Does observance of Ramadan affect sleep in athletes and physically active individuals? A systematic review and meta-analysis

Khaled Trabelsi; Achraf Ammar; Jordan M Glenn; Omar Boukhris; Aimen Khacharem; Bassem Bouaziz; Piotr Zmijewski; Paola Lanteri; Sergio Garbarino; Cain C T Clark; Karim Chamari; Nicola L Bragazzi; David Hill; Hamdi Chtourou

doi:10.1111/jsr.13503

Does observance of Ramadan affect sleep in athletes and physically active individuals? A systematic review and meta-analysis

J Sleep Res. 2022 Jun;31(3):e13503. doi: 10.1111/jsr.13503. Epub 2021 Oct 24.

Authors

Khaled Trabelsi^{1

2}, Achraf Ammar^{3

4}, Jordan M Glenn⁵, Omar Boukhris⁶, Aimen Khacharem⁷, Bassem Bouaziz⁸, Piotr Zmijewski⁹, Paola Lanteri¹⁰, Sergio Garbarino¹¹, Cain C T Clark¹², Karim Chamari^{13

14}, Nicola L Bragazzi^{15

16}, David Hill¹⁷, Hamdi Chtourou^{2

6}

Affiliations

¹ Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, Tunisia.
² High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
³ Institute of Sport Science, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
⁴ Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France.
⁵ Department of Health, Exercise Science Research Center Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA.
⁶ Research Unit, "Physical Activity, Sport and Health", UR18JS01, National Observatory of Sport, Tunis, Tunisia.
⁷ LIRTES (EA 7313), UFR SESS-STAPS, Paris-East Créteil University, Créteil, France.
⁸ Higher Institute of Computer Science and Multimedia of Sfax, University of Sfax, Sfax, Tunisia.
⁹ Jozef Pilsudski University of Physical Education in Warsaw, Warsaw, Poland.
¹⁰ Neurophysiopathology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy.
¹¹ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
¹² Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
¹³ ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
¹⁴ Laboratory "Sport Performance Optimization", (CNMSS); ISSEP Ksar-Said, Manouba University, Manouba, Tunisia.
¹⁵ Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.
¹⁶ Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, ON, Canada.
¹⁷ Applied Physiology Laboratory, Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, Texas, USA.

PMID: 34693577
DOI: 10.1111/jsr.13503

Abstract

The purpose of this systematic review and meta-analysis is to provide an accurate description of the effect of Ramadan observance on sleep duration, sleep quality, daily nap duration, and daytime sleepiness in athletes and physically active individuals. Five electronic databases (PubMed, Web of Science, Scopus, Wiley, and Taylor and Francis) were used to search for relevant studies conducted with athletes or physically active individuals during Ramadan, published in any language, and available before May 23, 2021. Studies that included assessments of sleep quantity and/or quality, and/or daytime sleepiness, and/or daily naps in athletes and physically active individuals were included. The methodological quality of the studies was assessed using "QualSyst". Of the 18 papers included in this study (298 participants in total), 14 were of strong quality, two were moderate, and the remaining two were rated as weak. Individuals who continued to train during Ramadan experienced a decrease in sleep duration (number of studies, K = 17, number of participants, N = 289, g = -0.766, 95% confidence interval [CI] -1.199 to -0.333, p = 0.001). Additionally, the global score of the Pittsburgh Sleep Quality Index increased from 4.053 (K = 5, N = 65, 95% CI 3.071-5.034) pre-Ramadan, to 5.346 (95% CI 4.362-6.333) during Ramadan, indicating a decrease in sleep quality. The duration of daytime naps increased during compared to pre-Ramadan (K = 2, N = 31, g = 1.020, 95% CI 0.595-1.445, p = 0.000), whereas Epworth Sleepiness Scale scores remained unchanged during versus pre-Ramadan (K = 3, N = 31, g = 0.190, 95% CI -0.139-0.519, p = 0.257). In conclusion, individuals who continued to train during Ramadan experienced a decrease in sleep duration, impairment of sleep quality, and increase in daytime nap duration, with no change in daytime sleepiness levels.

Keywords: Ramadan observance; athlete; daytime sleepiness; nap; physical activity; sleep-wake patterns.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Athletes
Disorders of Excessive Somnolence*
Fasting
Humans
Islam*
Sleep