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Publisher: Taylor & Francis

Journal: The Physician and Sportsmedicine

DOI: 10.1080/00913847.2018.1553467
Original Research

Sleep quality associated with mood in elite athletes

Andrade, Alexandro1; Bevilacqua, Guilherme1; Casagrande, Pedro1; Brandt, Ricardo2;

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Coimbra, Danilo1

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DEPARTMENTS AND INSTITUTIONS:

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Laboratory of Sports and Exercise Psychology – LAPE, Department of Physical Education,

State University of Santa Catarina, Florianopolis, Santa Catarina, Brazil;

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2
Department of Physical Education, State University of West Parana, Marechal Cândido
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Rondon, Paraná, Brazil.
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Corresponding author:

Andrade, Alexandro
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Department of Physical Education, State University of Santa Catarina, Florianopolis, Santa

Catarina, Brazil;
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Rua Paschoal Simone, 358, Florianopolis, Santa Catarina, Brasil. ZIP: 88080350.
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e-mail: alexandro.andrade.phd@gmail.com.
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Abstract

Objectives: This study aimed to analyze the association between sleep quality and mood in

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elite athletes of different competitive levels.

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Methods: Participants were 1,041 elite athletes (aged 20.82 ± 6.62 years), with 671 men

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(64.5%/21.52 ± 6.90 years) and 370 women (35.5%/19.55 ± 5.89 years) from 10 individual

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sports and 6 team sports. Participants self-reported sleep quality on a Likert-type scale and

mood was measured with the Brunel Mood Scale (BRUMS). The data were analyzed using
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the Kruskal-Wallis test, and binary logistic regression. Results: Results revealed that athletes

who compete internationally are 84% more likely to have poor sleep quality than athletes who
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compete at a regional level. International athletes with good sleep quality showed greater

vigor. National athletes with poor sleep quality showed more confusion, depression, and
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fatigue. Thus, mood and competitive level are factors associated with sleep quality.

Confusion, fatigue, and tension impair sleep, and vigor reduces the likelihood of poor sleep.
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Conclusions: Sleep should be monitored, especially in international level athletes, in order to

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prevent sleep disorders during competitions. Coaches and athletes should use techniques and

strategies for appropriate management of sleep and mood, to maintain the athletes in optimal
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condition before important competitions.

Keywords: Sleep, affect, sportsman, sport psychology, athletics.

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Introduction

High-performance sport is characterized by prolonged and strenuous physical

demands [1] that can influence physiological and mechanical aspects, and emotional, and

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psychosocial behavior of athletes, including sleep quality [2]. In this context, the sleep quality

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of athletes is associated, among other aspects, with time spent in bed, time taken to fall asleep,

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waking up no more than once per night, and obtaining adequate restorative sleep [3].

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The relationships between sleep, recovery, and sports performance, especially in elite

athletes, have been investigated [4,5]. These interactions have become a topic of great interest
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due to the scientific evidence supporting the link between sleep, cognitive processes, and

metabolic functions [6]. Research indicates that sleep plays an essential role in the
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physiological and psychological recovery of an individual, as well as general well-being [7-

9]. In addition, poor sleep quality is associated with increased risk of injury [10].
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Sleep quality is associated with sports performance [11, 12]. Studies show that one

night of reduced sleep duration or reduced sleep quality in athletes is associated with reduced
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reaction time and anaerobic performance [13], as well as a decline in cognitive processes such
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as visual tracking, attention, and mood [14]. In addition, there is evidence that athletes with

poor sleep quality are more likely to lose competitions than are athletes with good sleep
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quality [15].

In addition to influencing cognitive, physical, and metabolic processes, sleep has a

psychological impact, and can affect mood. In an investigation of 277 volleyball athletes,

Andrade et al. [16] found that for every percentage increase in the level of confusion, there

was an associated 19.7% reduction in sleep quality. In a study by Lastella et al. [4], fatigue

and tension showed a negative correlation with sleep quality in marathon runners; the worse
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the sleep quality, the greater the fatigue and tension. In addition, vigor was positively

associated with sleep quality.

