Author(s): CUI, X., PENG, Z., JIALIN, W., SHUYI, N., ZHOUPENG, L., Institution: CHINA INSTITUTE OF SPORT SCINENCE, Country: CHINA, Abstract-ID: 1176

INTRODUCTION: High-performance athletes face substantial physiological and psychological demands, making optimal sleep critical for recovery and performance. However, chronic insomnia is prevalent and detrimental in this population, yet evidence-based interventions like Cognitive Behavioral Therapy for Insomnia (CBT-I) remain understudied in athletic contexts.
METHODS: This prospective, non-randomized, parallel-group quasi-experimental trial enrolled elite track cycling and BMX athletes (aged 18-35) meeting ICSD-3 criteria for chronic insomnia. Participants were cluster-allocated from 6 training bases (three per group) to receive either a 6-week, face-to face CBT-I protocol (n=15; sleep hygiene, sleep restriction, relaxation therapy, stimulus control, cognitive restructuring) or a sleep education control (n=15). Assessments at baseline, post-intervention (6 weeks), and 6-month follow-up after intervention included the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Athlete Sleep Screening Questionnaire (ASSQ) sleep difficulty score (SDS), sleep diary parameters, cognitive pre-sleep arousal (PSAcog), heart rate variability (HRV) during sleep, the Short Recovery and Stress Scale (SRSS), and subjective performance ratings from 0 (terrible) to 10 (perfect). Data were analyzed using two-way ANOVA and ANCOVA, reporting 95% CIs and Cohen's d.
RESULTS: Of 30 participants, 29 completed the 6-month follow-up (CBT-I: n=14; control: n=15). Compared to controls, the CBT-I group demonstrated significantly greater reductions in ISI (post-intervention: -10.6 points, 95% CI, -5.42 to -17.04; 6-month: -8.2 points, 95% CI, -2.42 to -12.16), PSQI (post-intervention: -4.5 points, 95% CI, -7.41 to -2.04; 6-month: -3.9 points, 95% CI, -6.64 to -2.94), and ASSQ-SDS scores (post-intervention: -4.1 points, 95% CI, -6.91 to -2.05; 6-month: -3.8 points, 95% CI, -6.09 to -1.14). Post-intervention sleep diary measures showed greater improvements in the CBT-I group for sleep efficiency (+9.3%, p < 0.05), sleep onset latency (-0.5 h, p < 0.05), nocturnal awakenings (-1.8, p < 0.05), and PSAcog (-10.8 points, 95% CI, -5.12 to -17.93). HRV indices (RMSSD: +19.5 ms, 95% CI, 25.11 to10.42 ) and the SRSS recovery score (5.3 points, 95% CI, 9.72 to 2.14) improved significantly post-intervention in the CBT-I group. Subjective athletic performance ratings were significantly higher in the CBT-I group at both post-intervention (2.2 points, p < 0.05) and 6-month follow-up (+2.0 points, p < 0.05). No serious adverse effects were reported.
CONCLUSION: In elite athletes with chronic insomnia, a 6-week CBT-I intervention significantly improved sleep quality, autonomic recovery, and perceived athletic performance, with benefits sustained at 6 months. These findings support the integration of CBT-I into sports medicine practice to address clinically significant insomnia in athletes. Future randomized controlled trials with larger samples and objective performance measure.