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Chen JH, Chen JY, Wang YC. The effects of exercise programs on sleep architecture in obstructive sleep apnea: a meta-analysis of randomized controlled trials. J Sci Med Sport 2024; 27:293-301. [PMID: 38365534 DOI: 10.1016/j.jsams.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Exercise is an effective intervention for obstructive sleep apnea (OSA). However, the effects of exercise on objective sleep architecture in patients with OSA remain unknown. This meta-analysis aimed to collect data from randomized controlled trials of exercise interventions in patients with OSA, with a specific focus on objective sleep parameters derived from polysomnography. METHODS Randomized control trials that targeted patients with OSA aged >18 years, measured sleep using polysomnography after exercise programs, and reported the proportion of sleep stages were included for meta-analysis. Bias was assessed using the revised Cochrane risk-of-bias tool and funnel plots. The random effects model was applied. RESULTS Six studies with a total of 236 patients were included in the meta-analysis. There were no significant differences in the total sleep time (TST), sleep efficiency, sleep onset latency, stage N1 sleep, or rapid eye movement sleep between the exercise and control groups. Participation in an exercise program lasting >12 weeks significantly decreased stage N2 and increased stage N3 sleep as observed in the subgroup analysis. Although this tendency did not reach statistical significance in the total-group analysis, it was significant after excluding the possible confounding effects of heart disease. CONCLUSIONS The exercise program decreased N2 and increased N3 proportions over the TST among patients with OSA, which may correspond to subjective sleep quality. The beneficial effects were significant when the program lasted >12 weeks and after excluding the confounding effects of heart disease. Exercise program duration should be considered when providing clinical advice.
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Affiliation(s)
- Jian-Hong Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; School of Medicine, Chang Gung University, Taiwan; National Taiwan Sport University, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Taiwan
| | - Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Taiwan.
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Montero A, Baranoff J, Adams R, Drummond M. Athletic retirement: factors contributing to sleep and mental health problems. Front Psychol 2024; 15:1350925. [PMID: 38558779 PMCID: PMC10978592 DOI: 10.3389/fpsyg.2024.1350925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The aim of this investigation was to determine which factors were associated with symptoms of sleep and mental health disorders in former athletes. Methods Former athletes (N = 173, 50% women) who retired from any competition level within the last 20 years participated in an online survey. The survey consisted of the Athlete Sleep Screening Questionnaire (ASSQ), Personal Wellbeing Index-Adult (PWI-A), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and Generalised Anxiety Disorder Assessment (GAD-7). Results Binary logistic regressions revealed that both age (OR = 0.95 [95% CI:0.92, 0.99], p = 0.007) and gender (OR = 2.28 [95% CI:1.09, 4.79], p = 0.029) were associated with anxiety, with women and younger ex-athletes presenting greater risk of anxiety symptoms. Higher body mass was associated with an increased risk for sleep difficulty (OR = 1.13 [95% CI:1.03, 1.23], p = 0.008), sleep disordered breathing (OR = 1.20 [95% CI:1.10, 1.30], p < 0.001), and compromised wellbeing (OR = 0.89 [95% CI:0.83, 0.96], p = 0.001). Athletes who subjectively placed a lower priority on sport while competing presented greater risk of sleep disordered breathing (OR = 2.00[95% CI:1.05, 3.80], p = 0.035). No associations between recency retirement and any outcome measures were observed. Discussion Findings suggest potential predictive factors for difficulty transitioning out of sport. Future longitudinal research should consider the interplay between sport re-engagement and the incidence and chronicity of sleep and mental health disorders.
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Affiliation(s)
- Ashley Montero
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health, Bedford Park, SA, Australia
| | - John Baranoff
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health, Bedford Park, SA, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
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Charest J, Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health: An Update. Sleep Med Clin 2022; 17:263-282. [PMID: 35659079 DOI: 10.1016/j.jsmc.2022.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Jonathan Charest
- Department of Psychology, Universite Laval, Quebec City, Quebec, Canada; Centre for Sleep and Human Performance, #106, 51 Sunpark Drive Southeast, Calgary, Alberta T2X 3V4, Canada; Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, PO Box 245002, Tucson, AZ 8524-5002, USA.
