Sleep disturbance in elite athletes is closely associated with psychological fatigue and overall mood disturbance, with fatigue as the core predictor, and significant gender differences exist such that the mood-sleep association is stronger in female athletes.
Nearly half of the elite athletes sampled had disturbed sleep as defined by a PSQI score of 5 or above.
The disturbed-sleep group scored significantly higher than the normal-sleep group on the PSQI global score and on all seven PSQI component scales.
Athletes with disturbed sleep had markedly elevated scores on all negative mood dimensions and total mood disturbance compared to the normal-sleep group.
Fatigue and total mood disturbance (TMD) were positively correlated with PSQI global score in the full sample.
Fatigue and TMD were independent predictors of PSQI global score, together explaining 57% of the variance in sleep quality.
The correlations between fatigue, TMD, and sleep quality were significantly stronger in female athletes than in male athletes.
Depression scores in the disturbed-sleep group were significantly higher in female athletes than in male athletes.
This research suggests that poor sleep is common among elite athletes and is closely linked to negative psychological states. In a sample of 175 elite adult athletes from China, nearly half (87 out of 175) were classified as having disturbed sleep. Those with disturbed sleep reported significantly higher levels of tension, anger, fatigue, depression, confusion, and overall mood disturbance compared to athletes who slept well. The strongest psychological predictors of poor sleep quality were fatigue and overall mood disturbance, which together accounted for 57% of the variation in sleep quality scores. The study also found notable differences between male and female athletes. Female athletes showed stronger connections between their mood states and sleep quality — meaning that psychological distress was more closely tied to sleep problems in women than in men. Additionally, among athletes with disturbed sleep, female athletes reported significantly higher depression levels than their male counterparts. These findings highlight that the psychological burden of poor sleep may be more pronounced for female elite athletes. This research suggests that mental health monitoring — particularly tracking fatigue and overall mood — could be a useful tool for identifying athletes at risk for sleep problems. The findings also point to the potential value of gender-specific approaches when designing interventions to support athlete wellbeing, since female athletes appear to be especially vulnerable to the psychological consequences of disrupted sleep.
Li H, Liu H. (2026). Association between sleep quality and psychological wellbeing in 175 elite adult athletes: a cross-sectional study.. Frontiers in public health. https://doi.org/10.3389/fpubh.2025.1681005