Adverse childhood experiences associated with sleep health in collegiate athletes.

BACKGROUND: The relationship between adverse childhood experiences and sleep disturbances in collegiate athletes was examined. METHODS: A questionnaire was completed by 189 National Collegiate Athletic Association (NCAA) Division-I male (n = 102) and female (n = 87) student-athletes recruited by flyers on one campus. Variables included adverse childhood experiences (self-reported), insomnia (Insomnia Severity Index), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Fatigue Severity Scale), and sleep duration (self-reported). In relation to these variables, eight adverse childhood experience categories were examined. Linear regression adjusted for the effects of age and sex. Adverse childhood experience variables were explored as independent variables in separate and combined models. RESULTS: We found a statistically significant dose-response relationship between adverse childhood experience score and increased insomnia levels, poor sleep quality and decreased sleep duration (p < .05). Physical abuse was associated with increased fatigue (B=9.55, p = .017) and decreased sleep duration (B=-61.1, p = .017). Emotional neglect was associated with increased insomnia (B=5.82, p < .0005), decreased sleep quality (B=3.55, p = .001), fatigue (B=8.68, p = .013), and decreased sleep duration (B=-86.22, p < .0005). When adjusted for other adverse childhood experience categories, emotional neglect had the strongest association with sleep outcomes, independently associated with insomnia (B=5.19, p = .003), sleep quality (B=2.95, p = .008), and sleep duration (B=-76.6, p = .001). CONCLUSIONS: We found a significant relationship between adverse childhood experiences and adverse sleep outcomes in this sample of collegiate athletes.

Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model.

Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.

Chronotype and social support among student athletes: impact on depressive symptoms.

Previous studies have shown individuals with evening chronotype to have a greater likelihood for depression (self-reported and clinical ratings), especially in young adults. However, the mechanisms for this relationship remain unknown. Low levels of social support may be a plausible mechanism: young adults with evening chronotypes are awake when others are sleeping, which may lead to feelings of isolation or low support. This study examined links between chronotype, depression, and social support in relationship subtypes within a group of university student athletes. Data were obtained from 189 NCAA Division-I student athletes across all sports. Chronotype was assessed with the Circadian Energy Scale and ranged from -2 (definitely morning type) to +2 (definitely evening type). Depressive symptoms were assessed with Center for Epidemiological Studies Depression scale. Social support was assessed with the Multidimensional Scale of Perceived Social Support, which included subscales for Family, Friends, and Significant Other. A subscale for Team was created using the items from the Friends subscale (changing the word "friends" to "teammates"). Regression analyses adjusted for age, sex, and minority status. More evening chronotype was associated with higher reported depressive symptoms (p = .018), lower overall perceived social support (p = .001), and lower perceived social support specifically provided by family (p < .0001), friends (p < .0001), and teammates (p = .014). However, more evening chronotype was associated with higher depressive symptoms for higher, but not lower perceived social support from significant other. Moreover, chronotype-by-support interactions on depressive symptoms were observed; the statistical relationship between chronotype and depression was evident only in those with low (but not high) social support from friends and teammates. These data suggest that having a more evening chronotype may be associated with social isolation, and decreased opportunities for interactions with friends and teammates. This may contribute to the long-standing circadian association seen with depression in college student-athletes. Interventions aimed at increasing university support networks may reduce the impact of depression in students self-identifying with later chronotypes and sleep schedules.

Sleep problems are associated with academic performance in a national sample of collegiate athletes.

OBJECTIVE: Examine associations between a range of sleep problems and academic performance in a national sample of collegiate athletes. Participants: Data were obtained from the National College Health Assessment of US college/university students from 2011-2014 (N = 8,312 collegiate athletes). Methods: Univariate comparisons for all sleep variables and demographics were stratified across GPA, using one-way ANOVA for continuous variables and chi-square for categorical variables. Multinomial logistic regression models, with GPA as outcome (reference = A) and sleep variable as predictor, were examined and adjusted for age, sex, and survey year. Ordinal regression examined a 1-level change in GPA associated with each sleep variable, adjusted for covariates. Results: Sleep difficulty was associated with increased likelihood of B/C averages. Initial-insomnia was associated with increased likelihood of B/C, and D/F averages. Tiredness was associated with increased likelihood of B/C, and D/F averages. Conclusions: Sleep problems are highly prevalent and associated with poorer academic performance in collegiate athletes.

Onset insomnia and insufficient sleep duration are associated with suicide ideation in university students and athletes.