Mood has been measured composed of six states: tension, depression, anger,

confusion, vigor and fatigue. When the five negative states are low and vigor high, this profile

is known as "iceberg”, which is considered to be the best for athletes’ performance [17].

Mood states are regarded as one of the most important precompetitive predictive factors of

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sport performance, could be a decisive factor in athletes’ results [18] and has received

increasing attention and studied with athletes of various sports, and competitive levels. Recent

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studies have investigated the relationship between sleep and mood and the impact on athletic

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performance [19].

However, we did not identify studies that compared sleep quality in athletes of
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different competitive levels (regional, national, and international). Therefore, this study aimed

to analyze the association between sleep quality and mood in elite athletes of different
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competitive levels.
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Methods
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Participants
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Participants in this cross-sectional study included 1,041 elite athletes (aged 20.82 ± 6.62
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years), with 671 men (64.5%/21.52 ± 6.90 years) and 370 women (35.5%/19.55 ± 5.89 years).

We contacted all possible athletes in the competitions. The athletes were recruited from four

important sports competitions, one sailing, one jiujitsu, one tennis, and one multisport,

involving several individual and team sports. Those who agreed to participate were part of the

sample. Athletes signed an informed consent form agreeing to participate in the study, which
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was approved by the Institutional Ethics Committee, in accordance with the Declaration of

Helsinki. The study was approved by the Ethics Committee on Research Involving Human

Subjects of the Santa Catarina State University (44/2011).

In total, athletes from 10 individual sports were included (swimming, judo,

gymnastics, taekwondo, biathlon, jiu-jitsu, tennis, mixed martial arts, and karate) and 6 team

sports (volleyball, handball, basketball, beach volleyball, indoor soccer, and sailing).

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Regarding the competitive level, 280 (26.9%/19.66 ± 2.66 years) were regional level athletes,

406 (39%/20.18 ± 6.11 years) were national level athletes, and 355 (34.1%/22.44 ± 7.52

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years) were international level athletes. The participants were classified as elite athletes using

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the criteria of Swann et al. [20].
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Instruments
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Two instruments for data collection were used: an open-ended questionnaire was used
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with questions about: gender, age, sport, highest competitive level (regional, national or

international), and a self-reported perceived sleep quality. This question was “How would you
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evaluate the quality of your sleep in the past few days?” Participants reported their sleep

quality on a Likert-type scale as follows: 1 = very bad, 2 = bad, 3 = regular, 4 = good, 5 =

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excellent. For further analysis, two categories were established: Regular/bad sleep quality
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(very bad, bad, and regular) and good sleep quality (good and excellent). The use of a self-

reported questionnaire is a reliable method that reflected the athletes’ sleep quality

specifically during the competition period. Furthermore, several self-reported Likert-type

scales have been used in recent studies evaluating sleep [15,16,121] and the well-being of

athletes [22], beyond the perception of training load [23].

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To assess the mood, the Brunel Mood Scale – BRUMS [19,20] was used. The

BRUMS has been demonstrated to have Cronbach alpha values above 0.70 and is a reliable

tool used to measure the mood of Brazilian athletes. The instrument consisted of 24 items and

six subscales assessing mood: tension, depression, anger, vigor, fatigue and confusion. Each

item was reported on a Likert scale ranging from nothing (0) to extremely (4), where the

respondent indicated how they were feeling at that moment. The results were calculated using

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the mean of the items in each subscale.

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Procedures

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Data collection was performed during important competitions (at regional and national level).
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The researchers had access to the competition area for recruitment and assessment of the

athletes. Study information was given to all athletes and signed informed consent was
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provided by athletes who agreed to participate. Each participant was asked to complete a
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questionnaire in a quiet location in the presence of the investigator. Data collection occurred

at different times of day, to accommodate competition schedules. The questionnaires were

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completed at the competition location, approximately 30 minutes before a match or specific

competition took place. The timing and location were designed to cause minimal interference
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with athlete preparation, as well as to improve the quality of responses related to competition
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and sleep. Athletes traveled at least one day before competing, avoiding long distances to

minimize the effect of travel fatigue on sleep and mood. All athletes stayed in shared

accommodations during the competition. Figure 1 illustrates the study procedures.

