuscular fatigue, sleep and training load in elite Rugby Union. J Aust Strength Cond. 2018;26:6–16.
54.
Cahalan R, O’Sullivan P, Purtill H, Bargary N, Ni Bhriain O, O’Sullivan K. Inability to perform because of pain/injury in elite adult Irish dance: a prospective investigation of contributing factors. Scand J Med Sci Sports. 2016;26:694–702.PubMedCrossRef
55.
Cahalan R, Kearney P, Ni Bhriain O, Redding E, Quin E, McLaughlin LC, et al. Dance exposure, wellbeing and injury in collegiate Irish and contemporary dancers: a prospective study. Phys Ther Sport. 2018;34:77–83.PubMedCrossRef
56.
Kilic O, Aoki H, Goedhart E, Hagglund M, Kerkhoffs G, Kuijer P, et al. Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data. Knee Surg Sports Traumatol Arthrosc. 2018;26:946–54.PubMedCrossRef
57.
Johnston R, Cahalan R, Bonnett L, Maguire M, Nevill A, Glasgow P, et al. Training load and baseline characteristics associated with new injury/pain within an endurance sporting population: a prospective study. Int J Sports Physiol Perform. 2019;14:590–7.PubMedCrossRef
58.
Laux P, Krumm B, Diers M, Flor H. Recovery-stress balance and injury risk in professional football players: a prospective study. J Sports Sci. 2015;33:2140–8.PubMedPubMedCentralCrossRef
59.
Peacock CA, Mena M, Sanders GJ, Silver TA, Kalman D, Antonio J. Sleep data, physical performance, and injuries in preparation for professional Mixed Martial Arts. Sports (Basel). 2018;7:1–8.PubMedCentralCrossRef
60.
Raikes AC, Athey A, Alfonso-Miller P, Killgore WDS, Grandner MA. Insomnia and daytime sleepiness: risk factors for sports-related concussion. Sleep Med. 2019;58:66–74.PubMedPubMedCentralCrossRef
61.
Hughes T, Sergeant JC, van der Windt DA, Riley R, Callaghan MJ. Periodic health examination and injury prediction in professional football (soccer): theoretically, the prognosis is good. Sports Med. 2018;48:2443–8.PubMedPubMedCentralCrossRef
62.
63.
Meeuwisse WH. Assessing causation in sport injury: a mutifactorial model. Clin J Sports Med. 1994;4:166–70.CrossRef
64.
Yu L, Buysse DJ, Germain A, Moul DE, Stover A, Dodds NE, et al. Development of short forms from the PROMIS sleep disturbance and sleep-related impairment item banks. Behav Sleep Med. 2011;10:6–24.PubMedPubMedCentralCrossRef
65.
Davis H, Orzeck T, Keelan P. Psychometric item evaluations of the Recovery-Stress Questionnaire for athletes. Psychol Sport Exerc. 2007;8:917–38.CrossRef
66.
Moran RW, Schneiders AG, Mason J, Sullivan SJ. Do functional movement screen (FMS) composite scores predict subsequent injury? A systematic review with meta-analysis. Br J Sports Med. 2017;51:1661–9.PubMedCrossRef
67.
Clifton DR, Tra J, de la Motte SJ. Letter to the editor: measuring true accuracy of self-reported injuries. Musculoskelet Sci Pract. 2019;42:e1.PubMedCrossRef
68.
69.
Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009–2010 to 2013–2014: incidence, recurrence, and mechanisms. Am J Sports Med. 2016;44:NP5.PubMed
70.
McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, held in Zurich, November 2012. Br J Sports Med. 2013;47:250–8.PubMedCrossRef
71.
Silva A, Narciso FV, Soalheiro I, Viegas F, Freitas LSN, Lima A, et al. Poor sleep quality’s association with soccer injuries: preliminary data. Int J Sports Physiol Perform. 2020;15:671–6.PubMedCrossRef
72.
Meeuwisse WH, Tyreman H, Hagel B, Emery C. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17:215–9.PubMedCrossRef
73.
de Visser HM, Reijman M, Heijboer MP, Bos PK. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med. 2012;46:124–30.PubMedCrossRef
74.
Driller MW, Mah CD, Halson SL. Development of the athlete sleep behavior questionnaire: a tool for identifying maladaptive sleep practices in elite athletes. Sleep Sci. 2018;11:37–44.PubMedPubMedCentralCrossRef
75.
Peterson AL, Goodie JL, Satterfield WA, Brim WL. Sleep disturbance during military deployment. Mil Med. 2008;173:230–5.PubMedCrossRef
76.
Seelig AD, Jacobson IG, Smith B, Hooper TI, Boyko EJ, Gackstetter GD, et al. Sleep patterns before, during, and after deployment to Iraq and Afghanistan. Sleep. 2010;33:1615–22.PubMedPubMedCentralCrossRef
77.
Molloy JM, Pendergrass TL, Lee IE, Chervak MC, Hauret KG, Rhon DI. Musculoskeletal injuries and United States Army readiness Part I: overview of injuries and their strategic impact. Mil Med. 2020;185:e1461–71.PubMedCrossRef
78.
Bittencourt NFN, Meeuwisse WH, Mendonca LD, Nettel-Aguirre A, Ocarino JM, Fonseca ST. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med. 2016;50:1309–14.PubMedCrossRef
Metadata
Title
The Association Between Poor Sleep and the Incidence of Sport and Physical Training-Related Injuries in Adult Athletic Populations: A Systematic Review
Authors
Devon A. Dobrosielski
Lisa Sweeney
Peter J. Lisman
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 4/2021
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-020-01416-3

Other articles of this Issue 4/2021

Sports Medicine 4/2021 Go to the issue

Original Research Article

Hitting the Target but Missing the Point? Modelling Health and Economic Impacts of Different Approaches to Meeting the Global Action Plan for Physical Activity Target

Review Article

Recommendations for Hamstring Function Recovery After ACL Reconstruction

Review Article

Periodization: Variation in the Definition and Discrepancies in Study Design

Original Research Article

The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes

Correction

Correction to: The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes

Systematic Review

Risk Factors for Lower Limb Injury in Female Team Field and Court Sports: A Systematic Review, Meta-analysis, and Best Evidence Synthesis