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Vitale JA, Ieno C, Baldassarre R, Bonifazi M, Vitali F, La Torre A, Piacentini MF. The Impact of a 14-Day Altitude Training Camp on Olympic-Level Open-Water Swimmers' Sleep. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074253. [PMID: 35409934 PMCID: PMC8998594 DOI: 10.3390/ijerph19074253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/09/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
Despite the common belief that sleep quality at altitude is poor, the scientific evidence to support this notion is still modest. Therefore, the purpose of the present study was to evaluate possible changes of actigraphy-based and subjective sleep parameters in a group of elite open-water swimmers during a 14-day altitude training camp (ATC) at 1500 m. The study subjects were five Olympic-level open-water swimmers (mean age: 25.0 ± 3.2 years; 3 females and 2 males). All subjects wore a wrist activity monitor and filled a sleep diary for 18 consecutive nights, 4 nights before and 14 nights during ATC. The data were then analyzed at four different time points: before ATC (PRE), the first two days of ATC (T1), and after one (T2) and two weeks of ATC (T3). Training load, assessed as the covered distance (km), session rating of perceived exertion (sRPE), and heart rate (HR), was monitored during the week before and the first and second week of ATC. No significant differences in objective and subjective scores of sleep quality were detected, whereas the sleep onset time (p = 0.018; η2p = 0.83, large) and sleep offset time (p < 0.001; η2p = 0.95, large) significantly differed among PRE, T1, T2, and T3: elite athletes started to sleep and woke up ≃ 1 h earlier the first two days of ATC compared to PRE (sleep onset time: p = 0.049; sleep offset time: p = 0.016). Further, an increase in the training volume during the two weeks of the ATC was observed, with the most time spent in a low-intensity regime and an increase in time spent in a high-intensity regime compared to PRE. Sleep quality was not negatively influenced by a 14-day altitude training camp at 1500 m in a group of Olympic-level elite swimmers despite an increase in perceived exertion during training sessions. Nonetheless, early sleep onset and sleep offset times were observed for the first two nights of ATC: elite athletes started to sleep and woke up ≃ 1 h earlier compared to the baseline nights.
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Affiliation(s)
- Jacopo Antonino Vitale
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Correspondence: ; Tel.: +39-0266214980
| | - Cristian Ieno
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.I.); (M.F.P.)
- Department of Physiology and Pharmacology, University of Rome La Sapienza, 00185 Rome, Italy
| | | | - Marco Bonifazi
- Italian Swimming Federation, 00135 Rome, Italy; (R.B.); (M.B.)
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Francesca Vitali
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37124 Verona, Italy;
| | - Antonio La Torre
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milan, 20161 Milan, Italy
| | - Maria Francesca Piacentini
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy; (C.I.); (M.F.P.)
- Department of Human Physiology and Sports Medicine, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Walsh NP, Halson SL, Sargent C, Roach GD, Nédélec M, Gupta L, Leeder J, Fullagar HH, Coutts AJ, Edwards BJ, Pullinger SA, Robertson CM, Burniston JG, Lastella M, Le Meur Y, Hausswirth C, Bender AM, Grandner MA, Samuels CH. Sleep and the athlete: narrative review and 2021 expert consensus recommendations. Br J Sports Med 2020; 55:bjsports-2020-102025. [PMID: 33144349 DOI: 10.1136/bjsports-2020-102025] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
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).
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Affiliation(s)
- Neil P Walsh
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Shona L Halson
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Charli Sargent
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Gregory D Roach
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Mathieu Nédélec
- Laboratory Sport, Expertise and Performance (EA 7370), French National Institute of Sport (INSEP), Paris, France
| | - Luke Gupta
- English Institute of Sport, Bisham Abbey National High Performance Centre, Marlow, UK
| | | | - Hugh H Fullagar
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Aaron J Coutts
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ben J Edwards
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Samuel A Pullinger
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Sports Science Department, Aspire Academy, Doha, Qatar
| | - Colin M Robertson
- School for Sport and Exercise Sciences, University of Bolton, Bolton, UK
| | - Jatin G Burniston
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Michele Lastella
- Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, Queensland, Australia
| | - Yann Le Meur
- Laboratory Sport, Expertise and Performance (EA 7370), French National Institute of Sport (INSEP), Paris, France
| | | | - Amy M Bender
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Grandner
- Sleep and Health Research Program, University of Arizona, Tucson, Arizona, USA
| | - Charles H Samuels
- Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Caia J, Halson SL, Scott A, Kelly VG. Obstructive sleep apnea in professional rugby league athletes: An exploratory study. J Sci Med Sport 2020; 23:1011-1015. [DOI: 10.1016/j.jsams.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/19/2020] [Accepted: 04/08/2020] [Indexed: 01/20/2023]
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Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin 2020; 15:41-57. [PMID: 32005349 PMCID: PMC9960533 DOI: 10.1016/j.jsmc.2019.11.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Research has characterized the sleep of elite athletes and attempted to identify factors associated with athletic performance, cognition, health, and mental well-being. Sleep is a fundamental component of performance optimization among elite athletes, yet only recently embraced by sport organizations as an important part of training and recovery. Sleep plays a crucial role in physical and cognitive performance and is an important factor in reducing risk of injury. This article aims to highlight the prevalence of poor sleep, describe its impacts, and address the issue of sport culture surrounding healthy sleep.