*** Figure 1 near here ***

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Statistical analyses

According to a sample calculation performed a posteriori using the StatCalc function of Epi

Info version 7 (Centers for Disease Control and Prevention, Atlanta, GA, USA), our sample

was found to be representative. Our calculation used an infinite population size of athletes and

an expected sleep disturbance rate of 50%, with 5% error, 99% confidence level, 1.0 design

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effect, and 30% sample loss.

The data were analyzed using descriptive statistics (mean, standard deviation,

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frequency, and percentage) and inferential statistics. Normality of data was assessed using the

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Kolmogorov-Smirnov test that revealed non-normality. Inferential analysis was performed

using the Kruskal-Wallis test to compare the mood of athletes with different self-reported
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sleep quality. When differences were found, we used Dunn's post-hoc test.

Additionally, binary forward logistic regression analyses were performed to assess the
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association between sleep quality (dichotomized as good or bad) and competitive level
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(regional, national, and international). A crude analysis was then performed for the

association between each mood state and poor sleep quality, stratified by the competitive level
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(regional, national, and international). An adjusted analysis was performed according to age

and the six mood states using the Wald Forward method. We checked the performance of the
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model with regard to the goodness of fit using the Hosmer-Lemeshow test. The effect size
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was interpreted as follows: <0.2 trivial; 0.2–0.6 small; 0.6–1.2 moderate; 1.2–2.0 large; 2.0–

4.0 very large; and 4.0 nearly perfect [26]. All statistical calculations were performed using

SPSS Statistics for Windows. V.20.0 (IBM Corporation, Armonk, NY). For all tests, P-values

<0.05 were considered significant.

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Results

The majority of athletes reported good sleep quality (Table 1). However, the percentage of

athletes reporting poor or bad sleep was 9.7% (regional), 9.6% (national), and 14.1%

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(international).

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*** Table 1 near here ***

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International level athletes with excellent sleep quality showed lower confusion than
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did international level athletes with poor sleep quality (p=0.02). Furthermore, international

athletes with good sleep quality showed lower confusion than did international level athletes
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with bad (p=0.04) and poor sleep (p=0.02) quality. International level athletes with poor sleep

showed higher depression than did international level athletes with excellent (p=0.00), good
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(p=0.04) and regular (p=0.04) sleep quality. International level athletes with excellent sleep
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showed higher vigor than did international level athletes with poor (p=0.00), bad (p=0.00) and

regular (p =0.00) sleep quality. No differences were found in anger, fatigue and tension in
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international level athletes (p>0.05) (Table 2).

National level athletes with excellent sleep quality showed higher vigor than did
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national level athletes with regular sleep quality (p=0.04). No differences were found in

anger, confusion, depression, fatigue and tension in national level athletes (p>0.05) (Table 2).

Regional level athletes with bad sleep quality showed higher fatigue than did regional

level athletes with excellent (p=0.03) and good (p=0.01) sleep quality. No differences were

found in anger, confusion, depression, tension and vigor in regional level athletes (p>0.05)

(Table 2).
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International level athletes showed higher anger (p=0.03) than did national level

athletes and less confusion (p=0.00), tension (p=0.00) and depression (p=0.00) than did

regional level athletes. National level athletes showed higher anger (p=0.00) and vigor

(p=0.00) than did regional level athletes. National level athletes also showed lower depression

than did regional level athletes (p=0.00). No differences were found in fatigue levels among

athletes of different competitive levels (p=0>0.05) (Table 2).