BACKGROUND: Previous work has shown that poor sleep is a prospective risk factor for suicide in clinical populations and might contribute to risk in the general population. The present study evaluated whether sleep distress, onset insomnia, and insufficient sleep are associated with suicide ideation in university students and athletes participating in the 2011-2014 National College Health Assessment (NCHA; n = 113,185). METHODS: In the NCHA survey, students self-reported the presence or absence of suicide ideation within the past 12 months. SLEEP DISTRESS was assessed with an item indicating that "sleep difficulties" were "particularly traumatic or difficult to handle." ONSET INSOMNIA was assessed as at least 3 nights per week where survey participants reported an "extremely hard time falling asleep." INSUFFICIENT SLEEP was operationalized as the number of days per week where the participants felt they did not get "enough sleep to feel rested." All variables were yes/no except INSUFFICIENT SLEEP, which was categorized as 0-1 (reference), 2-3, 4-5, or 6-7 nights. Binary logistic regression analyses examined suicide ideation as the outcome and sleep variable as a predictor, adjusted for age, sex, year in school, recent depressed mood, and survey year. Associations within student-athletes were likewise assessed. RESULTS: 7.4% of students reported suicide ideation within the past 12 months. In adjusted models, this was significantly associated with SLEEP DISTRESS (OR = 3.01, 95% CI [2.86, 3.16], p < 0.0001), ONSET INSOMNIA (OR = 1.95, 95% CI [1.86, 2.04], p < 0.0001), as well as INSUFFICIENT SLEEP (4-5 nights, OR = 1.41, 95% CI [1.28, 1.56], p < 0.0001; 6-7 nights, OR = 1.92, 95% CI [1.74, 2.13], p < 0.0001). Although suicide ideation was less common among athletes, ORs were similar for athletes for all sleep variables of interest. CONCLUSION: Sleep distress, onset insomnia, and insufficient sleep were all strongly related to suicide ideation among university students. These relationships were the same among collegiate athletes, even though this group reported less overall suicide ideation. Our findings suggest that university students may benefit from educational materials linking sleep disruption to maladaptive thinking and suicide ideation.

Sleep and Health Among Collegiate Student Athletes.

Although the link between sleep, health, and performance has been well documented, research on this link in collegiate student athletes is still in its infancy. A large body of evidence indicates that collegiate student athletes are not obtaining enough sleep, but less is known about their sleep quality, patterns, and the impact on health and performance. Consequently, short sleep negatively affects physical and mental health, as well as several domains of performance (ie, aerobic, anaerobic, sport-specific, cognitive). The majority of studies examining the links between short sleep, health, and performance have been conducted with healthy adults or noncollegiate athlete samples; however, collegiate student athletes have demands unlike those of their nonathlete or noncollegiate athlete counterparts. Poor sleep health and sleep disorders are of increasing concern among the college athlete population and have recently been recognized by national and international sports governing bodies. The purpose of this review is to summarize the available literature on sleep and its impact on health and performance among athletes, specifically addressing gaps where little to no data is available on collegiate student athletes. Consideration is also given to evidence-based sleep interventions that have been utilized with athletes, as well as recommendations for future research and intervention development.

Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness.

Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes' sleep.

Insomnia and daytime sleepiness: risk factors for sports-related concussion.

OBJECTIVE/BACKGROUND: Poor quality and inadequate sleep are associated with impaired cognitive, motor, and behavioral components of sport performance and increased injury risk. While prior work identifies sports-related concussions as predisposing factors for poor sleep, the role of sleep as a sports-related concussion risk factor is unknown. The purpose of this study was to quantify the effect of poor sleep quality and insomnia symptoms on future sports-related concussion risk. PATIENTS/METHODS: In this study, 190 NCAA Division-1 athletes completed a survey battery, including the Insomnia Severity Index (ISI) and National Health and Nutrition Examination Survey (NHANES) Sleep module. Univariate risk ratios for future sports-related concussions were computed with ISI and NHANES sleepiness scores as independent predictors. An additional multiple logistic regression model including sport, sports-related concussion history, and significant univariate predictors jointly assessed the odds of sustaining a concussion. RESULTS: Clinically moderate-to-severe insomnia severity (RR = 3.13, 95% CI: 1.320-7.424, p = 0.015) and excessive daytime sleepiness two or more times per month (RR = 2.856, 95% CI: 0.681-11.977, p = 0.037) increased concussion risk. These variables remained significant and comparable in magnitude in a multivariate model adjusted for sport participation. CONCLUSION: Insomnia and daytime sleepiness are independently associated with increased sports-related concussion risk. More completely identifying bidirectional relationships between concussions and sleep requires further research. Clinicians and athletes should be cognizant of this relationship and take proactive measures - including assessing and treating sleep-disordered breathing, limiting insomnia risk factors, improving sleep hygiene, and developing daytime sleepiness management strategies - to reduce sports-related concussion risk and support overall athletic performance.

Driving After Drinking Alcohol Associated with Insufficient Sleep and Insomnia among Student Athletes and Non-Athletes.

INTRODUCTION: The proportion of university/college students (UCS) consuming alcohol is similar to the number of those reporting poor sleep, at approximately 30%, the proportion being greater in student athletes (SA). What remains to be understood is if poor sleep potentiates risky behaviors. OBJECTIVE: Our aim was to examine the association among sleep difficulties, insomnia symptoms, and insufficient sleep on the risk of driving under the influence of alcohol in a sample of UCS and whether these associations were more pertinent in SA. METHODS: Data from the National University/College Health Assessment was used from the years 2011⁻2014. Questions on number of drinks consumed and behaviors such as driving after drinking alcohol were related to answers to questions pertaining to sleep difficulties, insufficient sleep, and insomnia symptoms. RESULTS: Mean alcohol intake was of about 3 drinks; SA consumed significantly more than student non-athletes (SNA). Binge-drinking episodes were significantly higher among SA than SNA. Difficulty sleeping was associated with an increased likelihood of driving after any drinks and after 5 or more drinks in both groups, effects being stronger among SA. Insomnia was associated with an increased likelihood of driving after any drinks and after 5 or more drinks in SA and after 5 or more drinks in SNA. These effects were stronger among athletes. CONCLUSION: The present study found that self-reported difficulties sleeping, insomnia symptoms, and insufficient sleep are associated with driving after drinking alcohol. This relationship applied to driving after drinking any alcohol or binge drinking and was again stronger among SA than SNA.