Lack of Sleep and Sports Injuries in Adolescents: A Systematic Review and Meta-analysis

Sleep characteristics and adolescent physical activity-related injuries in sports clubs, leisure time and schools

OBJECTIVE

Sleep has been identified as an important factor in relation to physical activity-related injury (PARI) in adolescents. The study aimed to explore associations between sleep duration, sleep problems and PARI among Slovak adolescents in three different settings: sports clubs, leisure time and schools.

METHODS

We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 10 163 Slovak adolescents aged from 10.5 to 18.3 (mean age 13.4 (SD=1.5); 50.9% boys). Data were collected through self-administered online questionnaires completed by respondents in schools during the classes. Multiple logistic regression models were used to assess associations between sleep duration during schooldays and weekends, sleep problems and PARI in sports clubs, leisure time and schools.

RESULTS

Adolescents with normal sleep duration during schooldays and those who reported no problems with falling asleep, waking up at night and day sleepiness had a higher chance of not being injured during PA in sports clubs, leisure time and schools compared with adolescents with short sleep duration and sleep problems. Sufficient sleep duration during the weekend increased the probability of not having PARI in leisure time and schools, with the strongest association between long sleep duration and PARI in leisure time.

CONCLUSION

Good sleep quality and sufficient sleep duration were found to play a protective role in relation to PARI in adolescents. The findings suggest implementing sleep interventions in PARI prevention programmes, which must be considered a key component of adolescent PA promotion.

Sleep in the Athlete

Sleep is important for not only general health but also for lowering injury risk and maintaining athletic performance. Sleep disorders are prevalent in athletes, and taking a sleep history, evaluating sleep quality, and addressing other related factors including mental health are essential in diagnosing and understanding sleep disorders. Other methods such as polysomnography, actigraphy, and sheet sensors can also be used. Treatment options for sleep disorders include sleep hygiene, cognitive behavioral therapy, medication, and addressing contributing factors. For athletes, sleep can also be affected by factors such as travel fatigue and jet lag, which should be taken into consideration.

Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review

This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual's sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8-10 h) and actual sleep achieved. Sleep-wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes' ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.

Prevalence and factors associated with serious injuries and aggressive behaviours among in-school adolescents in Panama

Introduction

Injuries during adolescence cause lifelong harm and death. Our study used a nationally representative sample to examine the prevalence and risk factors associated with serious injuries among in-school adolescents in Panama.

Methods

We analysed Panama's 2018 Global School-Based Student Health Survey data using SPSS. Percentages were used to summarise the results of the prevalence of serious injuries. Binomial logistic regression analysis was performed to examine the risk factors of serious injuries. The results were presented as an adjusted odds ratio (AOR) at a 95% confidence interval (CI).

Results

The prevalence of serious injury among in-school adolescents in Panama is 45%. Furthermore, the study found that males (AOR= 1.495, CI=1.272--1.756), truancy (AOR=1.493, CI=1.249--1.785), overweight (AOR= 1.246, 95% CI=11.057--1.469), drinking alcohol (AOR= 1.397, CI=1.151--1.695), experiencing physical attack (AOR= 2.100, CI=11.646--2.681), engaging in a physical fight (AOR=1.586, CI=1.289--1.952) and bullied outside school (AOR=1.276, CI=1.005--1.621) significantly predict serious injuries among adolescents in Panama.

Conclusion

Multidisciplinary approaches targeting the correlates observed will help reduce the high prevalence of serious injuries among in-school adolescents in Panama.

Athlete Sleep Behavior Questionnaire in Japanese (ASBQ-J): An Adaptation and Validation Study

Purpose

The Athlete Sleep Behavior Questionnaire (ASBQ) is an 18-item self-reported questionnaire that can be used to screen for sleep disorders in athletes and assess environmental, behavioral, and sports-related factors along with sleep disorders. This study aimed to analyze the reliability and validity of the ASBQ translated into Japanese (ASBQ-J).

Patients and Methods

111 female collegiate athletes completed both the initial test and retest. Independent variables were what kind of sports they perform, level as an athlete, grade (freshman, sophomore, junior, senior), and age. The reliability of the survey was assessed using Cronbach's alpha and intraclass correlation, and Pearson's correlation coefficient was calculated to determine the correlation between the total ASBQ scores and three components which were routine/environmental, behavioral, and sports factors.