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*** Table 2 near here ***

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The first regression analysis (Table 3) indicated that for each percent increase in

confusion and fatigue, the likelihood of poor sleep increased by 10.5% and 5.4%,
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respectively. Moreover, vigor was also associated with sleep quality; for each percent increase

in vigor, the likelihood of bad sleep decreased by 7%. The model showed that athletes who
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compete internationally are 123% more likely to have poor sleep than athletes at the regional

level. We found that for each year of age, the likelihood of bad sleep decreased by 3.1%.
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*** Table 3 near here ***

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The second logistic regression analyses indicated that athletes who compete

internationally are 84% (33.8%-154%) more likely to have poor sleep than athletes at the
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regional level (X2 = 17.55, p < 0.01; df = 2). Prediction success overall was 58.5%.

The regression analysis stratified by level (Table 4) and adjusted by age and for the six

mood states using the Wald Forward method and the Hosmer-Lemeshow test indicated that in

athletes at the regional level, increase in confusion was associated with bad sleep quality

(Exp( ):1.157; 95%CI: 1.054 – 1.270; p = 0.00). In athletes at the national level, the odds
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ratio (OR) for fatigue in bad sleep quality was 1.124 (95%CI: 1.053 – 1.200; p = 0.00). In

international level athletes, the OR for tension in bad sleep quality was 1.140 (95%CI: 1.061 –

1.228; p = 0.00) and for vigor was 0.879 (95%CI: 0.818 – 0.943; p = 0.00).

*** Table 4 near here ***

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Discussion

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To our knowledge, this is the first study to investigate the associations between self-reported

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sleep quality and mood in elite athletes of different competitive levels. The main results of the

study show that international athletes had a 123% greater chance of having poor sleep than
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regional athletes. Moreover, bad sleep quality was associated with confusion, depression,

fatigue, and vigor.

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In our study, most athletes reported self-reported good sleep quality in the pre-

competitive period, corroborating the study by Rodrigues et al. [25] that investigated sleep
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quality in Paralympic athletes at different points in the season. In that study, athletes reported
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poor sleep at the beginning of the season, but not at the competitive period.

The prevalence of bad sleep quality in our study may be considered high. Fullagar et al
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[22] showed that athletes participating in competitions may have altered sleep patterns.

According to Lastella et al. [3], athletes may have bad sleep quality during a competitive
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period. Erlacher et al. [27] reported that most athletes had poorer sleep quality at least one

night before competition. Juliff et al. [28] found similar results, in which most athletes

reported sleep problems during a competitive period. The most commonly reported

impediment to "falling asleep" was related to thoughts about risk-taking and anxiety in

competition [27].
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Athletes may have impaired sleep during a competitive period or even pre-competition

sleep deprivation [3,27]; therefore, Brandt et al. [15] sought to identify how sleep quality may

compromise performance, and found that athletes who have poor sleep are 173% more likely

to lose games than athletes with good sleep quality. Moreover, Oliver, Costa, Laing, Bilzon

and Walsh [30] reported that one night of sleep deprivation decreases endurance and

cardiorespiratory and thermoregulatory functions.

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It was verified that fewer international level athletes had good sleep and more had bad

sleep. Moreover, they were twice as likely to report poor sleep as athletes at the regional level.

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In addition, our study found that international level athletes are 123% more likely to have

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poor sleep than athletes at the regional level.

Elite athletes are constantly exposed to stressors that may impair mental health [31]
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and negatively influence sleep quality [21]. Quarrie et al. [32] reported that elite athletes had

concerns about competitions, training, physical recovery, injuries, nutrition, interpersonal

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relationships (family, friends, teammates, coaching staff), personal development, media

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coverage, and travel.

Moreover, in elite international athletes, the demands are often greater because of
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greater visibility and exposure in the media, greater training volume, and pressure to achieve

results. These athletes tend to have longer and more exhausting travel and may also suffer
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from the effects of jet lag, which can impair sleep quality [29]. Jet lag is a misalignment of the
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sleep/wake cycle with local time, occurs on trips between different time zones, and has a

negative impact on the quality and quantity of sleep [5]. Coaches and athletes should choose

the most suitable travel itinerary [33], in order to minimize the effects [34] on the athlete, by

avoiding poor sleep quality before important competitions.

