Evidence suggests that sleep is a vital component of physical and health well-being. However, while sleep problems are present in individuals with mental health problems such as depression, it has not been clear whether these conditions are independent or whether they might be causally related. Indeed, if sleep or sleep disorders predispose or modify onset and outcomes of mental health issues, treatment of these factors could be explored as new mental health prevention or treatment options. The aim of this review was to examine in detail the bidirectional relationship between sleep, sleep disorders, and mental and physical health and well-being. It has considered the evidence that sleep architecture disruption, occurring through both quantity, quality, and timing of sleep as well as through the presence of sleep disorders may both influence mental health and well-being as well as be disrupted by both physical and mental health conditions. Also, the review has explored the effects of sleep disruption on mental health and performance through fatigue, mood, and vigilance. The review has considered the bidirectionality between sleep, sleep disorders, and mental health to examine how these may lead to or exacerbate mental health disorders such as affective, anxiety, autism, depressive and schizophrenia disorders but also considers how these conditions can affect sleep. The review highlights that poor sleep or the presence of a sleep disorder can increase the risks from mental health conditions such as suicidality. Furthermore, mental health conditions such as anxiety and worry can cause racing or repetitive thoughts that can keep an individual awake, leading to shortened sleep. It is important that sleep and sleep disorders are considered potential modifiable factors that could improve mental health outcomes. The important interconnect between both physical and mental health and sleep, in patient evaluations, also needs to be considered as these may affect treatment pathways and patient outcomes. Further, more robust and perspective research is required to establish the triad relationship of physical, mental health, and sleep.

This review centres around the recent evidence in examining the intersection of sleep and cardiovascular disease (CVD). Sleep in this review will be further subdivided to consider both sleep quantity and quality along and will also consider some of the more common sleep disorders, such as insomnia and obstructive sleep apnoea, in the context of CVD. Sleep disorders have been further explored in several specific populations which are both at risk of sleep disorders and CVD. Secondly, the review will present some of the risk factors for CVD that are affected by sleep and sleep disorders which include hypertension, diabetes, and obesity. It will also examine the potential underlying mechanisms including inflammation, appetite control, endocrine, and genetic processes that are affected by sleep and sleep disorders leading to increased risk of CVD development. In addition, we will consider the observed bi-directional relationships between sleep and cardiovascular risk factors. For example, obesity, a risk factor for CVD can be affected by sleep, but in turn can increase the risk of certain sleep disorder development which disrupts sleep, leading to further risk of obesity development and increased CVD risk. Finally, the review will explore emerging evidence around lifestyle interventions that have included a sleep component and how it impacts the management of CVD risk factor. The need for increased awareness of the health effects of poor sleep and sleep disorders will be discussed alongside the need for policy intervention to improve sleep to facilitate better health and well-being.

Primary ObjectiveTo investigate the effect of home and away game travel on risk of concussion across different levels of rugby union.Research DesignExploration study across school, university, and professional rugby teams.Methods and ProceduresRetrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons).Main Outcomes and ResultsSchool level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05).ConclusionsThis research highlights an increased prevalence of concussion in school and university-aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby players.

Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies.

Objective:To establish the extent to which Rugby Union was a compulsory physical education activity in state-funded secondary schools in England and to understand the views of Subject Leaders for Physical Education with respect to injury risk.Method:A cross-sectional research study using data obtained under the Freedom of Information Act (2000) from 288 state-funded secondary schools.Results:Rugby Union was delivered in 81% (n = 234 of 288) of state-funded secondary school physical education curricula, including 83% (n = 229 of 275) of state-funded secondary school boys' and 54% (n = 151 of 282) of girls' physical education curricular. Rugby Union was compulsory in 91% (n = 208 of 229) of state-funded secondary schools that delivered it as part of the boys' physical education curriculum and 54% (n = 82 of 151) of state-funded secondary schools that delivered contact Rugby Union as part of the girls' physical education curriculum. Subject Leaders for Physical Education also perceived Rugby Union to have the highest risk of harm of the activities they delivered in their school physical education curriculum.Conclusion:Notwithstanding discussions of appropriate measures (i.e., mandatory concussion training, Rugby Union specific qualifications and CPD) to reduce injury risk, it is recommended that Rugby Union should not be a compulsory activity given that it has a perceived high risk of injury and is an unnecessary risk for children in physical education.

