CHRONIC LACK OF SLEEP IS ASSOCIATED WITH INCREASED SPORTS INJURY IN ADOLESCENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Burke Gao; Shashank Dwivedi; Matthew D. Milewski; Aristides I. Cruz

摘要

Background: Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. Purpose: To systematically 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 and EMBASE databases were systematically searched for studies reporting statistics regarding the relationship between sleep and sports injury in adolescents aged &19 years published between 1/1/1997 and 12/21/2017. From 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. Additionally, a NOS (Newcastle-Ottawa Scale) assessment and an evaluation of the OCEM (Oxford Center for Evidence-Based Medicine) level of evidence for each study was conducted to assess each study’s individual risk of bias, and the risk of bias across all studies. 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 correlation between acutely poor sleep and injury, while the other study reported no significant correlation. 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 to 2.37, p = 0.03). OCEM criteria assessment showed that all but one study (a case-series) were of 2b level of evidence—which is the highest level of evidence possible for studies which were not randomized control trials or systematic reviews. NOS assessment was conducted for all six cohort studies to investigate each study’s individual risk of bias. Five out of six of these studies received between 4 to 6 stars, categorizing them as having a moderate risk of bias. One study received 7 stars, categorizing it as having a low risk of bias. NOS assessment revealed that the most consistent source of bias was in ascertainment of exposure: all studies relied on self-reported data regarding sleep hours rather than a medical or lab record of sleep hours. 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. Our results thus suggest that adolescents who either chronically sleep less than 8 hours per night, or have frequent night time awakenings, are more likely to experience sports or musculoskeletal injuries. Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram Figure 2. Random Effects Model Pooling the Following Studies: Von Rosen et al. ~(17), Picavet et al. ~(19), Kim et al. ~(20) Table 1. Study Characteristics, by publication year Study Year Mean age (range), years Questionnaire Timing No. of Patient Respondents No. of Females Patient Population Sport/Activity von Rosen et al. ~(17) 2017 17.1 (16-19) 1 questionnaire during “autumn semester” & 1 questionnaire during “spring semester” 340 162 “Swedish adolescent elite athletes” from 21 “National Sports High Schools”; “To attend the National Sports High Schools, the adolescent athletes must exhibit high national performance achievement and practice at the highest national level for their age group” “Athletics, cross-country skiing, orienteering, handball, downhill skiing, ski orienteering, and freestyle skiing” von Rosen et al. ~(18) 2017 17 (15-19) Questionnaires weekly or bi-weekly (depending on sport) for 52 weeks 496* 226* “Swedish adolescent elite athletes” from 24 “National Sports High Schools” Sports reporting weekly questionnaires: Skiing, Orienteering, Handball, and Athletics. Sports reporting bi-weekly questionnaires: Water ski, Canoe, Rowing, Wrestling, Bowling, Triathlon, Golf, Cycling, and American football. Watson et al. ~(12) 2016 15.5 (+/-1.6)^ Questionnaires given daily for 20 weeks (length of 1 soccer season) 75 75 “female youth soccer athletes” Soccer Picavet et al. ~(19) 2016 (11-14)^^ Questionnaire given once at age 11 and again at age 14 2517 1251 Children & adolescents in the Netherlands -- Kim et al. ~(20) 2015 14.50/14.81 (12-18)^^^ Unspecified 17232 Unspecified Korean adolescents from 7th through 12 ~(th) grades Bicycle riding Milewski et al. ~(4) 2014 15 (12-18) One time questionnaire 112 58 United States adolescent athletes in high school or middle school Unspecified Luke et al. ~(15) 2011 13.8 (6-18) One time questionnaire given during sports medicine clinic visit 360 Unspecified Patients visiting university-based sports medicine clinics in the US & Canada Football, basketball,

