Anomalous Perceptual Experience During Ultra-Endurance Sport: A Systematic Review.
Elizabeth E Davidson, Sean L Davidson, Paul Glue
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In 30 seconds
This systematic review examined anomalous perceptual experiences (APEs) in adults participating in ultra-endurance sports lasting at least 6 hours. Fourteen studies were included: 4 case reports, 4 case series, 4 field studies, and 2 cross-sectional surveys. APEs were described across several sports and commonly involved visual experiences, with auditory, somatic, and sensed-presence phenomena also reported. Sleep deprivation was the most consistent contributing factor, followed by exhaustion and low-light conditions; experiences typically emerged after ≥24 h of exertion, particularly in darkness. No long-term psychiatric sequelae were reported.
Key findings
- Fourteen studies met inclusion criteria: 4 case reports, 4 case series, 4 field studies, and 2 cross-sectional surveys.
- Sleep deprivation was the most consistent contributing factor, followed by exhaustion and low-light conditions.
- Experiences typically emerged after ≥24 h of exertion, especially in darkness.
- No long-term psychiatric sequelae were reported; interpretations of APEs ranged from distressing to neutral or supportive.
Why it matters
Recognising that perceptual experiences can occur during prolonged exertion may help distinguish transient responses to extreme physiological and environmental stress from psychiatric illness. Their association with sleep deprivation, exhaustion, and darkness also makes them relevant to athlete safety and event planning. The review highlights that inconsistent terminology limits comparisons across studies and understanding of prevalence and mechanisms.
What to keep in mind
The evidence base comprised only 14 studies, including case reports and case series, and the review describes fragmented literature with inconsistent terminology.