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8
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Bonnar D, Lee S, Gradisar M, Suh S. Risk Factors and Sleep Intervention Considerations in Esports: A Review and Practical Guide. SLEEP MEDICINE RESEARCH 2019. [DOI: 10.17241/smr.2019.00479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Park SM, Park S, Shin S, Lee H, Ahn SJ, Kim L, Lee SH, Noh G. Designing a mandibular advancement device with topology optimization for a partially edentulous patient. J Prosthet Dent 2019; 123:850-859. [PMID: 31590981 DOI: 10.1016/j.prosdent.2019.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/25/2022]
Abstract
STATEMENT OF PROBLEM Patients with partial tooth loss treated with implant-supported fixed partial dentures (FPDs) have difficulty using conventional mandibular advancement devices (MADs) because of the risk of side effects. Also, which design factors affect biomechanical stability when designing MADs with better stability is unclear. PURPOSE The purpose of this finite element (FE) analysis study was to analyze the effect of the MAD design on biomechanical behavior and to propose a new design process for improving the stability of MADs. MATERIAL AND METHODS Each 3D model consisted of the maxillofacial bones, teeth, and implant-supported FPDs located in the left tooth loss area from the first premolar to the second molar and a MAD. Three types of custom-made MADs were considered: a complete-coverage MAD covering natural tooth-like conventional MADs, a shortened MAD excluding the coverage on the implant-supported FPD, and a newly designed MAD without anterior coverage. For the new MAD design, topology optimization was conducted to reduce the stress exerted on the teeth and to improve retention of the MAD. The new MAD design was finished by excluding the coverage of the maxillary and mandibular central incisors based on the results of the topology optimization. A mandibular posterior restorative force for a protrusion amount of 40% was used as the loading condition. The principal stress and pressure of the cancellous bone and periodontal ligaments (PDLs) were identified. RESULTS Considering the load concentration induced by the complete-coverage MAD, bone resorption risk and root resorption risk were observed at both ends of the mandibular teeth. The shortened MAD resulted in the highest stress concentration and pressure with the worst stability. However, in the case of the complete-coverage MAD, the pressure in the PDLs was reduced to the normal range, and the risk of root resorption was reduced. CONCLUSIONS For patients with implant-supported FPDs, MAD designs with different extents of coverage had an influence on biomechanical behavior in terms of stress distribution in cancellous bone and PDLs. A MAD design without anterior coverage provided improved stability compared with complete-coverage or shortened designs. The presented method for MAD design, which combined FE analysis and topology optimization, could be effectively applied in the design of such improved MADs.
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Affiliation(s)
- Si-Myung Park
- Graduate student, Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Graduate student, School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Soyeon Park
- Graduate student, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Sangkyun Shin
- Researcher, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Hyeonjong Lee
- Assistant Professor, Department of Prosthodontics, Pusan National University, Yangsan, Republic of Korea
| | - Su-Jin Ahn
- Professor, Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Laehyun Kim
- Principal Researcher, Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Soo-Hong Lee
- Professor, School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Gunwoo Noh
- Assistant Professor, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea.
