Sleep quantity and quality as potentially modifiable factors associated with musculoskeletal injury risk in athletes: a narrative review

Abstract

  Background. Sleep is increasingly seen as a potentially modifiable factor in athlete health, but its link to injury risk is not well established across ages and sports. Aim. To summarize evidence on sleep quantity and quality as potential risk factors for musculoskeletal injury in athletes and identify areas of consistency and uncertainty. Material and methods. A narrative review was conducted, based on a structured but incompletely documented PubMed search supplemented by Consensus-assisted literature identification and informed by SANRA. Results. In adolescents, cross-sectional and prospective studies, with a broader review of adolescent sleep and injury literature, reported associations between short or poor sleep and injury risk, with some overlap in cohorts and non-athlete populations. In adults, evidence is heterogeneous, and findings from self-reported and actigraphy-based sleep measures have not been uniform; a systematic review did not confirm sleep as an independent risk factor. Sex, sport, and training load may relate to differences in risk, although evidence of effect modification remains unconfirmed. Conclusions. Short sleep, and less consistently poor sleep quality, are associated with injury risk, particularly in adolescents, and may represent potentially modifiable factors; however, causality and preventive efficacy have not been established, and evidence in adults remains inconsistent. Prospective studies using reproducible methods are needed.