The Clinical Validation of the Athlete Sleep Screening Questionnaire: an Instrument to Identify Athletes that Need Further Sleep Assessment

Abstract

BackgroundPrevious research has established that general sleep screening questionnaires are not valid and reliable in an athlete population. The Athlete Sleep Screening Questionnaire (ASSQ) was developed to address this need. While the initial validation of the ASSQ has been established, the clinical validity of the ASSQ has yet to be determined. The main objective of the current study was to evaluate the clinical validity of the ASSQ.MethodsCanadian National Team athletes (N = 199; mean age 24.0 ± 4.2 years, 62% females; from 23 sports) completed the ASSQ. A subset of athletes (N = 46) were randomized to the clinical validation sub-study which required subjects to complete an ASSQ at times 2 and 3 and to have a clinical sleep interview by a sleep medicine physician (SMP) who rated each subjects’ category of clinical sleep problem and provided recommendations to improve sleep. To assess clinical validity, the SMP category of clinical sleep problem was compared to the ASSQ.ResultsThe internal consistency (Cronbach’s alpha = 0.74) and test-retest reliability (r = 0.86) of the ASSQ were acceptable. The ASSQ demonstrated good agreement with the SMP (Cohen’s kappa = 0.84) which yielded a diagnostic sensitivity of 81%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 90%. There were 25.1% of athletes identified to have clinically relevant sleep disturbances that required further clinical sleep assessment. Sleep improved from time 1 at baseline to after the recommendations at time 3.ConclusionsSleep screening athletes with the ASSQ provides a method of accurately determining which athletes would benefit from preventative measures and which athletes suffer from clinically significant sleep problems. The process of sleep screening athletes and providing recommendations improves sleep and offers a clinical intervention output that is simple and efficient for teams and athletes to implement.Electronic supplementary materialThe online version of this article (10.1186/s40798-018-0140-5) contains supplementary material, which is available to authorized users.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

“…Addressing sleep problems in elite athletes requires screening for primary sleep disorders (such as circadian dysregulation, insomnia disorder or sleep apnoea), since solely treating comorbid mental health symptoms or disorders (such as depression or anxiety) will likely be unhelpful unless any primary sleep disorders are properly treated 156. A questionnaire validated for use in athletes may help identify athletes who need further sleep assessment 157. At the team level, the sports medicine team can promote healthy sleep by: (i) ensuring coaches model healthy sleep and schedule training around sleep and circadian rhythms; (ii) encouraging healthy sleep as part of the training protocol; (iii) promoting sleep health education; and (iv) engaging in proactive tracking and monitoring of sleep.…”

The Variability of Sleep Among Elite Athletes

“…Assessing the sleep quality and the prevalence of sleep disorders among a cohort of 107 professional ice hockey players, Tuomilehto et al [ 12 ] found that one in every four players had a significant sleeping disorder (e.g., obstructive sleep apnea, restless legs syndrome and periodic leg movement, insomnia). Likewise, 25% of Canadian National Team athletes were identified to have clinically relevant sleep disturbances that required further clinical sleep assessment [ 13 ]. Relatively high levels of sleep complaints are prevalent among elite athletes, with a prevalence of sleep disturbance ranging from 13 to 70% (for a review, [ 8 ]).…”

“…However, it is important to note that the PSQI has not been validated in an athlete population. In this respect, the Athlete Sleep Screening Questionnaire was developed as a sleep screening tool for detecting clinically significant sleep disturbances and daytime dysfunction, and to provide interventions based on the type and severity of the problem detected within an athlete population [ 13 , 79 ]. Differences in bedtime and wake time during pre-season may also be observed when compared to the competitive season, both for players and staff [ 80 ].…”

Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study

“…Sleep disturbance: Measured using the shortened Athlete Sleep Screening Questionnaire (ASSQ), sleep disturbance in the previous 4 weeks is assessed through five items (eg, ‘How satisfied/dissatisfied are you with the quality of your sleep?’) scored on 4-point and 5-point scales 34 35. The ASSQ has been validated in athletes (internal consistency: >0.7; test–retest reliability: >0.8; criterion-related validity: sensitivity >0.8, specificity >0.9) 34 35. A total score ranging from 1 to 17 is obtained by summing up the answers to the five items, a score of 8 or more indicating the presence of moderate sleep disturbance 34 35…”

“…The ASSQ has been validated in athletes (internal consistency: >0.7; test–retest reliability: >0.8; criterion-related validity: sensitivity >0.8, specificity >0.9) 34 35. A total score ranging from 1 to 17 is obtained by summing up the answers to the five items, a score of 8 or more indicating the presence of moderate sleep disturbance 34 35…”