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Silva A, Narciso FV, Rosa JP, Rodrigues DF, Cruz AÂDS, Tufik S, Viana F, Bichara JJ, Pereira SRD, da Silva SC, Mello MTD. Gender differences in sleep patterns and sleep complaints of elite athletes. Sleep Sci 2019; 12:242-248. [PMID: 32318244 PMCID: PMC7159080 DOI: 10.5935/1984-0063.20190084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 09/18/2019] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Andressa Silva
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
| | - Fernanda Veruska Narciso
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
| | - João Paulo Rosa
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
| | - Dayane Ferreira Rodrigues
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
| | | | - Sérgio Tufik
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Fernanda Viana
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
| | - Jorge José Bichara
- Comitê Olímpico do Brasil, Comitê Olímpico do Brasil - Rio de Janeiro - Rio de Janeiro - Brazil
| | | | | | - Marco Túlio De Mello
- Universidade Federal de Minas Gerais, Departamento de Esportes - Belo Horizonte - Minas Gerais - Brazil
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Nedelec M, Aloulou A, Duforez F, Meyer T, Dupont G. The Variability of Sleep Among Elite Athletes. SPORTS MEDICINE-OPEN 2018; 4:34. [PMID: 30054756 PMCID: PMC6063976 DOI: 10.1186/s40798-018-0151-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022]
Abstract
Practicing sport at the highest level is typically accompanied by several stressors and restrictions on personal life. Elite athletes’ lifestyle delivers a significant challenge to sleep, due to both the physiological and psychological demands, and the training and competition schedules. Inter-individual variability of sleep patterns (e.g., sleep requirements, chronotype) may have important implications not only for recovery and training schedules but also for the choice of measures to possibly improve sleep. This article provides a review of the current available literature regarding the variability of sleep among elite athletes and factors possibly responsible for this phenomenon. We also provide methodological approaches to better address the inter-individual variability of sleep in future studies with elite athletes. There is currently little scientific evidence supporting a specific influence of one particular type of sport on sleep; sleep disorders may be, however, more common in strength/power and contact sports. Sleep behavior may notably vary depending on the athlete’s typical daily schedule. The specificity of training and competition schedules possibly accounts for the single most influential factor leading to inconsistency in sleep among elite athletes (e.g., “social jet lag”). Additionally, athletes are affected by extensive exposure to electric light and evening use of electronic media devices. Therefore, the influence of ordinary sleep, poor sleep, and extended sleep as important additional contributors to training load should be studied. Future experimental studies on sleep and elite sport performance should systematically report the seasonal phase. Boarding conditions may provide a good option to standardize as many variables as possible without the inconvenience of laboratory. The use of interdisciplinary mixed-method approaches should be encouraged in future studies on sleep and elite sport. Finally, high inter- and intra-individual variability in the athletes’ sleep characteristics suggests a need for providing individual responses in addition to group means.
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Affiliation(s)
- Mathieu Nedelec
- French Institute of Sport (INSEP), Research Department, Laboratory Sport, Expertise and Performance (EA 7370), 11 Avenue du Tremblay, 75012, Paris, France.
| | - Anis Aloulou
- French Institute of Sport (INSEP), Research Department, Laboratory Sport, Expertise and Performance (EA 7370), 11 Avenue du Tremblay, 75012, Paris, France
| | - François Duforez
- Centre du Sommeil, Hotel Dieu de Paris, 1 Place du Parvis Notre Dame, 75004, Paris, France
| | - Tim Meyer
- Institute of Sport and Preventive Medicine, Saarland University, GEB. B82, 66123, Saarbrucken, Germany
| | - Gregory Dupont
- French Institute of Sport (INSEP), Research Department, Laboratory Sport, Expertise and Performance (EA 7370), 11 Avenue du Tremblay, 75012, Paris, France
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Hoshikawa M, Uchida S, Hirano Y. A Subjective Assessment of the Prevalence and Factors Associated with Poor Sleep Quality Amongst Elite Japanese Athletes. SPORTS MEDICINE-OPEN 2018; 4:10. [PMID: 29484576 PMCID: PMC5826912 DOI: 10.1186/s40798-018-0122-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/22/2018] [Indexed: 01/29/2023]
Abstract
Background The amount, quality, and timing of sleep are considered important for athletes’ ability to train, maximize training responses, and recover. However, some research has shown that elite athletes do not obtain sufficient sleep. Based on this background, researchers recently started to assess and manage sleep in elite athletes. The purpose of this study was to clarify the prevalence of poor sleep quality and its associated factors amongst elite Japanese athletes. Methods Eight hundred and ninety-one candidates for the 17th Asian Games Incheon 2014, who were over 20 years old, participated in this study. They completed a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, two-question case-finding instruments, and a checklist for sleep hygiene. Data from 817 of the 891 athletes (91.7%) with no missing values were analyzed. Results The mean time in bed was 7 h and 29 min. Two hundred and twenty-nine (28.0%) athletes showed a PSQI global score above the clinical criteria. A multiple logistic analysis revealed that sleep quality was significantly associated with five factors: “time in bed,” “eating breakfast every morning,” “avoiding the use of electronic devices (PC, smartphone, etc.) just before bedtime,” “depressive mood”, and “not thinking about troubles while in bed.” Forty percent of athletes reported they had been informed by someone about “snoring loudly” and/or “leg twitching or jerking during sleep.” Conclusions The results of this study demonstrate that 28% of the athletes showed the PSQI score above the cutoff for poor sleep quality (> 5.5), which suggests that there may be a high prevalence of poor sleep quality in this population of athletes. To improve athletes’ sleep, the five factors associated with sleep quality should be emphasized in athletes’ sleep education. Furthermore, in medical evaluations of athletes, it may be desirable to include screening for sleep disorders.
