LACK OF SLEEP AMONG YOUTH ATHLETES IS ASSOCIATED WITH A HIGHER PREVALENCE OF SELF-REPORTED HISTORY OF ANXIETY AND DEPRESSION
Authors: Stracciolini Andrea , McCracken Caitlin M. , Milewski Matthew D. , Meehan Bill 
Published: March 2019

Background: The importance of sleep in children, and the relationship to mental and physical health, is under recognized. The physical and emotional demands of sports participation may contribute positively and negatively to sleep quality and quantity. Aim: To investigate sleep duration, daytime sleepiness, and mental health in youth athletes. Hypotheses: 1. The majority of youth athletes will not meet the current age based recommendations for sleep duration. 2. Athletes not meeting the current sleep recommendation will have an increased prevalence of anxiety/depression, and have greater daytime sleepiness scores. Study Design: Cross-sectional study Methods: Questionnaire data were analyzed from an injury prevention evaluation (IPE) at a sports injury prevention center affiliated with a tertiary level pediatric medical center between April 2013 and February 2018. Reason for playing was coded into thematic categories. Fun related responses include: to have fun, to make friends, to be part of a team, enjoyment/love etc. Goal oriented reasons include: to win a championship, college or scholarship purposes, to compete to control my weight, to be strong etc. BMI was adjusted by age and sex using ranges recommended by the Center for Disease Control. Anxiety and or depression is measured by a clinician diagnoses but was self-reported by the participant. Homework was measured as total hours spent during weeknights and was measured by categories in three hour units; each category composed approximately 25% of participants. Main outcome measures included sleep duration, scores on daytime sleepiness scale, self-reported anxiety and, self-reported depression. Age, sex, BMI, reasons for playing sports (fun related versus goal oriented), hours of homework per week, and internet access were also analyzed. Results: 756 athletes, =18 years old (mean age 13.5±2.5 yrs.) were included; 56% (N=426) were female. Overall 39% (N= 296) of athletes were not getting the age recommended amount of sleep. Among athletes 6-12 years old, 26% were not meeting the sleep recommendation for age, compared to 45% of 13-18-year-old athletes (p<0.01). Female athletes (44% vs. 33%, p<0.01) and athletes with either depression and/or anxiety (62% vs. 37%, p<0.01) were less likely to meet sleep recommendations. Athletes also appeared less likely to meet the current sleep recommendation if they reported a prior sport-related injury (44% vs. 37%, p=0.05), goal-oriented reasons for playing sports (52% vs. 35%, p<0.01), night time internet access (51% vs. 28%, p<0.01), and as number of weeknight homework hours increase (0-3 hours (22%) compared to 11+ hours (64%); p<0.01). After adjusting for age, gender, injury history, nighttime internet access, and hours of homework per week, the odds of not meeting the recommended amount of sleep increased with age (OR=1.29, 95% CI, 1.2 -1.4, p<0.01). Athletes reporting past diagnoses of anxiety and/or depression had higher odds of not meeting the sleep recommendation (OR 1.92, CI 1.0 – 3.6, p<0.05) and increased daytime sleepiness (ß=2.83, 95% SE 0.7, p<0.01). Goal driven athletes had 1.63 the odds of not meeting the sleep recommendation (CI 1.1-2.4, p<0.05), but were not significantly different from their counterparts with regards to daytime sleepiness scale scores. When stratified by age group, the odds of not meeting the recommended amount of sleep increased among older athletes (OR=1.29, 95% CI, 1.2 -1.4, p<0.01). Middle-school athletes with a self reported history of anxiety and/or depression had a greater likelihood of not meeting the sleep recommendation (OR = 4.49,95% CI, 1.2 – 18.1, p<0.05) and also had higher daytime sleepiness scores (OR=3.19, 95% SE, 1.5, p<0.05). Only daytime sleepiness increased among high school aged athletes with anxiety/depression (ß=3.0, 95% SE, 0.8, p<0.01) Conclusions: Female athletes, those who play sports for goal-oriented reasons, and those with a history of anxiety/depression are at increased risk of not meeting current sleep recommendations. Among middle school aged athletes, self reported history of anxiety and or depression has an even larger impact on sleep.