Our study showed that athletes with poor and bad sleep had more tension, depression,

anger, fatigue, and mental confusion, and less vigor than athletes with good or excellent sleep.
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Andrade et al. [16] reported that mental confusion was also associated with bad sleep quality,

as observed in our study. Mah and Dement [35] reported that better-performing basketball

athletes show an increase in vigor and a reduction in fatigue. Recent studies have reported that

sleep and mood are associated variables that may influence athlete performance [3,15,16].

Among the six mood factors, our study showed that an increase in mental confusion,

fatigue, and tension with a decrease in vigor was associated with bad sleep in regional,

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national, and international athletes, respectively. Mental confusion is characterized by feeling

stunned, and is related to new situations in which the athlete has no control, generating

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emotional instability [36]. The regulation of this mood factor is important, since increased

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confusion impairs performance [37], and is associated with poor sleep quality [16]. Fatigue

represents a state of exhaustion, apathy, and low energy [36]. Symptoms of fatigue can
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gradually affect attention, concentration, and memory, and can cause changes in sleep [38].

Additionally, in international athletes, tension and vigor was associated to bad sleep
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quality. Lastella et al. [3] also found a relationship between tension and sleep quality in
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international athletes which poor sleep quality, sleep time, and waking at night were

associated with increased stress before major competitions.

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Our findings corroborated other studies that also found relationships between sleep

quality and mood in elite athletes. These results indicate that an increase in negative mood
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factors leads to worsening sleep quality and that high vigor may contribute to better sleep
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quality.

The cross-sectional design of this study can be considered a limitation, because we

cannot conclude whether sleep influences mood or vice versa. The bi-directional relationship

between sleep and mood was considered, but was mitigated by the size of the sample.

Another limitation is the self-reported instrument used to assess sleep quality. However,

recent studies have used this method to evaluate sleep, and the instrument appears to be a
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reliable and important method of investigating sleep in large groups of athletes during

competition [15,16,21].

Conclusions

Our results indicate that international athletes are more likely to have poor sleep

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quality. In addition, the increase in tension and decrease in vigor (in international athletes

only) can adversely affect sleep quality. These findings can inform coaches, physiotherapists,

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psychologists, sports physicians, and athletes about the need for sleep and mood management

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during competitive events, to minimize adverse effects and maintain optimum conditions for

excellent performance in competitive events.

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Funding
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This work was supported by the Research and Innovation Support Foundation of the State of

Santa Catarina (FAPESC) under Grant [Project No. 2287/PAP 04/2014].

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or
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entity with a financial interest in or financial conflict with the subject matter or materials

discussed in the manuscript. This includes employment, consultancies, honoraria, stock

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ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial relationships to disclose.

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Figure legends

Figure 1- Data collection desiign.

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Table 1. Sleep quality in elite athletes of different competitive levels.

Sleep Quality

Poor (n=20) Bad (n=99) Regular (n=320) Good (n=478) Excellent (n=124)

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n % (95% CI) n % (95% CI) n % (95% CI) n % (95% CI) n % (95% CI)

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Regional (n = 280) 06 2.1 (0.9-4.6) 24 8.6 (5.8-12.4) 71 25.4 (20.6-30.8) 144 51.4 (45.6-57.2) 35 12.5 (9.1-16.9)

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National (n = 406) 07 1.7 (0.8-3.5) 32 7.9 (5.6-10.9) 118 29.1 (24.8-33.7) 198 48.8 (43.9-53.6) 51 12.6 (9.7-16.1)

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International (n = 355) 07 2.0 (1.0-4.0) 43 12.1 (9.1-15.9) 131 36.9 (32.0-42.0) 136 38.3 (33.4-43.47) 38 10.7 (7.9-14.3)

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* Legend: 95% CI: confidence interval of 95%.

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Table 2. Descriptive analysis of mood states in elite athletes of different sleep quality and competitive level.

