AUTHOR=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 

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

JOURNAL=Frontiers in Nutrition

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.925092

DOI=10.3389/fnut.2022.925092

ISSN=2296-861X

ABSTRACT=<sec><title>Objective</title><p>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.</p></sec><sec><title>Methods</title><p>From an international sample of athletes (<italic>n</italic> = 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: (<bold>i</bold>) Pittsburgh sleep quality index (PSQI); (<bold>ii</bold>) insomnia severity index (ISI); (<bold>iii</bold>) bespoke questions about training, napping, and eating behaviors, and (<bold>iv</bold>) 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.</p></sec><sec><title>Results</title><p>The lockdown reduced sleep quality and increased insomnia severity (both <italic>p</italic> &lt; 0.001). Compared to non-Muslim (<italic>n</italic> = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both <italic>p</italic> &lt; 0.001), but not pre-lockdown (<italic>p</italic> &gt; 0.05). Muslim athletes reported longer (<italic>p</italic> &lt; 0.001; <italic>d</italic> = 0.29) and later (<italic>p</italic> &lt; 0.001; <italic>d</italic> = 0.14) daytime naps, and an increase in late-night meals (<italic>p</italic> &lt; 0.001; <italic>d</italic> = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p &lt; 0.001). Both sleep quality (χ<sup>2</sup> = 222.6; <italic>p</italic> &lt; 0.001) and training volume (χ<sup>2</sup> = 342.4; <italic>p</italic> &lt; 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes.</p></sec><sec><title>Conclusion</title><p>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.</p></sec>