Results

A total of 37.8% of athletes had ASBQ scores equal or less than 36 indicating good sleep. However, 19.8% of athletes scored more than 42, indicating poor sleep. Cronbach alpha was 0.62 and 0.65 for test and retest, respectively. Intraclass correlation was 0.78 (P < 0.01), indicating sufficient internal consistency and test-retest validity. Mean ASBQ scores were 38.5 ± 5.0 and 37.0 ± 6.5 for test and retest, respectively, and it was not significantly different between the two groups (P = 0.37). The correlation coefficients between the ASBQ-J and component scores were all statistically significant (all P < 0.01).

Conclusion

ASBQ-J is a reliable questionnaire for assessing sleep disorders in athletes whose primary language is Japanese.

Irish Dancing Injuries and Associated Risk Factors: A Systematic Review

Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. The aim of this study is to conduct a systematic review, previously registered with PROSPERO, to identify the prevalence, incidence, and the injury pattern among Irish dancers and analyse the associated risk factors. Six online databases and two dance-specific science publications were searched systematically. Studies were included if the patterns of injuries among Irish dancers were evaluated or the factors associated with injury were analysed, published in English or Portuguese, in peer-reviewed scientific journals. Four reviewers assessed the quality and level of evidence using the Downs and Black criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Eleven articles were included, eight of Level 3c (cross-sectional) and three of Level 3b (prospective). Mean DB percentage score was 63% ± 7.2%. Prevalence ranged from 72.2% to 92.6%, affecting mostly the foot/ankle complex. Only two articles reported incidence, which ranged from 3.4 to 10.6 injuries/1000 h danced depending on injury definition. Psychological factors, elite level, and insufficient/poor sleep were associated with musculoskeletal injury. Injury prevalence and incidence is high in Irish dancers, with the foot and ankle being more affected. Due to heterogeneity in injury definitions, methods, and populations, along with the need for improvement in studies quality, recommendations were made for future research.

Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes

Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.

The relationship between sleep, pain,and musculoskeletal injuries in US Army Soldiers

INTRODUCTION

The purpose of this study was to investigate the relationship between sleep and pain in military personnel and to determine if metrics of sleep and pain intensity differ between the injured and uninjured in this population.

METHODS

Active-duty US Army Soldiers (n=308; 26.8±6.5 years, 82% male) from the 2nd Infantry Division, Joint Base Lewis-McChord, Washington, and 101st Airborne Division, Fort Campbell, Kentucky, completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and questionnaires about current musculoskeletal injuries and pain intensity (0=no pain to 10=worst imaginable pain). Pearson correlation coefficients were used to assess the association between pain and sleep. Differences in sleep and pain between injured and uninjured participants were determined using an analysis of covariance.

RESULTS

Pain intensity was positively correlated with sleep quality (global PSQI score, r=0.337, p<0.001) and daytime sleepiness (ESS score, r=0.163, p=0.005), and negatively associated with sleep duration (r=-0.118, p=0.039). Injured participants accounted for 37.7% (n=116) of the study population. Injured participants reported greater pain intensity (3.7±2.5 vs 1.3±1.9, p<0.001), were older (28.5±7.4 years vs 25.8±5.7 years, p=0.001) and in the service longer (6.3±6.3 years vs 4.6±4.7 years, p=0.013) than uninjured participants. Injured participants had higher global PSQI scores (9.0±4.1 vs 6.4±3.4, p<0.001), including each of the seven PSQI components (all p<0.050), and reported sleeping less per night than uninjured participants (5.7±1.3 hours vs 6.1±1.2 hours, p=0.026).

CONCLUSION

These data demonstrate that pain intensity is associated with sleep in active-duty US Army Soldiers and that those who report a musculoskeletal injury, regardless of age and time in service, report poorer sleep quality, shorter sleep durations, and greater levels of pain than uninjured Soldiers.

Short sleep duration is associated with a wide variety of medical conditions among United States military service members

OBJECTIVES

This cross-sectional study investigated self-reported sleep duration and its association with a comprehensive range of clinically-diagnosed medical condition categories (CDMCs), as well as the relationship between short sleep duration (≤6 h) and demographic/lifestyle factors, among United States military service members (SMs).

METHODS

A stratified random sample of SMs (n = 20,819) completed an online questionnaire on usual daily hours of sleep and demographic/lifestyle characteristics. CDMCs for a six-month period prior to questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 33 CDMCs covering both broad and specific medical conditions. Prevalence of CDMCs was compared among three sleep duration categories (≤4, 5-6 and ≥7 h).

