Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis

Sleep quality monitoring in individual sports athletes: parameters and definitions by systematic review

In the present review, we identify which instruments and parameters are used for sleep quality monitoring in individual sport athletes and which definitions were used for sleep quality parameters in this literature field. Systematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews. The initial search returned 3316 articles. After the removal of duplicate articles, eligibility assessment, 75 studies were included in this systematic review. Our main findings were that the most widely used measurement instruments were Actigraphy (25%), Rating Likert Scales (16%) and Sleep Diary (13%). On sleep quality parameters (Sleep duration = 14%; Wake after sleep onset = 14%; Sleep Quality = 12%; Sleep Effciency = 11% and Sleep Latency = 9%), the main point is that there are different definitions for the same parameters in many cases reported in the literature. We conclude that the most widely used instruments for monitoring sleep quality were Actigraphy, Likert scales and Sleep diary. Moreover, the definitions of sleep parameters are inconsistent in the literature, hindering the understanding of the sleep-sport performance relationship.

A critical review on sleep assessment methodologies in athletic populations: factors to be considered

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 (eg such as sleep environment, familiarization procedures and napping) and daily habits (eg 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.

Extended Sleep Maintains Endurance Performance Better than Normal or Restricted Sleep

PURPOSE

The cumulative influence of sleep time on endurance performance remains unclear. This study examined the effects of three consecutive nights of both sleep extension (SE) and sleep restriction (SR) on endurance cycling performance.

METHODS

Endurance cyclists/triathletes (n = 9) completed a counterbalanced crossover experiment with three conditions: SR, normal sleep (NS), and SE. Each condition comprised seven days/nights of data collection (-2, -1, D1, D2, D3, D4, and +1). Sleep was monitored using actigraphy throughout. Participants completed testing sessions on days D1-D4 that included an endurance time-trial (TT), mood, and psychomotor vigilance assessment. Perceived exertion (RPE) was monitored throughout each TT. Participants slept habitually before D1; however, time in bed was reduced by 30% (SR), remained normal (NS), or extended by 30% (SE) on nights D1, D2, and D3. Data were analyzed using generalized estimating equations.

RESULTS

On nights D1, D2, and D3, total sleep time was longer (P < 0.001) in the SE condition (8.6 ± 1.0, 8.3 ± 0.6, and 8.2 ± 0.6 h, respectively) and shorter (P < 0.001) in the SR condition (4.7 ± 0.8, 4.8 ± 0.8, and 4.9 ± 0.4 h) compared with NS (7.1 ± 0.8, 6.5 ± 1.0, and 6.9 ± 0.7 h). Compared with NS, TT performance was slower (P < 0.02) on D3 of SR (58.8 ± 2.5 vs 60.4 ± 3.7 min) and faster (P < 0.02) on D4 of SE (58.7 ± 3.4 vs 56.8 ± 3.1 min). RPE was not different between or within conditions. Compared with NS, mood disturbance was higher, and psychomotor vigilance impaired, after SR. Compared with NS, psychomotor vigilance improved after SE.

CONCLUSION

Sleep extension for three nights led to better maintenance of endurance performance compared with normal and restricted sleep. Sleep restriction impaired performance. Cumulative sleep time affects performance by altering the perceived exertion of a given exercise intensity. Endurance athletes should sleep >8 h per night to optimize performance.

Global Research Output on Sleep Research in Athletes from 1966 to 2019: A Bibliometric Analysis

This study examined sleep research in athletes published between 1966 and 2019, through a bibliometric analysis of research output in the Scopus database. Following a robust assessment of titles, the bibliometric indicators of productivity for studies included in the final analysis were: Distribution of publications and citations (excluding self-citations), top ten active journals, countries, institutions and authors, single- and multi-country collaboration, and 25 top-cited papers. Out of the 1015 papers, 313 were included in the final analysis. The majority of the papers were research articles (n = 259; 82.8%) and published in English (n = 295; 94.3%). From 2011, there was a dramatic increase in papers published (n = 257; 82.1%) and citations (n = 3538; 91.0%). The number of collaborations increased after 2001, with papers published through international (n = 81; 25.9%) and national (n = 192; 61.3%) collaboration. Australia was the most prolific country in terms of number of publications (n = 97; 31.0%), and citations (n = 1529; 15.8%). In conclusion, after the beginning of the twenty-first century, the scientific production on sleep research in athletes has seen significant growth in publication and citation output. Future research should focus on interventions to improve sleep in athletes.