Regional (n = 280) National (n = 406) International (n = 355)

Within Within Within
comparisons comparisons comparisons Between
Sleep Quality Sig. 25th 75th Sig. 25th 75th Sig. 25th 75th groups

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Anger p = 0.00

ip
Poor (n = 20) 2.5 0.0 10.5 0.0 0.0 3.0 5.0 0.0 9.0
Bad (n = 99) 2.5 0.0 4.7 0.5 0.0 2.0 1.0 0.0 5.0 I>N

cr
Regular (n = 320) p = 0.12 0.0 0.0 3.0 p = 0.53 0.0 0.0 2.0 p = 0.23 0.0 0.0 3.0 N>R
Good (n = 478) 0.5 0.0 3.0 0.5 0.0 2.0 0.5 0.0 3.0

us
Excellent (n = 124) 0.0 0.0 3.0 0.0 0.0 2.0 0.0 0.0 3.0
Total 1.0 0.0 3.0 0.0 0.0 2.0 0.0 0.0 3.0
Confusion p = 0.00

an
Poor 4.0 1.7 10.0 1.0 0.0 6.0 p = 0.00 3.0 2.0 10.0
Bad 2.5 1.0 6.7 2.0 1.0 4.7 E<P 2.0 0.0 5.0 N<R
Regular p = 0.00# 3.0 1.0 4.0 p = 0.07 2.0 0.0 4.0 G<B 1.0 0.0 3.0 I<R

M
Good 2.0 1.0 3.0 1.0 1.0 3.0 G<P 1.0 0.0 2.0
Excellent 1.0 0.0 3.0 1.0 0.0 3.0 0.0 0.0 2.2
Total 2.0 1.0 4.0 1.0 0.0 3.0 1.0 0.0 3.0

d
Depression p = 0.00
Poor 3.0 0.7 11.2 1.0 0.0 2.0 p = 0.02 1.0 1.0 8.0
Bad
Regular p = 0.08
1.0
0.0
0.0
0.0
te
3.0
3.0 p = 0.34
0.5
0.0
0.0
0.0
2.7
1.0
E<P
G<P
0.0
0.0
0.0
0.0
3.0
1.0
I<R
N<R
ep
Good 0.0 0.0 2.0 0.0 0.0 1.0 R<P 0.0 0.0 2.0
Excellent 0.0 0.0 1.0 0.0 0.0 1.0 0.0 0.0 0.0
Total 0.0 0.0 2.0 0.0 0.0 1.0 0.0 0.0 1.0
c

Fatigue
Poor p = 0.02 0.5 0.7 9.7 7.0 2.0 8.0 8.0 4.0 11.0
Ac

Bad E<B 5.0 3.0 8.0 3.0 2.0 6.7 5.0 1.0 7.0
p = 0.37
Regular G<B 3.0 1.0 4.0 p = 0.00 3.0 0.0 6.0 p = 0.01 3.0 1.0 6.0
Good 3.0 1.0 4.0 2.0 1.0 4.2 2.0 0.0 5.0
Excellent 2.0 0.0 4.0 2.0 0.0 3.0 2.0 0.0 4.0
Total 3.0 1.0 5.0 2.0 1.0 5.0 3.0 1.0 6.0
 21

Tension p = 0.00
Poor 6.5 2.5 11.0 3.0 0.0 8.0 6.0 3.0 9.0
Bad 5.0 2.0 9.7 5.0 3.0 6.7 5.0 3.0 7.0 I<R
Regular p = 0.42 4.0 3.0 6.0 p = 0.48 4.0 2.0 6.0 p = 0.00# 4.0 2.0 6.0
Good 4.0 3.0 6.0 4.0 2.0 7.0 3.0 1.2 6.0
Excellent 5.0 3.0 8.0 3.0 1.0 7.0 3.0 1.0 5.2