机译：背景：尽管已将睡眠确定为运动损伤的重要可改变危险因素，但睡眠不足对青少年运动损伤的影响研究却很少。目的：系统地回顾已发表的文献，以检查青少年睡眠不足是否与运动损伤有关，并描述慢性睡眠不足与急性睡眠不足的关系。方法：系统地搜索PubMed和EMBASE数据库，以研究报告发表于1/1/1997至12/21/2017之间的19岁以下青少年睡眠与运动损伤之间关系的统计数据。从纳入的研究中，提取了以下信息：书目和人口统计学信息，与伤害和睡眠有关的已报告结局，以及伤害和睡眠减少的定义。此外，针对每项研究进行了NOS（纽卡斯尔-渥太华量表）评估和OCEM（牛津循证医学中心）证据水平评估，以评估每项研究的个体偏倚风险以及所有偏倚风险学习。结果：在907篇鉴定文章中，有7篇符合纳入标准。五项研究报告说，长期睡眠不佳的青少年遭受运动或肌肉骨骼损伤的可能性大大增加。两项研究报告了急性睡眠行为。一项报告严重睡眠不良与伤害之间存在显着正相关，而另一项研究则报告无显着相关。在我们的随机效应模型中，长期睡眠质量较差的青少年比睡眠质量良好的青少年受伤害的可能性更大（OR 1.58，95％CI 1.05至2.37，p = 0.03）。 OCEM标准评估显示，除一项研究（一个病例系列）外，所有研究的证据水平均为2b级，这是非随机对照试验或系统评价未进行研究的最高证据水平。对所有六项队列研究均进行了NOS评估，以调查每项研究的个体偏倚风险。这些研究中，有五分之二获得了4到6颗星，将它们归类为具有中等偏见的风险。一项研究获得了7颗星，被归类为偏见风险低。 NOS评估显示，偏差的最一致来源是确定接触量：所有研究均依赖于有关睡眠时间的自我报告数据，而不是医学或实验室记录的睡眠时间。结论：青少年长期缺乏睡眠与运动和肌肉骨骼损伤的风险较高有关。目前的证据还不能确切确定急性睡眠不足对受伤率的影响。因此，我们的结果表明，长期每晚睡眠少于8小时或经常夜间醒来的青少年更有可能遭受运动或肌肉骨骼伤害。图1.系统评价和元分析（PRISMA）流程图的首选报告项目。图2.汇总以下研究的随机效应模型：Von Rosen等。〜（17），Picavet等。〜（19），Kim等。〜（20）表1.按出版年份划分的研究特征研究年份平均年龄（范围），年份问卷时间病人被访者人数女性病人人口运动/活动von Rosen等。〜（17）2017 17.1（16-19）1个“秋季学期”问卷和1个“春季学期”问卷340162来自21个“国家体育高中”的“瑞典青少年精英运动员”; “要进入国家体育高中，青少年运动员必须在同龄人中表现出很高的国家水平成就和最高水平的国家实践”。“田径，越野滑雪，定向越野，手球，速降滑雪，定向越野和自由式滑雪”冯·罗森（von Rosen）等人。〜（18）2017 17（15-19）每周或每两周问卷调查一次（取决于运动），为期52周496 * 226 *来自24个“国家体育高中”的“瑞典青少年精英运动员”体育报告每周调查表：滑雪，定向运动，手球和田径运动。体育每两周提交一次调查问卷：滑水，独木舟，赛艇，摔跤，保龄球，铁人三项，高尔夫，自行车和美式足球。沃森等。〜（12）2016 15.5（+/- 1.6）^每天接受问卷调查，持续20周（1个足球赛季的时长）75 75“女青年足球运动员” Soccer Picavet等。〜（19）2016（11-14）^^ 11岁时接受问卷调查，14岁时再次接受问卷调查2517 1251荷兰的儿童和青少年-Kim等。〜（20）2015 14.50 / 14.81（12-18）^^^未指定17232从未指定的7至12年级青少年韩国骑自行车Milewski等。〜（4）2014 15（12-18）一次性调查表112 58美国高中或中学的青少年运动员未指定Luke等。〜（15）2011 13.8（6-18）在运动医学诊所就诊期间进行的一次问卷调查360名未指定患者在美国和加拿大的大学运动医学诊所就诊，足球，篮球，

CHRONIC LACK OF SLEEP IS ASSOCIATED WITH INCREASED SPORTS INJURY IN ADOLESCENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

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