Sleep quantity and quality as potentially modifiable factors associated with musculoskeletal injury risk in athletes: a narrative review
DOI:
https://doi.org/10.12775/QS.2026.72.74894Keywords
Sleep, Sleep Duration, Sleep Quality, Athletes, Athletic Injuries, Musculoskeletal Injuries, Injury Prevention, AdolescentAbstract
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.
References
1. Walsh NP, Halson SL, Sargent C, Roach GD, Nédélec M, Gupta L, Leeder J, Fullagar HH, Coutts AJ, Edwards BJ, Pullinger SA, Robertson CM, Burniston JG, Lastella M, Le Meur Y, Hausswirth C, Bender AM, Grandner MA, Samuels CH. Sleep and the athlete: narrative review and 2021 expert consensus recommendations. Br J Sports Med. 2021;55(7):356-368. https://doi.org/10.1136/bjsports-2020-102025
2. Charest J, Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin. 2020;15(1):41-57. https://doi.org/10.1016/j.jsmc.2019.11.005
3. Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports. 2017;27(3):266-274. https://doi.org/10.1111/sms.12703
4. de Sousa Nogueira Freitas L, Rodrigues da Silva FR, de Araújo Andrade H, Guerreiro RC, Viegas Paulo FV, de Mello MT, Silva A. Sleep debt induces skeletal muscle injuries in athletes: A promising hypothesis. Med Hypotheses. 2020;142:109836. https://doi.org/10.1016/j.mehy.2020.109836
5. Kaczmarek F, Bartkowiak-Wieczorek J, Matecka M, Jenczylik K, Brzezińska K, Gajniak P, Marchwiak S, Kaczmarek K, Nowak M, Kmiecik M, Stężycka J, Krupa KK, Mądry E. Sleep and Athletic Performance: A Multidimensional Review of Physiological and Molecular Mechanisms. J Clin Med. 2025;14(21):7606. https://doi.org/10.3390/jcm14217606
6. Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TA, Barzdukas A. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. https://doi.org/10.1097/BPO.0000000000000151
7. Gao B, Dwivedi S, Milewski MD, Cruz AI Jr. Lack of Sleep and Sports Injuries in Adolescents: A Systematic Review and Meta-analysis. J Pediatr Orthop. 2019;39(5):e324-e333. https://doi.org/10.1097/BPO.0000000000001306
8. 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):1364-1371. https://doi.org/10.1111/sms.12735
9. Dobrosielski DA, Sweeney L, Lisman PJ. The Association Between Poor Sleep and the Incidence of Sport and Physical Training-Related Injuries in Adult Athletic Populations: A Systematic Review. Sports Med. 2021;51(4):777-793. https://doi.org/10.1007/s40279-020-01416-3
10. Dennis J, Dawson B, Heasman J, Rogalski B, Robey E. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2016;19(2):113-116. https://doi.org/10.1016/j.jsams.2015.02.003
11. Haraldsdottir K, Sanfilippo J, McKay L, Watson AM. Decreased Sleep and Subjective Well-being as Independent Predictors of Injury in Female Collegiate Volleyball Players. Orthop J Sports Med. 2021;9(9):23259671211029285. https://doi.org/10.1177/23259671211029285
12. Silva A, Narciso FV, Soalheiro I, Viegas F, Freitas LSN, Lima A, Leite BA, Aleixo HC, Duffield R, de Mello MT. Poor Sleep Quality's Association With Soccer Injuries: Preliminary Data. Int J Sports Physiol Perform. 2020;15(5):671-676. https://doi.org/10.1123/ijspp.2019-0185
13. Johnston R, Cahalan R, Bonnett L, Maguire M, Glasgow P, Madigan S, O'Sullivan K, Comyns T. General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study. J Sci Med Sport. 2020;23(3):252-257. https://doi.org/10.1016/j.jsams.2019.10.013
14. Messman BA, Petrie KA, Moore EWG, Petrie TA. Sleep Disturbances and Risk of Sports Injury Among Collegiate Student-Athletes. Clin J Sport Med. 2025;35(5):e54-e60. https://doi.org/10.1097/JSM.0000000000001278
15. Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C, Sall J. The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2020;172(5):325-336. https://doi.org/10.7326/M19-3575
16. Foulis SA, Proctor SP, Spiering BA, Walker LA, Aaron KG, Castellani CM, Hussian IM, Heaton KJ, Bouxsein ML, Gaffney-Stomberg E, Fraley AL, Popp KL, Davis IS, Staab JS, Staab JE, Judkins JL, Merkle SL, Ritland BM, Matheny RW Jr, Hauret KG, Canham-Chervak M, McClung JP, Jones BH, Friedl KE, Hughes JM, Taylor KM; ARIEM Reduction in Musculoskeletal Injury (ARMI) Study Team. Model for Musculoskeletal Injury Risk Factors Among US Army Basic Combat Trainees. JAMA Netw Open. 2025;8(6):e2513177. https://doi.org/10.1001/jamanetworkopen.2025.13177
17. Lisman P, Ritland BM, Burke TM, Sweeney L, Dobrosielski DA. The Association Between Sleep and Musculoskeletal Injuries in Military Personnel: A Systematic Review. Mil Med. 2022;187(11-12):1318-1329. https://doi.org/10.1093/milmed/usac118
18. Wickwire EM, Capaldi VF, Herrin J, Stryckman B, Thomas C, Williams SG, Werner JK, Funk W, Nassif TH, Albrecht JS. Burden of Insomnia Disorder Among US Active-Duty Military Personnel. Neurology. 2025;105(9):e214106. https://doi.org/10.1212/WNL.0000000000214106
19. Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. https://doi.org/10.1186/s41073-019-0064-8
20. von Rosen P, Frohm A, Kottorp A, Fridén C, Heijne A. Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective. Scand J Med Sci Sports. 2017;27(12):2059-2069. https://doi.org/10.1111/sms.12855
21. Abrahamson J, Sandstedt E, Sansone M, Lindman I. Female sex, training volume and sleep amount are risk factors for sports-related injuries: a 1-year prospective cohort study on adolescent elite athletes. BMJ Open Sport Exerc Med. 2025;11(4):e002699. https://doi.org/10.1136/bmjsem-2025-002699
22. Lytle C, Krishnan P, Saraf SM, Mulcahey MK. Association between sports injuries and sleep as measured by sleep actigraphy: a scoping review. Phys Sportsmed. 2026;54(3):173-179. https://doi.org/10.1080/00913847.2026.2626259
23. Klyne DM, Hall M, Smith SS, Barbe MF, Egorova-Brumley N, Serafimovska A, Hodges PW, Suraev A. Understanding the relationship between sleep, psychological and musculoskeletal health from a neuroimmune perspective. Musculoskelet Sci Pract. 2026;82:103509. https://doi.org/10.1016/j.msksp.2026.103509
24. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med. 2018;48(3):683-703. https://doi.org/10.1007/s40279-017-0832-x
25. Cunha LA, Costa JA, Marques EA, Brito J, Lastella M, Figueiredo P. The Impact of Sleep Interventions on Athletic Performance: A Systematic Review. Sports Med Open. 2023;9(1):58. https://doi.org/10.1186/s40798-023-00599-z
26. Haskell B, Eiler A, Essien H. Sleep Quality and Cognitive Skills Impact Neurocognitive Function and Reduce Sports-Related Injury Risk. Arthrosc Sports Med Rehabil. 2025;7(2):101077. https://doi.org/10.1016/j.asmr.2025.101077
27. Lindman I, Ryman Augustsson S, Baranto A, Sansone M, Abrahamson J. Prospective cohort study identifying risk factors for sports injuries in adolescent athletes: the Healthy Injury-Free Adolescent Athletes (HIFAA) study. BMJ Open Sport Exerc Med. 2024;10(3):e002253. https://doi.org/10.1136/bmjsem-2024-002253
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Paweł Klimas, Małgorzata Witaszczyk , Alicja Sołtan, Natalia Wiktorzak, Julia Lipska, Jagoda Prządka, Dominika Kochan-Olszewska, Longin Rudnicki, Jakub Pawlicki, Gracjan Koźma, Justyna Laskus, Bartosz Gawior, Olga Stasiak, Marta Borkowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 7
Number of citations: 0