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Affiliation(s)
- Masako Hoshikawa
- Department of Sport Research, Japan Institute of Sport Sciences, 3-15-1 Nishigaoka, Kita-ku, Tokyo, 115-0056, Japan.
| | - Sunao Uchida
- Faculty of Sport Sciences, Waseda University, Mitakajima, Tokorozawa, Saitama, Japan
| | - Yuichi Hirano
- Faculty of Sports and Health Studies, Hosei University, 4342 Aihara-Cho, Machida, Tokyo, 194-0298, Japan
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Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med 2018; 48:683-703. [DOI: 10.1007/s40279-017-0832-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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A pilot study on the biomechanical assessment of obstructive sleep apnea pre and post bariatric surgery. Respir Physiol Neurobiol 2018; 250:1-6. [PMID: 29339193 DOI: 10.1016/j.resp.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 01/18/2023]
Abstract
Obesity is a major risk factor for obstructive sleep apnea patients. In obese patients the severity of this risk can be reduced by bariatric surgery. This pilot study investigates the perioperative effects of bariatric surgery on obstructive sleep apnea and on the physical and biomechanical characteristics of the upper airway. Polysomnography and computer tomography data for 10 morbid obese patients promoted for bariatric surgery were conducted before surgery and at 6 and 12 months postoperatively for assessment of the oropharyngeal anatomy, and subsequent three-dimensional modelling of the airway. Mean values for the apnea/hypopnea index and body mass index significantly reduced after surgery. To combine the effect of changes in the upper airway volume and body mass index, a new volume body mass index is introduced. This index increases with a successful bariatric surgery. Although bariatric surgery leads to an effective weight reduction for all age groups, for obstructive sleep apnea patients it may be effective for middle age, less effective for 50-60 years, and further less effective for patients over the age of 60 years.
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Ashaat S, Al-Jumaily AM. Reducing upper airway collapse at lower continuous positive airway titration pressure. J Biomech 2016; 49:3915-3922. [DOI: 10.1016/j.jbiomech.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
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Dunican IC, Eastwood PR. Sleep is an important factor when considering rugby union player load. Br J Sports Med 2016; 51:1640. [PMID: 27864290 DOI: 10.1136/bjsports-2016-097122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Ian C Dunican
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia, Australia
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Abstract
In elite soccer, players are frequently exposed to various situations and conditions that can interfere with sleep, potentially leading to sleep deprivation. This article provides a comprehensive and critical review of the current available literature regarding the potential acute and chronic stressors (i.e., psychological, sociological and physiological stressors) placed on elite soccer players that may result in compromised sleep quantity and/or quality. Sleep is an essential part of the recovery process as it provides a number of important psychological and physiological functions. The effects of sleep disturbance on post-soccer match fatigue mechanisms and recovery time course are also described. Physiological and cognitive changes that occur when competing at night are often not conducive to sleep induction. Although the influence of high-intensity exercise performed during the night on subsequent sleep is still debated, environmental conditions (e.g., bright light in the stadium, light emanated from the screens) and behaviours related to evening soccer matches (e.g., napping, caffeine consumption, alcohol consumption) as well as engagement and arousal induced by the match may all potentially affect subsequent sleep. Apart from night soccer matches, soccer players are subjected to inconsistency in match schedules, unique team schedules and travel fatigue that may also contribute to the sleep debt. Sleep deprivation may be detrimental to the outcome of the recovery process after a match, resulting in impaired muscle glycogen repletion, impaired muscle damage repair, alterations in cognitive function and an increase in mental fatigue. The role of sleep in recovery is a complex issue, reinforcing the need for future research to estimate the quantitative and qualitative importance of sleep and to identify influencing factors. Efficient and individualised solutions are likely needed.
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Swinbourne R, Gill N, Vaile J, Smart D. Prevalence of poor sleep quality, sleepiness and obstructive sleep apnoea risk factors in athletes. Eur J Sport Sci 2015; 16:850-8. [PMID: 26697921 DOI: 10.1080/17461391.2015.1120781] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Benton ML, Friedman NS. Treatment of obstructive sleep apnea syndrome with nasal positive airway pressure improves golf performance. J Clin Sleep Med 2013; 9:1237-42. [PMID: 24340283 DOI: 10.5664/jcsm.3256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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