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

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 (χ ² = 222.6; p < 0.001) and training volume (χ ² = 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.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Romdhani, Ammar, Trabelsi, Chtourou, Vitale, Masmoudi, Nédélec, Rae, Al Horani, Ben Saad, Bragazzi, Dönmez, Dergaa, Driss, Farooq, Hammouda, Harroum, Hassanmirzaei, Khalladi, Khemila, Mataruna-Dos-Santos, Moussa-Chamari, Mujika, Muñoz Helú, Norouzi Fashkhami, Paineiras-Domingos, Khaneghah, Saita, Souabni, Souissi, Washif, Weber, Zmijewski, Taylor, Garbarino and Chamari.)