CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(03): 305-311
DOI: 10.5935/1984-0063.20220055

The sleep as a predictor of musculoskeletal injuries in adolescent athletes

Fernanda Viegas
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
Juliana Melo Ocarino
2   Universidade Federal de Minas Gerais, Physiotherapy Department - Belo Horizonte - Minas Gerais - Brazil
Luísa de Sousa Freitas
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
Marina Costa Pinto
2   Universidade Federal de Minas Gerais, Physiotherapy Department - Belo Horizonte - Minas Gerais - Brazil
Lucas Alves Facundo
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
Adriana Souza Amaral
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
Samuel Silva
2   Universidade Federal de Minas Gerais, Physiotherapy Department - Belo Horizonte - Minas Gerais - Brazil
Marco Túlio de Mello
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
1   Universidade Federal de Minas Gerais, Sports Department - Belo Horizonte - Minas Gerais - Brazil
› Institutsangaben

Objectives Sleep is essential for musculoskeletal and cognitive recovery. Adolescent athletes tend to sleep poorly compared to adults and it may predispose them to sports injuries. Our aims are to estimate whether the quantity/quality of sleep are associated with sports injuries in adolescent athletes and to compare the quantity/quality of sleep between the training and competition seasons, and the school vacation period.

Material and Methods It was a cohort study with 19 track and field athletes of both sexes, aged between 12 and 21 years. We evaluated their sleep-wake habit through actigraphy during three phases: 1 - mid-season, 2 - competition, and 3 - school vacation. The previous six months injury history and the occurrence of injuries in a six-month follow-up were recorded. Logistic regression and variance analysis were performed. The significance level used was 0.05.

Results Wake after sleep onset (WASO) predicted previous injuries (OR=1.144) and time awake (TA) predicted injury occurrence (OR=0.974). TA decreased from phase 2 to phase 3 (p=0.004), total sleep time (TST) increased from phase 2 to phase 3 (p=0.012), and WASO decreased between phases 1 and 2 (p=0.001) and between phases 1 and 3 (p=0.025).

Conclusion Our study demonstrated that the quantity and quality of sleep were associated with musculoskeletal injuries in adolescent track and field athletes. Previous injuries were predicted by WASO and the occurrence of injuries was predicted by TA. Furthermore, during the vacation period they had lower TA and WASO, and higher TST than on school days.