RESULTS

SMs reported a mean ± standard deviation of 6.3 ± 1.4 h of sleep per day. After adjustment for demographic/lifestyle characteristics, shorter sleep duration was associated with higher odds of a medical condition in 25 of 33 CDMCs, with most (n = 20) demonstrating a dose-response relationship. The five CDMCs with the largest differences between ≤4 vs ≥ 7 h sleep were: diseases of the nervous system (odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 2.4-3.4), mental/behavioral diseases (OR = 2.7, 95%CI = 2.3-3.2), diseases of the musculoskeletal system (OR = 1.9, 95%CI = 1.6-2.1), diseases of the circulatory system (OR = 1.7, 95%CI = 1.3-2.2), and diseases of the digestive system (OR = 1.6, 95%CI = 1.2-2.0). Six hours of sleep or less was independently associated with older age, less formal education, race, Hispanic ethnicity, higher body mass index, smoking, and military service branch.

CONCLUSIONS

In this young, physically active population, reporting shorter sleep duration was associated with a higher risk of multiple CDMCs.

Risk factors for injury and illness in youth floorball players - A prospective cohort study

OBJECTIVES

To investigate risk factors for injury and illness in female and male youth floorball players (12-17 years) during a 26-week floorball season.

DESIGN

Prospective cohort study.

SETTING

Recreational youth sport.

PARTICIPANTS

471 players (142 females) 12-17 years.

MAIN OUTCOME MEASURES

Weekly survey including questions about stress, sleep quality, well-being, sport exposure and average weekly rating of perceived exertion (RPE). Acute:chronic workload ratio (ACWR) was calculated. The Oslo Sports Trauma Research Center questionnaire on health problems was used. Predictors of new injury and illness were examined using multi-level logistic regression models with weekly measures nested within individuals.

RESULTS

Higher stress, poorer sleep quality and well-being increased the odds of a new injury in the subsequent week by 8% (2.0-13.5%), 10% (4.2-15.9%) and 8% (2.4-13.5%) per 1 unit increase. Higher stress, and poorer well-being increased the odds of illness by 8% (2.6-12.6%), and 12% (7.2-16.6%). ACWR below 0.8 or above 1.3 increased the odds of illness by 34% (4.9-70.8%).

CONCLUSIONS

Perceived stress, well-being, and sleep quality were associated with injury and illness occurrence in the subsequent week. ACWR outside the range 0.8-1.3 was associated with illness the subsequent week.

TRIAL REGISTRATION

Clinical Trials registration NCT03309904.

Association between Self-Reported Prior Night's Sleep and Single-Task Gait in Healthy, Young Adults: A Study Using Machine Learning

Failure to obtain the recommended 7−9 h of sleep has been associated with injuries in youth and adults. However, most research on the influence of prior night’s sleep and gait has been conducted on older adults and clinical populations. Therefore, the objective of this study was to identify individuals who experience partial sleep deprivation and/or sleep extension the prior night using single task gait. Participants (n = 123, age 24.3 ± 4.0 years; 65% female) agreed to participate in this study. Self-reported sleep duration of the night prior to testing was collected. Gait data was collected with inertial sensors during a 2 min walk test. Group differences (<7 h and >9 h, poor sleepers; 7−9 h, good sleepers) in gait characteristics were assessed using machine learning and a post-hoc ANCOVA. Results indicated a correlation (r = 0.79) between gait parameters and prior night’s sleep. The most accurate machine learning model was a Random Forest Classifier using the top 9 features, which had a mean accuracy of 65.03%. Our findings suggest that good sleepers had more asymmetrical gait patterns and were better at maintaining gait speed than poor sleepers. Further research with larger subject sizes is needed to develop more accurate machine learning models to identify prior night’s sleep using single-task gait.

Sleep and the Young Athlete

CONTEXT

Sleep plays a vital role in cognitive and physical performance. Teenage athletes (ages 13-19 years) are considered especially at risk for disordered sleep and associated negative cognitive, physical, and psychosomatic effects. However, there is a paucity of evidence-based recommendations to promote sleep quality and quantity in athletes who fall within this age range. We performed a review of the literature to reveal evidence-based findings and recommendations to help sports instructors, athletic trainers, physical therapists, physicians, and other team members caring for young athletes provide guidance on sleep optimization for peak sports performance and injury risk reduction.

METHODS

PubMed, Scopus, and Cochrane CENTRAL were searched on May 11, 2016, and then again on September 1, 2020, for relevant articles published to date.

