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Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review
Open accessAbstract
This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual’s sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8–10 h) and actual sleep achieved. Sleep–wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes’ ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.
Overview
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TL;DR
This narrative review examines how sleep and nutrition interact with recovery and injury risk in adolescent athletes, noting injury rates of ~1.4–6.4 per 1000 h during training and ~22.4 per 1000 h during competition. It concludes that poor sleep and inadequate diet are associated with higher injury risk, but evidence in adolescent athletes remains limited and largely subjective.
Key findings
- Adolescent athletes achieve, on average, ~6.3 h of sleep, below the 8–10 h recommendation; elite athletes may need ~8.3 h to feel rested.
- Sleep loss is associated with injury: adolescent athletes with <8 h sleep per night were 1.7 times more likely to sustain injury (95% CI 1.0–3.0; p = 0.04); decreasing sleep during high-volume intense training produced a 2.25-fold increase (95% CI 1.46–3.45; p < 0.001); and <8 h specifically gave a 1.31-fold increase (95% CI 0.97–1.78; p = 0.080). Actigraphy found wake after sleep onset predicted previous injury (OR = 1.144), time spent awake predicted injury occurrence (OR = 0.974), and increasing time spent awake by at least 1 min reduced future injury likelihood [F(2.36) = 6.512; p = 0.004].
- In 340 elite adolescent Swedish athletes, meeting recommended nutrition intake decreased injury risk by 64% (OR 0.36; 95% CI 0.14–0.91), and sleeping >8 h per weeknight decreased injury risk by 61% (OR 0.39; 95% CI 0.16–0.99).
- Nutrition knowledge is low in adolescent athletes, with mean scores ranging from 43.8 ± 11.4% to 48.85 ± 12.7%, lower than adult athletes (40.2 ± 12.4% to 70 ± 9%; overall NK% = 55.1 ± 10.7%); a weak positive relationship (r = >0.26) exists between nutrition knowledge and energy balance/dietary quality.
Methods
- Narrative review design, synthesizing available literature on sleep, nutrition, and injury risk in adolescent athletes.
- Data/sample: literature involving adolescent athletes, adult athletes, and general adolescent populations; cited studies include subjective questionnaires, actigraphy, and multiple nutrition knowledge assessment tools, with one analysis involving 340 elite adolescent Swedish athletes.
- Main analysis: narrative synthesis; no primary data collection or meta-analysis is reported, and the text does not describe a systematic search strategy, inclusion/exclusion criteria, or quality appraisal.
Limitations
- Stated limitations: limited research investigates the impact of both sleep and nutrition on injury risk in adolescent athletes; consensus is mainly informed by adult athletes and/or general adolescent populations; objective sleep measures such as actigraphy or polysomnography are scarce in adolescent athletes, so conclusions are inferred from subjective questionnaires and sleep diaries; many studies involve limited sample sizes, case studies, or cross-sectional investigations, limiting conclusions; future longitudinal research using objective sleep measures is warranted.
- Evident limitations: as a narrative review, it lacks a reported systematic search and quality appraisal, so selection and synthesis bias cannot be assessed; the paper also notes that nutrition knowledge research is difficult to infer because of multiple assessment tools.
