Waking up to the issue! Research inattention and sex-related differences warrant more sleep studies in female athletes

Power, Cody J ORCID: https://orcid.org/0000-0003-1001-8725, Fox, Jordan L, Elliott-Sale, Kirsty J ORCID: https://orcid.org/0000-0003-1122-5099, Bender, Amy M, Dalbo, Vincent J and Scanlan, Aaron T (2024) Waking up to the issue! Research inattention and sex-related differences warrant more sleep studies in female athletes. Sports Medicine, 54 (3). pp. 565-583. ISSN 0112-1642

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Abstract

Understanding sleep patterns and behaviors of athletes is essential for developing targeted sleep-based interventions for implementation in practice. However, more than double the number of sleep studies have examined male athletes compared with female athletes, making the current understanding of sleep patterns, behaviors, and interventions among athletes disproportionately indicative of men. Consequently, this review demonstrates the need for more female-specific sleep data among athlete populations due to research inattention and sex-related differences. Specifically, this review identifies variations in sleep patterns and behaviors between male and female athletes, as well as physiological and lifestyle factors that potentially affect sleep patterns and behaviors across the lifespan, specifically in female athletes. In this regard, evidence suggests some female athletes experience longer sleep durations and better objective sleep quality, but similar or worse subjective sleep quality compared with male athletes. Additionally, scheduling training in the morning or throughout the day may benefit sleep in some female athletes. Considering sleep disorders, women may be at greater risk for insomnia and restless legs syndrome compared with men, which may be attributed to pregnancy, as well as a higher prevalence of anxiety and depressive symptoms, iron deficiency without anemia, and use of psychotropic medication among women. Finally, the menstrual cycle, menstrual disorders, oral contraceptive use, and the postpartum period have been shown to exert detrimental effects on sleep patterns and behaviors and should theoretically be considered when monitoring and managing sleep in female athletes.