STUDY DESIGN

Narrative review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Few studies exist on the effects disordered sleep may have on teenage athletes. By optimizing sleep patterns in young athletes during training and competitions, physical and mental performance, and overall well-being, may be optimized. Adequate sleep has been shown to improve the performance of athletes, although further studies are needed.

CONCLUSION

Twenty-five percent of total sleep time should be deep sleep, with a recommended sleep time of 8 to 9 hours for most young athletes. Screen and television use during athletes' bedtime should be minimized to improve sleep quality and quantity. For young athletes who travel, jet lag can be minimized by allowing 1 day per time zone crossed for adjustment, limiting caffeine intake, planning meals and onboard sleeping to coincide with destination schedules, timing arrivals in the morning whenever possible, and using noise-canceling headphones and eyeshades.

STRENGTH-OF-RECOMMENDATION TAXONOMY (SORT)

B.

Relationship Between Poor Sleep Quality and Injury Experience in Korea

To develop preventive policies to reduce injuries, the responsible factors should be identified. In this study, causative factors were identified by analyzing data from the Korean Community Health Survey. Logistic regression was used to analyze the data of 192 480 individuals in the survey. Correlations were found between the injury experience and the following socioeconomic factors: age, sex, monthly income, smoking status, education, marital status, and neuropsychiatric factors: depressive symptoms, cognitive decline, and stress. The study subjects were divided into two groups based on sleep quality, as determined by Pittsburgh Sleep Quality Indices of ≤5 or >5. Logistic regression analysis adjusted for potential confounders revealed a correlation between sleep quality and injury experience. The odds ratio (OR) of poor sleep quality was associated with higher odds of injury (OR: 1.26, 95% confidence interval [1.19, 1.34]), and it was also associated with higher odds of severe injury (OR: 1.23, 95% confidence interval [1.15, 1.32]), even in the adjustment of socioeconomic factors only as well as in the adjustment of socioeconomic and neuropsychiatric factors. Poor sleep quality was associated with higher odds of several injury mechanisms of severe injury, such as slipping, poisoning, and falling into water.

Youth athletes sleep more, practice less, and may lose interest in playing sports due to social distancing mandates

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62% were single sports athletes with >50% elementary and middle school aged.

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Specialization may contribute to psychological symptoms following routine alteration.

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Training hours per week decreased 3.3 h per week during the pandemic.

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Older participants, age 15–19 reported the least compliance with social distancing.

In-person sport participation was suspended across the United States in the spring of 2020 to slow the spread of the novel coronavirus (COVID-19). The purpose of this study was to survey the impact of COVID-19 on young athletes during a period of social and organized sports restrictions. An anonymous cross-sectional survey study was conducted of youth athletes in the midst of social distancing mandates and consisted of six components: demographics, sport participation, changes in sport-related goals/aspirations, sleep habits, and measures of anxiety and depression. 711 individuals who accessed the survey link yielded 575 (81%) participants with responses available for analysis. All respondents (aged 13.0 years) played organized sports, 62% were single-sport athletes, and 74% considered high-level. Participants were training ∼3.3 h less per week, spending more time outside, and 86% of participants continued to train while social distancing. Sleep duration increased (∼1.2 h/night) and sleep quality improved in 29% of young athletes. Additionally, 22% and 28% reported PROMIS® anxiety and depression scores characterized as ‘mild’, ‘moderate’, or ‘severe’. Older single-sport participants reported higher depression scores, while higher anxiety scores were seen in female participants with fewer years played. 10% of young athletes and 20% of teenagers changed their sports-related goals. Training style modifications, decreased training, and increased sleep quantity and quality were positive effects of COVID-19 restrictions, while athletic aspirational changes were undesirable effects. Single-sport athletes may be at greater risk for psychological symptoms when their routine is altered.

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

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.

Lack of Sleep Among Adolescent Athletes Is Associated With a Higher Prevalence of Self-Reported History of Anxiety and Depression

Purpose: To study mental health, sleep duration, and daytime sleepiness in young athletes. Methods: A cross-sectional questionnaire study was conducted. The main outcome measures included sleep duration and daytime sleepiness. Results: Study participants included 756 athletes with a mean age of 13.5 years. A total of 39% (n = 296/756) reported not meeting current sleep recommendations for age. Athletes >12 years and with a self-reported anxiety and/or depression history were less likely to meet sleep recommendations and showed higher daytime sleepiness (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] [1.2, 1.4], β [SE] = 3.06 [0.74], respectively). Athletes with goal-oriented reasons for playing versus enjoyment (52% vs. 35%, aOR = 1.70, 95% CI [1.12, 2.58]) were less likely to meet sleep recommendations. Night time internet access and weeknight homework hours were negatively associated with sleep recommendations (aOR = 1.68, 95% CI [1.68, 2.47] and aOR = 3.11, 95% CI [1.82, 5.3]) and positively associated with daytime sleepiness (β [SE] = 1.44 [0.45] and 2.28 [0.59]). Conclusions: Many young athletes are not meeting sleep recommendations. Associated factors include mental health, reasons for play, internet access, and homework demand.