Partial sleep deprivation after an acute exercise session does not augment hepcidin levels the following day

The purpose of the present study was to determine the effects of partial sleep deprivation (PSD) after an exercise session in the evening on the endurance exercise-induced hepcidin response the following morning. Ten recreationally trained males participated under two different conditions. Each condition consisted of 2 consecutive days of training (days 1 and 2). On day 1, participants ran for 60 min at 75% of maximal oxygen uptake ( V ˙ O2max ) followed by 100 drop jumps. Sleep duration at night was manipulated, with a normal length of sleep (CON condition, 23:00-07:00 hr) or a shortened length of sleep (PSD condition). On the morning of day 2, the participants ran for 60 min at 65% of V ˙ O2max . Sleep duration was significantly shorter under the PSD condition (141.2 ± 13.3 min) than under the CON condition (469.0 ± 2.3 min, p < .0001). Serum hepcidin, plasma interleukin (IL)-6, serum haptoglobin, iron, and myoglobin levels did not differ significantly between the conditions (p > .05) on the morning (before exercise) of day 2. Additionally, the 3-hr postexercise levels for the hematological variables were not significantly different between the two conditions (p > .05). In conclusion, the present study demonstrated that a single night of PSD after an exercise session in the evening did not affect baseline serum hepcidin level the following morning. Moreover, a 60 min run the following morning increased serum hepcidin and plasma IL-6 levels significantly, but the exercise-induced elevations were not affected by PSD.

You Snooze, You Win? An Ecological Dynamics Framework Approach to Understanding the Relationships Between Sleep and Sensorimotor Performance in Sport

Sleep has a widespread impact across different domains of performance, including sensorimotor function. From an ecological dynamics perspective, sensorimotor function involves the continuous and dynamic coupling between perception and action. Sport performance relies on sensorimotor function as successful movement behaviors require accurate and efficient coupling between perceptions and actions. Compromised sleep impairs different aspects of sensorimotor performance, including perceptual attunement and motor execution. Changes in sensorimotor performance can be related to specific features of sleep, notably sleep spindles and slow waves. One unaddressed area of study is the extent to which specific sleep features contribute to overall sport-specific performance.

The effect of night-time exercise on sleep architecture among well-trained male endurance runners

The aim of the present study was to investigate the effects of night-time (21:00 hours) high-intensity, intermittent exercise on sleep architecture among well-trained athletes in a laboratory setting. In a randomized, counterbalanced order, 11 well-trained male runners completed a simulated trail-running exercise (TRAIL) on a motorized treadmill and a resting condition (REST; no exercise during the day). After each condition, nocturnal autonomic nervous system activity and core body temperature (CBT) were measured and sleep was analysed using polysomnography and actigraphy. Markers of muscle damage (maximal voluntary contraction [MVC], plasma creatine kinase concentration [CK] and perceived muscle soreness) were recorded before and immediately (POST), 24 hr (H24) and 48 hr (H48) after exercise. TRAIL induced a high level of fatigue and mild exercise-induced muscle damage, as determined by a reduction in MVC (-9.4%, p < .01, d = -1.36) and increases in [CK] (+176.0%, p < .01, d = 1.49) and perceived muscle soreness (+4.5 UA, p < .01, d = 2.17) compared with REST at H24. A trend for increased non-rapid eye movement (+4.2%; p = .10; d = 0.86) and reduced rapid eye movement (-4.4%; p = .07; d = -0.87) during sleep was observed for TRAIL compared with the REST condition. Moreover, compared with REST, TRAIL significantly increased CBT and nocturnal HR during the first part of the night. In conclusion, sleep architecture was modified after night-time, high-intensity exercise among well-trained runners.

High-intensity exercise in the evening does not disrupt sleep in endurance runners

PURPOSE

To investigate the effect of early evening exercise training at different intensities on nocturnal sleep and cardiac autonomic activity in endurance-trained runners.

METHODS

Eight runners completed three experimental trials in a randomised, counterbalanced order. In the early evening (end of exercise 3.5 h before bedtime), participants performed either: (i) a 1 h high-intensity interval running session (HIGH, 6 × 5 min at 90% VO_2peak interspersed with 5 min recovery); (ii) a 1 h low-intensity running session (LOW, 60 min at 45% VO_2peak) or (iii) no exercise (CON). Subsequent nocturnal sleep was assessed using polysomnography, wristwatch actigraphy, and subjective sleep quality. A two-lead electrocardiogram recorded nocturnal cardiac autonomic activity.