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Figures
![Figure 1 The perfect storm model adapted from [41,42].](/paper-figures/35f52da8f6084f279d3eb581f2ef0f07/sleep-nutrition-and-injury-risk-in-adolescent-athletes-a-narrative-review-figure-1.jpg)
![Figure 2 Training load framework adapted from [152].](/paper-figures/852e257f6fd1460bbeed3b97e83b0e23/sleep-nutrition-and-injury-risk-in-adolescent-athletes-a-narrative-review-figure-2.jpg)
Verification
Claims the paper makes
0 Valid · 0 Not valid · 32 Not checked · 4 Own results and interpretations
In the paper
“Moreover, solely accounting for a decreased sleep volume resulted in a 1.46-fold (95% CI; 1.10–1.94; p < 0.01) increased risk”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
What the sources say
- Not checked yetcites [163] Frohm, 2017, Multiple Factors Explain Injury Risk in Adolescent Elite Athletes: Applying a Biopsychosocial Perspective, Scand. J. Med. Sci. Sports source
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“while adolescent athletes who specifically reported that obtaining < 8 h of sleep resulted in a 1.31-fold (95% CI; 0.97–1.78; p = 0.080) increased injury risk [163].”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
What the sources say
- Not checked yetcites [163] Frohm, 2017, Multiple Factors Explain Injury Risk in Adolescent Elite Athletes: Applying a Biopsychosocial Perspective, Scand. J. Med. Sci. Sports source
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Furthermore, the researchers found that athletes who increased TA by at least 1 min reduced their likelihood of sustaining future injury ([F(2.36) = 6.512; p = 0.004]) [186].”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
What the sources say
- Not checked yetcites [186] Viegas, 2022, The Sleep as a Predictor of Musculoskeletal Injuries in Adolescent Athletes, Sleep Sci. source
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Furthermore, it was reported that athletes who slept for more than 8 h per weeknight decreased their injury risk by 61% (OR, 0.39; 95% CI, 0.16–0.99) [162].”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
What the sources say
- Not checked yetcites [162] Frohm, 2017, Too Little Sleep and an Unhealthy Diet Could Increase the Risk of Sustaining a New Injury in Adolescent Elite Athletes, Scand. J. Med. Sci. Sports source
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Research using subjective questionnaires have purported that adolescent athletes who experience < 8 h of sleep per night are 1.7 times (95% CI; 1.0–3.0; p = 0.04) more likely to sustain an injury [45].”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
What the sources say
- Not checked yetcites [45] Milewski, 2014, Chronic Lack of Sleep Is Associated with Increased Sports Injuries in Adolescent Athletes, J. Pediatr. Orthop. source
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Several factors may increase the risk of injury in youth and adolescent athletes, including early sports specialisation; high volume training loads; and inadequate dietary intake to support growth, development, sports performance, and recovery [6,7,8].”
From Youth and Adolescent Athlete Musculoskeletal Health: Dietary and Nutritional Strategies to Optimise Injury Prevention and Support Recovery (2024) · cites this paper as [7]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 11. Conclusions
“compromised sleep (OR, 0.39; 95% CI, 0.16–0.99) and an inadequate diet (OR, 0.36; 95% CI, 0.14–0.91) may increase the likelihood of injury occurrence”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
“athletes who slept for more than 8 h per weeknight decreased their injury risk by 61% (OR, 0.39; 95% CI, 0.16–0.99)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 11. Conclusions
“compromised sleep (OR, 0.39; 95% CI, 0.16–0.99) and an inadequate diet (OR, 0.36; 95% CI, 0.14–0.91) may increase the likelihood of injury occurrence”
§ Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review > 9. Relationship between Sleep, Nutrition, and Injury Risk in Adolescent Athletes
“athletes who reached the recommended nutrition intake decreased their injury risk by 64% (OR, 0.36; 95% CI, 0.14–0.91)”
Citations
Cites
National Sleep Foundation's sleep time duration recommendations: methodology and results summary.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., et al. (2015) · Sleep Health · doi:10.1016/j.sleh.2014.12.010 · Cited by 4,404 · cited 3×
“…sleep durations, which includes recommendations The literature has suggested that athletes have increased sleep needs, and thus the general recommendations may not be sufficient for athletic populations [23,63]. for the following: adolescents (8–10 h), adults (7–9 h), and older adults (7–8 h) [46].”
BackgroundTwo-Process Model of Sleep Regulation
(2009) · Encyclopedia of Neuroscience · doi:10.1007/978-3-540-29678-2_6166 · Cited by 3,899
Impact of sleep debt on metabolic and endocrine function
Spiegel, K., Leproult, R., & Van Cauter, E. (1999) · The Lancet · doi:10.1016/s0140-6736(99)01376-8 · Cited by 3,668
Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004) · Sleep · doi:10.1093/sleep/27.7.1255 · Cited by 3,349
Growth, Maturation, and Physical Activity
Malina, R. M., Bouchard, C., & Bar-Or, O. (2004) · Human Kinetics eBooks · doi:10.5040/9781492596837 · Cited by 3,277
Adolescence: A foundation for future health
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S.-J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60072-5 · Cited by 2,635
Sleep Health: Can We Define It? Does It Matter?