A Contemporary Approach to Patellofemoral Pain in Runners

Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.

Special Considerations for Growing Dancers

Care of young dancers requires a unique approach during a critical time of growth and development. Young dancers' well-being depends on factors including sleep, mental health, growth-associated musculoskeletal imbalances, and nutrition. Puberty is a particularly important time for young dancers. It coincides with an increased commitment to their art form and physical/psychosocial changes. It is imperative for practitioners to understand these various factors in order to optimize young dancers' health and allow them to safely train and perform.

Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis

BACKGROUND

Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population.

METHODS

PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration).

RESULTS

The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69).

CONCLUSIONS

Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The relationship between depressive symptoms, somatic complaints, and concussion history with poor sleep in collegiate athletes

OBJECTIVE

Ongoing exploration of factors related to poor sleep in collegiate athletes is important as understanding of the risks and consequences of poor sleep in this specific population increases.

DESIGN

Retrospective cohort study.

SETTING

University in the Pacific Northwest.

PARTICIPANTS

One-hundred thirty-seven male and female collegiate athletes across 5 collision, contact, and limited contact team sports.

MEASUREMENTS

Depressive symptoms (Patient Health Questionnaire 9; PHQ-9), anxiety symptoms (General Anxiety Disorder 7; GAD-7), and somatic complaints (Patient Health Questionnaire 15; PHQ-15). Sleep quality (Pittsburgh Sleep Quality Index; PSQI) used both a cutoff score ≥6 and a cutoff score of ≥8, indicating "poor sleep quality" to reduce threats to divergent validity.

RESULTS

Poor sleep quality as defined by PSQI ≥ 6 was present in 53% of athletes, and as defined by PSQI ≥ 8 was identified in 33.5% of the cohort. There were no differences in the incidence of poor sleepers between sport, race/ethnicity, or sex. Multiple regression analysis revealed that depressive symptoms, somatic complaints, Caucasian race, male sex, and number of concussions were significant predictors of poor sleep (P < .05). The model accounted for 43% of the variance in PSQI and primarily by depressive symptoms explaining 9% of reported sleep quality variability. Anxiety symptoms, sport category, and history of migraines were not significant predictors of poor sleep quality.

CONCLUSIONS

A high incidence of poor sleep among collegiate athletes was observed regardless of sport, and may be related to depressive symptoms, somatic complaints, Caucasian race, male sex, and historical number of concussions.

Cognition and Alertness in Medical Students: Effects of a Single Night of Partial Sleep Deprivation

BACKGROUND

Partial sleep deprivation is common among young adults today. Though multiple studies have stressed on the benefits of having a good sleep, medical students often compromise their sleep due to academic targets and stress. This can lead to changes in attention and cognition. The effects of acute partial sleep deprivation of a single night have been studied less and studies in the past in Indian context have shown controversial results that reaction time is decreased following acute partial sleep deprivation.

PURPOSE

The purpose of the study was to evaluate the effects of a single night of partial sleep deprivation on the cognitive status and alertness of medical students in the Indian context and to find out the change in auditory event-related potential (AERP) and psychomotor vigilance of medical students following a single night of partial sleep deprivation.

METHODS

The study was a before-after experimental trial conducted among 20 medical student volunteers of a tertiary care hospital of eastern India. Baseline psychomotor vigilance task measured by unprepared serial reaction time, and AERP measured by P300, were assessed at baseline (after normal sleep) and after four hours of sleep deprivation (intervention).

RESULTS

It was seen that median RT had increased from 320.4 ms to 337.6 ms after acute partial sleep deprivation (P < .001). P300 and lapses (P < .05) were also found to increase significantly (P < .05), while there was significant decrease in correctness (P < .01).

CONCLUSION

The study concluded that cognition is affected, including alertness and latency, following partial sleep deprivation even for a single night and contradicted earlier results of Indian studies stating variable effect on psychomotor vigilance.