Comment on: "Does Elite Sport Degrade Sleep Quality? A Systematic Review"

Translation and Validation of the Arabic Version of the Athlete Sleep Screening Questionnaire

Sleep improves the cognitive and physical performance of athletes. A detailed questionnaire that detects sleep disruptions is required to identify sleep-deprived athletes. This study evaluates the translated Athlete Sleep Screening Questionnaire (ASSQ), a tool suggested by the International Olympic Committee, among Arabic-speaking athletes. The ASSQ was translated into Arabic and examined for floor or ceiling effects, internal consistency, and validity among Arabic-speaking athletes. The Arabic Pittsburgh Sleep Quality Index (PSQI) was employed to assess convergent validity. Ninety athletes (28.9% women) participated and completed this study's questionnaires. The Cronbach's alpha for the ASSQ-Sleep Difficulty Score (SDS) was 0.435, and that of the ASSQ-chronotype was 0.632. The SDS and chronotype subset of the ASSQ demonstrated excellent test-retest reliability, with intraclass correlation coefficients of 0.84 and 0.938, respectively. The ASSQ-SDS correlated positively with the PSQI (0.734, p = 0.001). The ASSQ-chronotype was inversely associated with the PSQI (p = 0.001). This study's findings can assist clinicians in assessing sleep disorders in sports. The Arabic version of the ASSQ has satisfactory psychometric qualities and can identify clinically relevant sleep problems in athletes.

Propiedades psicométricas del índice de calidad de sueño de Pittsburgh en deportistas

El índice de calidad de sueño de Pittsburgh (ICSP) es un instrumento ampliamente utilizado en poblaciones clínicas y no clínicas para la evaluación de la calidad de sueño. El objetivo de este trabajo fue determinar la estructura factorial y consistencia interna del ICSP en deportistas universitarios del sur de Sonora México para la evaluación de las propiedades psicométricas del instrumento. Se realizó un estudio transversal no experimental con 98 deportistas universitarios, 39 mujeres (38,2%), en un rango de 17 a 25 años. Se evaluó la consistencia interna y homogeneidad del instrumento, así como los análisis factorial exploratorio (AFE) y confirmatorio (AFC). Los resultados de confiabilidad indicaron un α de Cronbach de 0,79 eliminando los componentes de uso de medicamentos para dormir y eficiencia habitual del sueño. El AFE identificó un modelo de dos factores y el AFC un modelo unidimensional. Se concluye que la calidad de sueño en esta muestra de deportistas se explica mejor mediante un modelo unidimensional de cinco componentes.

Sleep Characteristics of Elite Youth Athletes: A Clustering Approach to Optimize Sleep Support Strategies

PURPOSE

Elite athletes experience chronic sleep insufficiency due to training and competition schedules. However, there is little research on sleep and caffeine use of elite youth athletes and a need for a more nuanced understanding of their sleep difficulties. This study aimed to (1) examine the differences in sleep characteristics of elite youth athletes by individual and team sports, (2) study the associations between behavioral risk factors associated with obstructive sleep apnea and caffeine use with sleep quality, and (3) characterize the latent sleep profiles of elite youth athletes to optimize the sleep support strategy.

METHODS

A group (N = 135) of elite national youth athletes completed a self-administered questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI) and questions pertaining to obstructive sleep apnea, napping behavior, and caffeine use. K-means clustering was used to characterize unique sleep characteristic subgroups based on PSQI components.

RESULTS

Athletes reported 7.0 (SD = 1.2) hours of sleep. Out of the total group, 45.2% of the athletes had poor quality sleep (PSQI global >5), with team-sport athletes reporting significantly poorer sleep quality than individual-sport athletes. Multiple logistic regression analysis indicated that sport type significantly correlated with poor sleep quality. The K-means clustering algorithm classified athletes' underlying sleep characteristics into 4 clusters to efficiently identify athletes with similar underlying sleep issues to enhance interventional strategies.

CONCLUSION

These findings suggest that elite youth team-sport athletes are more susceptible to poorer sleep quality than individual-sport athletes. Clustering methods can help practitioners characterize sleep-related problems and develop efficient athlete support strategies.

Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression

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.

The Clinical Validation of the Athlete Sleep Screening Questionnaire: an Instrument to Identify Athletes that Need Further Sleep Assessment

Background

Previous research has established that general sleep screening questionnaires are not valid and reliable in an athlete population. The Athlete Sleep Screening Questionnaire (ASSQ) was developed to address this need. While the initial validation of the ASSQ has been established, the clinical validity of the ASSQ has yet to be determined. The main objective of the current study was to evaluate the clinical validity of the ASSQ.

Methods

Canadian National Team athletes (N = 199; mean age 24.0 ± 4.2 years, 62% females; from 23 sports) completed the ASSQ. A subset of athletes (N = 46) were randomized to the clinical validation sub-study which required subjects to complete an ASSQ at times 2 and 3 and to have a clinical sleep interview by a sleep medicine physician (SMP) who rated each subjects’ category of clinical sleep problem and provided recommendations to improve sleep. To assess clinical validity, the SMP category of clinical sleep problem was compared to the ASSQ.

Results

The internal consistency (Cronbach’s alpha = 0.74) and test-retest reliability (r = 0.86) of the ASSQ were acceptable. The ASSQ demonstrated good agreement with the SMP (Cohen’s kappa = 0.84) which yielded a diagnostic sensitivity of 81%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 90%. There were 25.1% of athletes identified to have clinically relevant sleep disturbances that required further clinical sleep assessment. Sleep improved from time 1 at baseline to after the recommendations at time 3.

Conclusions

Sleep screening athletes with the ASSQ provides a method of accurately determining which athletes would benefit from preventative measures and which athletes suffer from clinically significant sleep problems. The process of sleep screening athletes and providing recommendations improves sleep and offers a clinical intervention output that is simple and efficient for teams and athletes to implement.

Electronic supplementary material

The online version of this article (10.1186/s40798-018-0140-5) contains supplementary material, which is available to authorized users.