Rugby union, alongside other collision and contact sports, faces ever mounting pressure from increased recognition of concussive injuries and the risks they present to athletes, both in the short-term and long-term. Here, the media is a central component of increasing pressure for cultural change. This research analysed data from 524 self-selected survey respondents to examine rugby union fans’ and stakeholders’ perceptions of media portrayal of concussion and how it might influence their own perceptions. We found evidence of a complex and heterogenous relationship between perceptions of masculinity, views and attitudes toward mass media, and degree of involvement in rugby union. Specifically, partisans of the sport generally saw mass media as hostile, with coverage biased against rugby, allowing them to manufacture doubt regarding risk information, as well as maintaining involvement in the sport. We conclude that critical commentaries from the media have the ability to challenge masculinities around concussion.

Obstructive sleep apnea (OSA), a frequently under-diagnosed sleep disorder, may lead to future poor health, performance, and wellbeing. Increased OSA prevalence has been reported in individuals who have had a head injury.We systematically searched EMBASE, PSYCINFO, WEB OF SCIENCE, COCHRANE and PUBMED to 18th June 2022. OSA prevalence and demographic data was extracted according to PRISMA guidelines from 14 eligible studies with 6,116 participants, with study quality assessed using the modified Downs and Black Score.Meta-analysis of proportions yielded a pooled OSA prevalence of 30.0% (95% confidence interval (CI), 24.0–36.0%) with significant heterogeneity between studies (I2 = 94.4%, p<0.001). Sub-group analysis by different sports gave OSA prevalence of: American football (29% (95%CI: 22–36%); Rugby (35.0% (95%CI: 24.0–47.0%)) and ‘other contact’ sports (31% (95%CI: 24.0–37.0%)). Prevalence was higher in retired (from play) (34.0% (95%CI: 25.0–44.0%)) v current (21.0% (95%CI: 10.0–32.0%)) American football players.The prevalence of OSA in contact sports was higher than that reported in the general population, especially in retired American Football players. Further high-quality longitudinal studies in a wider range of contact sports are required to explore OSA prevalence and its possible effects on participants performance and current and future health.

The issue of concussion in sport continues to be discussed widely in the community as current and retired players reveal personal experiences, and concerns, about the long-term sequelae of their concussive injuries. This is the first study to examine evolving attitudes and beliefs towards concussion in sport by comparing data in an Australian exercise science student cohort between 2015 and 2020. Using a repeated cross-sectional design 1,013 participants (2020 cohort: n = 751; 21.6 ± 7.1 years; 2015 cohort: n = 312; 22.0 ± 5.2 years) responded to statements about concussion, including: personal attitudes, the media’s portrayal , elite athletes who continue to play concussed, if participants would continue to play on when concussed, and on completing rehabilitation for concussion. Comparisons revealed statistically significant differences between cohorts across the majority of statements. Specifically, more progressive attitudes were found regarding the media presentation (glorification) of concussed athletes (decreased agreement of 14.7%, p < 0.001), admiration of concussed athletes who continued to play (decreased agreement of 10.5%, p < 0.001), and rehabilitation (increased agreement of 13%, p < 0.001). However, participants still presented attitudes of wishing to continue to train or play if they had a concussion for fear of letting team-mates down, or if the injury was not noticeable. While positive attitudes are evolving, more work is required, particularly as attitudes towards concussion still appear to be situation dependent.

As an emergency service in the UK, the police require a 24-h presence to assist the most vulnerable in society. There is a need to consider the impact of providing a round-the-clock service on police officers and staff. Discussion on sleep and managing well-being whilst working shifts is urgently needed in order to protect the protectors, with both authors currently researching this critical area. This commentary, however, will focus on why such attention and discussions are required. Shift workers are exposed to acute and chronic sleep deprivation beyond those who work regular office hours [1]. Police staff are not immune. The 2019 National Police Wellbeing Survey [2] emphasized high, self-reported levels of sleep disturbance and reduced sleep duration, when compared to the general population [3]. Although the report [2] describes the difference in sleep, consideration should be given to the risks to...