Interplay Between Sleep and Mental Health in Elite Ice Hockey: A Synthesis of Evidence and Implications for Athlete Care
Jakob M. Cherry, Anna Davidson, Jessica J. Love, Matthew D. Weaver, Stuart F. Quan, Laura K. Barger, Lovemore KunorozvaContext:
Elite ice hockey players experience physical and psychological stressors due to the sport’s intensity, frequent travel, and irregular schedules, potentially increasing sleep disturbances and mental health (MH) disorders, including anxiety and depression. However, evidence linking these outcomes remains limited.
Objective:
To systematically review literature on sleep and MH outcomes in elite ice hockey players, including prevalence, risk factors, and research gaps in sleep disturbances, anxiety, and depression.
Design:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, PubMed and EBSCOhost databases were searched. The review was registered with the International Prospective Register of Systematic Reviews (CRD42024592616). Three reviewers independently screened studies, evaluated quality using a modified Downs and Black checklist, and graded evidence using the 2009 Oxford Centre for Evidence-Based Medicine framework.
Eligibility Criteria:
Studies reporting sleep and MH measures in ice hockey athletes aged 16 or older.
Study Selection:
Prospective and retrospective studies were included, while reviews, editorials, and case reports were excluded.
Main Outcome Measures:
Sleep and MH outcomes were assessed using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance tools, Sport Concussion Assessment Tool 5th Edition, Athlete Sleep Screening Questionnaire, General Health Questionnaire-12, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Four-Dimensional Symptom Questionnaire, Alcohol Use Disorders Identification Test-Consumption, and the Eating Disorder Screen for Primary Care.
Results:
Of 292 studies screened, five met inclusion criteria, representing 2341 elite athletes (2159 males and 182 females; aged 16–50 yr). Sleep disturbances affected 15%–29.7% of athletes, 18%–24.1% experienced anxiety or depression, and up to 41.2% reported co-occurring symptoms. Retired athletes reported persistent sleep and MH challenges.
Conclusions:
Elite ice hockey players face a significant burden of sleep disturbances and MH symptoms during and after competition. Limited cross-sectional evidence demonstrates the need for longitudinal, interventional, and gender-sensitive research to inform targeted athlete support strategies.