RESULTS

Total sleep time increased after HIGH (477.4 ± 17.7 min, p = 0.022) and LOW (479.6 ± 15.6 min, p = 0.006) compared with CON (462.9 ± 19.0 min). Time awake was lower after HIGH (31.8 ± 18.5 min, p = 0.047) and LOW (30.4 ± 15.7 min, p = 0.008) compared with CON (46.6 ± 20.0 min). There were no differences between conditions for actigraphy and subjective sleep quality (p > 0.05). Nocturnal heart rate variability was not different between conditions, but average nocturnal heart rate increased after HIGH (50 ± 5 beats min^-1) compared with LOW (47 ± 5 beats min^-1, p = 0.02) and CON (47 ± 5 beats min^-1, p = 0.028).

CONCLUSION

When performed in the early evening, high-intensity exercise does not disrupt and may even improve subsequent nocturnal sleep in endurance-trained runners, despite increased cardiac autonomic activity. Additionally, low-intensity exercise induced positive changes in sleep behaviour that are comparable to those obtained following high-intensity exercise.

Gender differences in sleep patterns and sleep complaints of elite athletes

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.

Intra-individual variability of sleep and nocturnal cardiac autonomic activity in elite female soccer players during an international tournament

PURPOSE

To describe individual sleeping patterns and nocturnal cardiac autonomic activity of National team female soccer players during an international tournament.

MATERIALS AND METHODS

Twenty elite female soccer players (aged 25.2±3.1 years) wore wrist actigraph units and heart rate (HR) monitors during night-sleep throughout 9 consecutive days (6 day-time training sessions [DT], 2 day-time matches [DM], and 1 evening-time match [EM]) of an international tournament. Training and match loads were monitored using the session-rating of perceived exertion (s-RPE) and wearable 18-Hz GPS (total distance covered [TD], training and match exposure time, and high-speed running [HSR]) to characterize training and match loads.

RESULTS

Individually, s-RPE, TD, exposure time, and HSR during training sessions ranged from 20 to 680 arbitrary units (AU), 892 to 5176 m, 20 to 76 min, and 80 to 1140 m, respectively. During matches, s-RPE, TD, exposure time, and HSR ranged from 149 to 876 AU, 2236 to 11210 m, 20 to 98 min, and 629 to 3213 m, respectively. Individually, players slept less than recommended (<7 hours) on several days of the tournament, especially after EM (n = 8; TST ranging between 6:00-6:54 h). Total sleep time coefficient of variation (CV) ranged between 3.1 and 18.7%. However, all players presented good sleep quality (i.e., sleep efficiency ≥75%; individual range between: 75-98%) on each day of the tournament. Most of the players presented small fluctuations in nocturnal cardiac autonomic activity (individual nocturnal heart rate variability [HRV] ranged from 3.91-5.37 ms and HRV CV ranged from 2.8-9.0%), while two players presented higher HRV CV (11.5 and 11.7%; respectively).

CONCLUSION

Overall, this study highlights the substantial individual variability in sleep and HRV measures, suggesting the adoption of an individual approach to monitor sleep, training and match loads and recovery, to better understand how players cope with highly demanding competitions.

Effects of total sleep deprivation on endurance cycling performance and heart rate indices used for monitoring athlete readiness

This study investigated effects of total sleep deprivation on self-paced endurance performance, and heart rate (HR) indices of athletes' "readiness to perform". Endurance athletes (n = 13) completed a crossover experiment comprising a normal sleep (NS) and sleep deprivation (SD) condition. Each required completion of an endurance time-trial (TT) on consecutive days (D1, D2) separated by normal sleep or total sleep deprivation. Finishing time, perceived exertion (RPE), mood, psychomotor vigilance (PVT), and HR responses were assessed. Time on D2 of SD was 10% slower than D2 of NS (64 ± 7 vs 59 ± 4 min, P < 0.01), and 11% slower than D1 of SD (58 ± 5 min, P < 0.01). Subjective to objective (RPE:mean HR) intensity ratio was higher on D2 of SD compared with D2 of NS and D1 of SD (P < 0.01). Mood disturbance and PVT mean response time increased on D2 of SD compared with D2 of NS and D1 of SD. Anaerobic threshold and change in TT time were correlated (R = -0.73, P < 0.01). Sleep helps to optimise endurance performance. Subjective to objective intensity ratios appear sensitive to effects of sleep on athletes' readiness. Research examining more subtle sleep manipulation is required.

