Firefighting is a mentally and physically demanding profession which is compounded by poor sleep due to shift schedules commonly used by fire departments. Compared to other professions, firefighters are at high risk for musculoskeletal injuries, mental illnesses, and cardiovascular diseases. The purpose of this study was to systemically review the effects of sleep on firefighter occupational performance and health. A search was conducted for studies that conducted a quantitative analysis involving sleep and occupational performance in firefighters. Relevant data were extracted and study quality evaluated with Newcastle-Ottawa Scale. There were 15 articles meeting the inclusion criteria with a total sample of 1591 (1539 male, 52 female) firefighters. We found that firefighters with poor sleep measures had worse cognitive performance and overall health, but physical capabilities were not impacted by acute sleep restriction. However, chronic poor sleep would likely negatively impact physical performance due to being associated with a decline in numerous health measures. To avoid sleep-related declines in occupational performance fire departments should consider the consequences of shift schedules on the performance and health of firefighters. Furthermore, sleep education interventions, the use of wearables to monitor, recovery and sleep health screening appear beneficial based on prior research.