Sleep Strategies and Performance Outcomes in Ultramarathon Runners: A Systematic Review
Daniel A. Brown, Jason Parreira, Katie Spencer, Serena Skinner, Wataru Goto, Larissa SattlerContext:
Ultramarathon events impose prolonged physiological and cognitive demands, often spanning 1 or more nights with limited sleep opportunity.
Objective:
To examine associations between pre-race and intra-race sleep strategies and physical and cognitive performance outcomes in ultramarathon runners.
Data Sources:
PubMed, EMBASE, PsycINFO, SPORTDiscus, and Web of Science were searched from inception to July 25, 2025.
Study Selection:
Primary observational or experimental studies published in English, or available in English translation were eligible when they involved ultramarathon runners (>42.2 km) and reported sleep as a variable of interest in relation to race performance or cognitive performance.
Study Design:
Systematic review.
Level of Evidence:
Level 3.
Data Extraction:
Two reviewers independently extracted study design, participant characteristics, race characteristics, sleep outcomes, performance outcomes, and cognitive outcomes. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklists.
Results:
Nine studies involving 2262 participants were included, with overall low risk of bias. Of the 4 studies examining pre-race sleep, 3 reported a significant association or group difference with a race-performance outcome. Reduced sleep was generally associated with poorer physical and cognitive performance. Greater intra-race sleep duration was consistently associated with longer finish times, reflecting additional nonmoving time and increased sleep need in longer events. Greater pre-race sleep duration, including sleep extension, was associated with faster finish times, and better pre-race sleep quality was linked to higher cognitive performance.
Conclusion:
Pre-race sleep extension was associated with faster finish times, although the observational evidence does not establish causality. Further research using objective sleep measures and controlled designs is required.