Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors : A International Survey on 1,681 Muslim Athletes

Romdhani, Mohamed; Ammar, Achraf; Trabelsi, Khaled; Chtourou, Hamdi; Vitale, Jacopo A; Masmoudi, Liwa; Nédélec, Mathieu; Rae, Dale E; Al Horani, Ramzi A; Ben Saad, Helmi; Bragazzi, Nicola; Dönmez, Gürhan; Dergaa, Ismail; Driss, Tarak; Farooq, Abdulaziz; Hammouda, Omar; Harroum, Nesrine; Hassanmirzaei, Bahar; Khalladi, Karim; Khemila, Syrine; Mataruna-Dos-Santos, Leonardo Jose; Moussa-Chamari, Imen; Mujika, Iñigo; Muñoz Helú, Hussein; Norouzi Fashkhami, Amin; Paineiras-Domingos, Laisa Liane; Khaneghah, Mehrshad Rahbari; Saita, Yoshitomo; Souabni, Maher; Souissi, Nizar; Washif, Jad Adrian; Weber, Johanna; Zmijewski, Piotr; Taylor, Lee; Garbarino, Sergio; Chamari, Karim

Methods
From an international sample of athletes (n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: (i) Pittsburgh sleep quality index (PSQI); (ii) insomnia severity index (ISI); (iii) bespoke questions about training, napping, and eating behaviors, and (iv) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim (n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown (p > 0.05). Muslim athletes reported longer (p < 0.001; d = 0.29) and later (p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals (p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ2 = 222.6; p < 0.001) and training volume (χ2 = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes.

Conclusion

Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan.

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