Ramadan observance exacerbated the negative effects of COVID-19 lockdown on sleep and training behaviors: a international survey on 1,681 Muslim athletes

• Main Authors: M Romdhani, A Ammar, K Trabelsi, H Chtourou, JA Vitale, L Masmoudi, M Nédélec, DE Rae, RA Al Horani, H Ben Saad, N Bragazzi, G Dönmez, I Dergaa, T Driss, A Farooq, O Hammouda, N Harroum, B Hassanmirzaei, K Khalladi, S Khemila, LJ Mataruna-Dos-Santos, I Moussa-Chamari, I Mujika, H Muñoz Helú, A Norouzi Fashkhami, LL Paineiras-Domingos, MR Khaneghah, Y Saita, M Souabni, N Souissi, JA Washif, J Weber, P Zmijewski, Lee Taylor, S Garbarino, K Chamari
• Format: Article
• Language: English
• Subjects: Agricultural biotechnology; confinement; Nutrition and dietetics; pandemic; religious fasting; sleep-wake pattern; training load

Objective: Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes.  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 survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020.  Results: 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.