Sleep and mental health of current and retired athletes across playing status and level of competition

Sleep and mental health problems are common in athletic cohorts; however, our knowledge is limited to current, elite athletes. We attempted to compare the symptomology of sleep and mental health problems across different playing statuses and competition levels. An online survey was completed by 946 adults from 37 sports (52.3% women) in seven countries. Athletes were currently competing, retired from competition (<20 years ago), or temporarily unable to play (i.e. injury/season postponed), from all competition levels. Retired athletes were at greater risk of sleep disordered breathing than current athletes (OR=2.30, 95% CI1.66,3.20) and those unable to play (OR=1.83, 95% CI1.07,3.13. Retired athletes (OR=1.54, 95% CI1.11,2.15) and those unable to play (OR=2.15, 95% CI1.36,3.39) were at greater risk of compromised wellbeing than current athletes. Sports institute/university/college level and semi-professional athletes were at greater risk of anxiety than professional athletes (OR=2.82, 95% CI1.29, 6.17; OR=2.38, 95% CI1.10, 5.16), respectively. Current and retired athletes had comparable risk of sleep difficulty, depression, and anxiety, while retired athletes were at the greatest risk for sleep apnoea, reflecting previous literature. Foreclosure of sport may explain reduced wellbeing in retired and temporarily unable to compete athletes. Emerging athletes were at elevated risk for depression and anxiety, with distinct barriers and stressors to elite athletes. The high risk prevalence observed has significant implications for the assessment and identification of sleep and mental health issues in athletic populations, highlighting the importance of intervention and prevention strategies. Findings underscore the necessity for longitudinal research, increased transparency from sporting organisations, and enhanced support during and beyond athletic careers.