t
Total 5.0 3.0 7.0 4.0 2.0 6.0 4.0 2.0 6.0

ip
Vigor p = 0.00
Poor 11.5 8.5 12.2 p = 0.01 9.0 6.0 12.0 p = 0.00 7.0 6.0 15.0

cr
Bad 11.0 9.0 12.0 R<E 11.0 9.0 12.7 P<E 10.0 6.0 13.0 N>R
Regular 10.0 8.0 12.0 11.0 8.0 13.0 B<E 10.0 8.0 13.0
p = 0.43

us
Good 11.0 9.0 12.0 12.0 9.7 13.0 R<E 11.0 9.0 13.0
Excellent 11.0 8.0 13.0 12.0 10.0 15.0 13.0 11.0 15.0
Total 11.0 9.0 12.0 12.0 9.0 13.0 11.0 9.0 13.0

an
Legend: : Median; 25th: 1° Quartile; 75th:3º Quartile; P: Poor; B: Bad; R: Regular; G: Good; E: Excellent; R: Regional; N: National; I: International; p: Significant difference in Kruskal-Wallis test; <: Significant
difference between groups after adjustment; #No significant difference after post hoc analysis.

M
d
te
c ep
Ac
 22

Table 3. Binary logistic regression crude and adjusted odds ratio in relation to sleep quality,
age, competitive level, and mood of elite athletes.
Crude Adjusted
p P
(Exp B, 95% CI) (Exp B, 95% CI)
Age 0.972 (0.953-0.991) 0.00 0.969 (0.949-0.989) 0.00
Competitive Level
National 1.117 (0.815-1.532) 0.49 -

t
International 1.844 (1.338-2.540) 0.00 2.230 (1.582-3.143) 0.00

ip
Tension 1.055 (1.013-1.098) 0.10 -
Depression 1.082 (1.025-1.141) 0.00 -

cr
Anger 1.072 (1.024-1.123) 0.00 -
Fatigue 1.107 (1.065-1.151) 0.00 1.054 (1.003-1.107) 0.03

us
Confusion 1.128 (1.074-1.185) 0.00 1.105 (1.028-1.188) 0.00
Vigor 0.911 (0.875-0.948)
an 0.00 0.936 (0.894-0.981) 0.00
M
ed
pt
ce
Ac
 23

Table 4. Odds ratio and confidence intervals for the crude and adjusted analyses between the bad

sleep quality and mood of elite athletes.

Crude Adjusted
p p
OR (95% CI) OR (95% CI)
Competitive Level
Regional
Anger 1.067 (0.978 - 1.163) 0.14 -
Confusion 1.160 (1.057 - 1.273) 0.00 -
Depression -

t
1.108 (1.013 - 1.211) 0.02

ip
Fatigue 1.119 (1.031 - 1.214) 0.00 -
Tension 1.046 (0.961 - 1.138) 0.29 -
Vigor 0.209 (0.862 - 1.033) 0.20 -

cr
National

us
Anger 1.073 (0.990 - 1.164) 0.08 -
Confusion 1.109 (1.028 - 1.196) 0.00 1.130 (1.009 - 1.126) 0.03
Depression 1.043 (0.944 - 1.152) 0.41 0.842 (0.721 - 0.984) 0.03
Fatigue 1.121 (1.051 - 1.195)
an 0.00 1.108 (1.020 - 1.203) 0.01
Tension 1.019 (0.953 - 1.090) 0.57 -
Vigor 0.921 (0.865 - 0.981) 0.01 -
M
International
Anger 1.072 (0.993 - 1.159) 0.07 -
Confusion 1.200 (1.083 - 1.329) 0.00 -
Depression -
ed

1.109 (1.008 - 1.221) 0.03

Fatigue 1.081 (1.015 - 1.151) 0.01 -
Tension 1.117 (1.044 - 1.195) 0.00 -
Vigor 0.880 (0.824 - 0.941) 0.00 0.880 (0.812 - 0.953) 0.00
pt

OR: odds ratio; 95% CI: confidence interval of 95%. *Adjusted analysis by age.
ce
Ac

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