Buysse, D. J. (2014) · Sleep · doi:10.5665/sleep.3298 · Cited by 2,536
Spiegel, K., Tasali, E., Penev, P., & Cauter, E. V. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-11-200412070-00008 · Cited by 2,459
Adverse metabolic and cardiovascular consequences of circadian misalignment
Scheer, F. A. J. L., Hilton, M. F., Mantzoros, C. S., & Shea, S. A. (2009) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0808180106 · Cited by 2,351
Sleep-dependent memory consolidation
Stickgold, R. (2005) · Nature · doi:10.1038/nature04286 · Cited by 1,857 · cited 1×
“REM sleep facilitates neurological regeneration, learning, memory, and emotional regulation [27,29,30].”
Background
Research works printed but not linked: 6
- Kryger, M.H., Roth, T., and Dement, W.C. (2005). Principles and Practice of Sleep Medicine, W.B. Saunders. [4th ed.].
- Kryger, M.H., Roth, T., and Dement, W.C. (2017). Principles and Practice of Sleep Medicine, Elsevier. [6th ed.].
- Hannon, M.P., Unnithan, V., Morton, J.P., and Close, G.L. (2019). Strength and Conditioning for Young Athletes, Routledge.
- Coutts, A., Crowcroft, S., and Kempton, T. (2017). Sport, Recovery and Performance: Interdisciplinary Insights, Routledge.
- Selye, H. (1956). The Stress of Life, McGraw-Hill.
- Read, M., Rietveld, R., Deigan, D., Birnie, M., Mason, L., and Centofanti, A. (2022). Peak Performance for Soccer, Routledge.
Cited by
Alcock, R., Hislop, M., Vidgen, H. A., & Desbrow, B. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9040221 · Cited by 33
Real-Time Athlete Fatigue Monitoring Using Fuzzy Decision Support Systems
Li, A. (2025) · International Journal of Computational Intelligence Systems · doi:10.1007/s44196-025-00732-8 · Cited by 22
The Sleep, Recovery, and Nutrition Characteristics of Elite Adolescent Athletes
Mason, L., Connolly, J., Devenney, L. E., Lacey, K., O’Donovan, J., Faulkner, M., & Doherty, R. (2025) · Sports · doi:10.3390/sports13020050 · Cited by 17
Self-citationMechanism of Action and Beneficial Effects of Probiotics in Amateur and Professional Athletes
Nami, Y., Barghi, A., Shahgolzari, M., Salehian, M., & Haghshenas, B. (2024) · Food Science & Nutrition · doi:10.1002/fsn3.4658 · Cited by 16
Xu, Z., Sun, W., Qian, H., & Yao, M. (2025) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-025-03331-x · Cited by 14
Metadata
- Authors
- Mason, L., Connolly, J., Devenney, L. E., Lacey, K., O’Donovan, J., & Doherty, R.
- Affiliations
- Atlantic Technological University (IE)
- The Open University (GB)
- Dublin City University (IE)
- Corresponding author
- Mason, Lorcán
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2023-12-13
- Volume
- 15
- Issue
- 24
- Pages
- 5101
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC10745648
- OpenAlex
- W4389670054
- Cited by
- 50
- References
- 182
- Citations by year
- 2026: 25 · 2025: 18 · 2024: 7
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ulster University Research Portal (Ulster University) (publishedVersion, cc-by)
- Open Research Online (The Open University) (acceptedVersion)
- Funders
- the Atlantic Technological University of Donegal President’s Research Bursary
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- sleep, nutrition, injury risk, youth athletes, sleep need, circadian rhythm, sleep regulation, recovery, athletic performance, psychological well-being
- MeSH terms
- Adolescent, Circadian Rhythm, Humans, Nutritional Status, Sleep, Athletic Performance, Athletes
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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