Exploring Associations Between Sleep, Reproductive And Mental Health Among Team USA Female Athletes.

Sleep can influence athlete physical and psychological health, performance, recovery, and reproductive health. Elite athletes suffer sleep inadequacies due to cohort-specific challenges, and data suggests these may be worse in female athletes. However, limited elite female athlete specific exploration of their sleep data relative to their reproductive health, contraception use, and mental health, has been performed. PURPOSE: Examine sleep quality and explore associations with reproductive and mental health of Team USA Olympic and Paralympic female athletes. METHODS: Data was collected from the health histories and Sport Mental Health Assessment Tool-1 (SMHAT-1) screening tests of 1340 Team USA Olympic and Paralympic female athletes. Of these, at least 270 athletes also completed the SMHAT-1 questionnaires concurrently and were subsequently included in the present analysis. Menstrual cycle regularity (MR), hormonal-based therapy contraception (HBT) use, and SMHAT-1 (Athlete Sleep Screening Questionnaire [ASSQ; sleep], General Anxiety Disorder [GAD-7; anxiety], and Patient Health Questionnaire [PHQ-9; depression]) were treated as binary variables (e.g., flag or no flag), and the ASSQ was further analyzed as a continuous variable. Associations between MR, HBT and SMHAT-1 variables were examined using Cross-tabulations with Pearson Chi-Square (χ2) and Mann-Whitney U test where appropriate. RESULTS: All athletes reported being eumenorrheic, yet 28% reported not having a regular menstrual cycle. 62% of athletes reported not using HBT for contraception (38% using) and 13% of athletes flagged in the ASSQ. MR (P = .704, P = .813) and HBT use (P = .189) did not influence ASSQ total scores. However, non-HBT users had higher [median (range); 5 (1-13)] within-group variability than HBT users [5 (1-10), P = .036]. Sleep subcomponents had no associations with MR and HBT use (P = .120-P = .776). Flagging in the GAD-7 (P = .412) and PHQ-9 (P = .767) was not associated to flagging in the ASSQ. CONCLUSION: Self-reported sleep quality was adequate in 87% of the Team USA female athletes. Flagging in the ASSQ (13%) was not associated with reproductive health, contraception use or symptoms of mental health conditions in this particular cohort. This study was funded in part by a Research Centre Grant from the International Olympic Committee.