The effects of a single night of complete and partial sleep deprivation on physical and cognitive performance: A Bayesian analysis

This study investigated the effects of complete and partial sleep deprivation on multiple aspects of athletic performance. Ten males completed a cognitive function test, maximal handgrip strength, countermovement jump (CMJ) and a 15 min all out cycling test to assess aerobic performance. These tests were performed following 3 different sleep conditions; normal sleep (CON), a 4 hr sleep opportunity (PART) and complete sleep deprivation (DEP). Data were analysed using a Bayesian multi-level regression model to provide probabilities of impairment (p = %). Aerobic performance, CMJ and handgrip strength were impaired by 11.4% (p = 100%), 10.9% (p = 100%) and 6% (p = 97%) following DEP, while aerobic performance and CMJ were highly likely impaired by 4.1% (p = 90%) and 5.2% (p = 94%) following PART. Cognitive reaction time was not impacted by PART or DEP. In contrast the accuracy of responses was highly likely impaired by 2% (91) following DEP, while there was less certainty of impaired accuracy following PART (-1%, p = 73). Multiple aspects of physical and cognitive performance were impacted by sleep deprivation. The greatest detrimental effects were seen for aerobic performance and CMJ. Partial sleep deprivation equating to 4 hrs of sleep causes subtle, but potentially important negative impairments on athletic performance.

Accelerating Recovery from Exercise-Induced Muscle Injuries in Triathletes: Considerations for Olympic Distance Races

The triathlon is one of the fastest developing sports in the world due to expanding participation and media attention. The fundamental change in Olympic triathlon races from a single to a multistart event is highly demanding in terms of recovery from and prevention of exercise-induced muscle injures. In elite and competitive sports, ultrastructural muscle injuries, including delayed onset muscle soreness (DOMS), are responsible for impaired muscle performance capacities. Prevention and treatment of these conditions have become key in regaining muscular performance levels and to guarantee performance and economy of motion in swimming, cycling and running. The aim of this review is to provide an overview of the current findings on the pathophysiology, as well as treatment and prevention of, these conditions in compliance with clinical implications for elite triathletes. In the context of DOMS, the majority of recovery interventions have focused on different protocols of compression, cold or heat therapy, active regeneration, nutritional interventions, or sleep. The authors agree that there is a compelling need for further studies, including high-quality randomized trials, to completely evaluate the effectiveness of existing therapeutic approaches, particularly in triathletes. The given recommendations must be updated and adjusted, as further evidence emerges.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Which parameters to use for sleep quality monitoring in team sport athletes? A systematic review and meta-analysis

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.

Long-Haul Northeast Travel Disrupts Sleep and Induces Perceived Fatigue in Endurance Athletes

Introduction: Long-haul transmeridian travel is known to cause disruptions to sleep and immune status, which may increase the risk of illness. Aim: This study aimed to determine the effects of long-haul northeast travel for competition on sleep, illness and preparedness in endurance athletes. Methods: Twelve trained (13.8 ± 3.2 training h/week) masters (age: 48 ± 14 years) triathletes were monitored for sleep (quantity via actigraphy and quality via self-report), mucosal immunity (salivary immunoglobulin-A) and stress (salivary cortisol) as well as self-reported illness, fatigue, recovery and preparedness. Baseline measures were recorded for 2 weeks prior to travel for all variables except for the saliva samples, which were collected on three separate days upon waking. Participants completed normal training during the baseline period. Measures were subsequently recorded before, during and after long-haul northeast travel from the Australian winter to the Hawaiian summer, and in the lead up to an Ironman 70.3 triathlon. Results: All comparisons are to baseline. There was a most likely decrease in sleep duration on the over-night flight (-4.8 ± 1.2 h; effect size; ±90% confidence limits = 3.06; ±1.26) and a very likely increase in sleep duration on the first night after arrival (0.7 ± 1.0 h; 1.15; ±0.92). After this time, sleep duration returned to baseline for several days until it was very likely decreased on the night prior to competition (-1.2 ± 1.0 h; 1.18; ±0.93). Nap duration was likely increased on the first day after arrival (36 ± 65 min; 3.90; ±3.70). There was also a likely increase in self-reported fatigue upon waking after the first night in the new destination (1.1 ± 1.6 AU; 0.54; ±0.41) and there were three athletes (25%) who developed symptoms of illness 3-5 days after arrival. There were no changes in sleep quality or mucosal measures across study. Discussion: Long-haul northeast travel from a cool to a hot environment had substantial influences on sleep and self-reported fatigue, but these alterations had returned to pre-departure baseline 48 h after arrival. Endurance athletes undertaking similar journeys may benefit from optimizing sleep hygiene, especially on the first 2 days after arrival, or until sleep duration and fatigue levels return to normal.