Eingereicht: 22. September 2021

Angenommen: 10. Januar 2022

Artikel online veröffentlicht:
01. Dezember 2023

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  • 1 Fullagar HHK, Duffield R, Skorski S, White D, Bloomfield J, Kölling S, et al. Sleep, travel, and recovery responses of national footballers during and after long-haul international air travel. Int J Sports Physiol Perform. 2016;11(1):86-95. DOI:
  • 2 Ohayon M, Wickwire EM, Hirshkowitz M, Albert SM, Avidan A, Daly FJ, et al. National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health. 2017 Feb;3(1):6-19. DOI: https://doi. org/10.1016/j.sleh.2016.11.006
  • 3 Halson SL. Nutrition, sleep and recovery. Eur J Sport Sci. 2008;8(2):119-26. DOI:
  • 4 Dattilo M, Antunes HKM, Medeiros A, Mônico Neto M, Souza HS, Tufik S, Mello MT. Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis. Med Hypotheses. 2011 Aug;77(2):220-2. DOI:
  • 5 O’Donnell S, Bird S, Jacobson G, Driller M. Sleep and stress hormone responses to training and competition in elite female athletes. Eur J Sport Sci. 2018 Feb;18(5):611-8. DOI:
  • 6 Kivlighan KT, Granger DA. Salivary alpha-amylase response to competition: relation to gender, previous experience, and attitudes. Psychoneuroendocrinology. 2006 Jul;31(6):703-14. DOI: https://doi. org/10.1016/j.psyneuen.2006.01.007
  • 7 Veale JP, Pearce AJ. Physiological responses of elite junior Australian rules footballers during match-play. J Sports Sci Med. 2009 Sep;8(3):314-9.
  • 8 Hainline B, Derman W, Vernec A, Budgett R, Deie M, Vorak J, et al. International Olympic committee consensus statement on pain management in elite athletes. Br J Sports Med. 2017;51(17):1245-58. DOI:
  • 9 Juliff LE, Halson SL, Peiffer JJ. Understanding sleep disturbance in athletes prior to important competitions. J Sci Med Sport. 2015 Jan;18(1):13-8. DOI:
  • 10 Mônico-Neto M, Dáttilo M, Ribeiro DA, Lee KS, Mello MT, Tufik S, et al. REM sleep deprivation impairs muscle regeneration in rats. Growth Factors. 2017 Apr;35(1):12-8. DOI:
  • 11 Reilly T, Edwards B. Altered sleep-wake cycles and physical performance in athletes. Physiol Behav. 2007 Feb;90(2-3):274-84. DOI: https://doi. org/10.1016/j.physbeh.2006.09.017
  • 12 Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016a;12(6):785-6. DOI: jcsm.5866
  • 13 Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Consensus Statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med. 2016b;12(11):1549-61. DOI: https://
  • 14 Copenhaver EA, Diamond AB. The value of sleep on athletic performance, injury, and recovery in the young athlete. Pediatr Ann. 2017 Feb;46(3):106-11. DOI:
  • 15 Segura-Jimenez V, Carbonell-Baeza A, Keating XD, Ruiz JR, Castro- Pinero J. Association of sleep patterns with psychological positive health and health complaints in children and adolescents. Qual Life Res. 2015;24:885-95. DOI:
  • 16 Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117-29. DOI: https://doi. org/10.1055/s-2005-867080
  • 17 Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Tishya W, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014 Mar;34(2):129-33. DOI:
  • 18 Andrade MM, Benedito-Silva AA, Domenice S, Arnhold IJ, Menna- Barreto L. Sleep characteristics of adolescents: a longitudinal study. J Adolesc Health. 1993 Jul;14(5):401-6. DOI: S1054-139X(08)80016-X
  • 19 Roenneberg T, Kuehnie T, Pramstaller PP, Ricken J, Havel M, Guth A, et al. A marker for the end of adolescence. Curr Biol. 2004 Dec;29(14):R1038-R9. DOI:
  • 20 Louzada FM, Pereira SIR. Adolescents’ sleep/wake patterns and school schedules: towards flexibility. Biol Rhythm Res. 2018 Jun;50(1):78-84. DOI:
  • 21 Taylor L, Chrismas BCR, Dascombe B, Chamari K, Fowler PM. The importance of monitoring sleep within adolescent athletes: athletic, academic, and health considerations. Front Physiol. 2016;7:101. DOI:
  • 22 Patel AR, Hsu A, Perez IA, Wren TAL, Edison BR. Assessing the effects of sleep on neurocognitive performance and injury rate in adolescent athletes using actigraphy. Res Sports Med. 2020 Jan;28(4):498-506. DOI:
  • 23 Silva A, Narciso FV, Soalheiro I, Viegas F, Freitas LSN, Lima A, et al. Poor sleep quality’s association with soccer injuries: preliminary data. Int J Sports Physiol Perform. 2019;15(5):671-6. DOI: https://doi. org/10.1123/ijspp.2019-0185
  • 24 Natale V, Plazzi G, Martoni M. Actigraphy in the assessment of insomnia: a quantitative approach. Sleep. 2009 Jun;32(6):767-71. DOI: https://doi. org/10.1093/sleep/32.6.767
  • 25 Roberts SSH, Teo WP, Warmington SA. Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2018;53(8):1-11. DOI: http://dx.doi. org/10.1136/bjsports-2018-099322
  • 26 Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med. 2006 Mar;40(3):193-
  • 201
  • 27 Von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017;27(11):1364-71. DOI:
  • 28 Bittencourt NFN, Meeuwisse WH, Mendonça LD, Nettel-Aguirre A, Ocarino JM, Fonseca ST. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition – narrative review and new concept. Br J Sports Med. 2016;50:1309-14. DOI:
  • 29 Sargent C, Lastella M, Halson SL, Roach GD. The impact of training schedules on the sleep and fatigue of elite athletes. Chronobiol Int. 2014 Sep;32(10):1160-8. DOI:
  • 30 Gradisar M, Gardner G, Dohnt H. Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep. Sleep Med. 2011 Feb;12(2):110-8. DOI: https://doi. org/10.1016/j.sleep.2010.11.008
  • 31 Nedelec M, Aloulou A, Duforez F, Meyer T, Dupont G. The variability of sleep among elite athletes. Sports Med Open. 2018 Jul;4(34):1-13. DOI:
  • 32 Owens JA, Dearth-Wesley T, Lewin D, Gioia G, Whitaker RC. Self-regulation and sleep duration, sleepiness, and chronotype in adolescents. Pediatrics. 2016 Dec;138(6):e20163157. DOI: https://doi. org/10.1542/peds.2016-1406
  • 33 Bernardo MPSL, Pereira EF, Louzada FM, D’Almeida V. Duração do sono em adolescentes de diferentes níveis socioeconômicos. J Bras Psiquiatr. 2009;58(4):231-7. DOI:
  • 34 George NM, Davis JE. Assessing sleep in adolescents through a better understanding of sleep physiology. Am J Nurs. 2013 Jun;113(6):26-31. DOI:
  • 35 Burke TM, Lisman PJ, Maguire K, Skeiky L, Choynowski JJ, Capaldi VF, et al. Examination of Sleep and injury among college football athletes. The J Strength Cond Res. 2019 Mar;34(3):609-16. DOI: http://doi. org/10.1519/JSC.20220055202200553464
  • 36 Thorleifsdottir B, Björnsson JK, Benediktsdottir B, Gislason T, Kristbjarnarson H. Sleep and sleep habits from childhood to young adulthood over a 10-year period. J Psychosom Res. 2002 Jul;53(1):529-37. DOI:
  • 37 Mello L, Louzada F, Menna-Barreto L. Effects of school schedule transition on sleep-wake cycle of Brazilian adolescents. Sleep Hypn. 2001 Jan;3(3):106-11.
  • 38 Kansagra SM. Adolescent chronotype and self-regulation: the power of when. Pediatrics. 2016;138(6):e20163157. DOI: peds.2016-3157
  • 39 McKnight-Eily LR, Eaton DK, Lowry R, Croft JB, Presley-Cantrell L, Perry GS. Relationships between hours of sleep and health-risk behaviors in US adolescent students. Prev Med. 2011 Oct/Dec;53(4-5):271-3. DOI:
  • 40 Felden EPG, Filipin D, Barbosa DG, Andrade RD, Meyer C, Louzada FM. Factors associated with short sleep duration in adolescents. Rev Paul Pediatr. 2016 Mar;34(1):64-70. DOI: rppede.2015.10.007
  • 41 Fullagar HHK, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med. 2015;45:161-86. DOI:
  • 42 Roberts RE, Roberts CRR, Duong HT. Sleepless in adolescence: prospective data on sleep deprivation, health and functioning. J Adolesc. 2009 Apr;32(5):1045-57. DOI: adolescence.2009.03.007
  • 43 Sousa IC, Louzada FM, Azevedo CVM. Sleep-wake cycle irregularity and daytime sleepiness in adolescents on school days and on vacation days. Sleep Sci. 2009;2(1):30-5.