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Lack of Sleep and Sports Injuries in Adolescents

A Systematic Review and Meta-analysis

Gao, Burke, BS*; Dwivedi, Shashank, MD*; Milewski, Matthew D., MD; Cruz, Aristides I. Jr, MD, MBA

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p e324–e333
doi: 10.1097/BPO.0000000000001306
Sports Medicine

Background: Although sleep has been identified as an important modifiable risk factor for injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. The objective of this study was to quantitatively and qualitatively review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep.

Methods: PubMed (includes MEDLINE) and EMBASE databases were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported statistics regarding the relationship between sleep and sports injury in adolescents aged 19 years or younger published between January 1, 1997 and December 21, 2017. From these included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. A random effects model was then created to quantify the odds of injury with decreased sleep in adolescents.

Results: Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive association between acutely poor sleep and injury, whereas the other study reported no significant association. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR, 1.58; 95% CI, 1.05-2.37; P=0.03).

Conclusions: Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates.

Level of Evidence: Level IV—systematic review of level II studies and one level IV study.

*Warren Alpert Medical School of Brown University

Department of Orthopaedic Surgery, Hasbro Children’s Hospital, Providence, RI

Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA

A.I.C.: is a member of the POSNA (Pediatric Orthopaedic Society of North America) Advocacy Committee and QSVI Sports Committee. M.M.: receives editorial royalties from Elsevier Inc and is a member of POSNA’s Evidence-based Medicine Committee; a committee co-chair for the PRISM (Pediatric Research in Sports Medicine) Society; and a member of the Research on Osteochondritis Dissecans of the Knee (ROCK) research group. Vericel Inc and Allosource Inc provide unrestricted research support for the ROCK research group. The remaining authors declare that they have nothing to disclose. No funding sources supported this project.

Reprints: Aristides I. Cruz Jr, MD, MBA, 2 Dudley Street, Ste. 200, Providence, RI 02905. E-mail:

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