Lockdown Duration and Training Intensity Affect Sleep Behavior in an International Sample of 1,454 Elite Athletes

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

doi:10.3389/fphys.2022.904778

Lockdown Duration and Training Intensity Affect Sleep Behavior in an International Sample of 1,454 Elite Athletes

Front Physiol. 2022 Jun 15:13:904778. doi: 10.3389/fphys.2022.904778. eCollection 2022.

Authors

Mohamed Romdhani^{1

2}, Hugh H K Fullagar³, Jacopo A Vitale⁴, Mathieu Nédélec⁵, Dale E Rae⁶, Achraf Ammar^{7

8}, Hamdi Chtourou^{1

2}, Ramzi A Al Horani⁹, Helmi Ben Saad¹⁰, Nicola Luigi Bragazzi^{11

12}, Gürhan Dönmez¹³, Ismail Dergaa¹⁴, Tarak Driss⁸, Abdulaziz Farooq¹⁵, Omar Hammouda^{8

16}, Nesrine Harroum¹⁷, Bahar Hassanmirzaei^{18

19}, Karim Khalladi¹⁵, Syrine Khemila^{2

20}, Leonardo Jose Mataruna-Dos-Santos^{21

22}, Imen Moussa-Chamari²³, Iñigo Mujika^{24

25}, Hussein Muñoz Helú²⁶, Amin Norouzi Fashkhami²⁷, Laisa Liane Paineiras-Domingos^{28

29}, Mehrshad Rahbari Khaneghah²⁷, Yoshitomo Saita³⁰, Nizar Souissi^{2

20}, Khaled Trabelsi^{1

31}, Jad Adrian Washif³², Johanna Weber^{33

34}, Piotr Zmijewski³⁵, Lee Taylor^{36

37}, Sergio Garbarino^{38

39}, Karim Chamari¹⁵

Affiliations

¹ High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia.
² Physical Activity, Sport and Health, UR18JS01, National Observatory of Sports, Tunis, Tunisia.
³ School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
⁴ IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
⁵ Research Unit, Laboratory Sport, Expertise and Performance (EA7370), The French National Institute of Sport (INSEP), Paris, France.
⁶ Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁷ Institute of Sport Science, Otto-Von-Guericke University, Magdeburg, Germany.
⁸ Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France.
⁹ Department of Exercise Science, Yarmouk University, Irbid, Jordan.
¹⁰ Laboratoire de Recherche (LR12SP09) "Insuffisance Cardiaque", Hôpital Farhat HACHED, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia.
¹¹ Department of Health Sciences, Postgraduate School of Public Health, University of Genoa, Genoa, Italy.
¹² Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada.
¹³ Department of Sports Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
¹⁴ Primary Health Care Corporation (PHCC), Doha, Qatar.
¹⁵ Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar.
¹⁶ Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
¹⁷ School of Kinesiology and Physical Activity Science, Faculty of Medicine, Montreal University, Montreal, QC, Canada.
¹⁸ Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
¹⁹ Iran Football Medical Assessment and Rehabilitation Center, IFMARC, FIFA Medical Center of Excellence, Tehran, Iran.
²⁰ High Institute of Sports and Physical Education Ksar-Said, Manouba University, Manouba, Tunisia.
²¹ Department of Sport Management, Faculty of Management, Canadian University of Dubai, Dubai, United Arab Emirates.
²² Coventry University-Centre for Trust, Peace and Social Relation, Coventry, United Kingdom, United Kingdom.
²³ Physical Education Department, College of Education, Qatar University, Doha, Qatar.
²⁴ Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Bilbao, Spain.
²⁵ Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile.
²⁶ Department of Economic-Administrative Sciences, Universidad Autónoma de Occidente, Culiacán, Mexico.
²⁷ Esteghlal Physiotherapy Clinic, EPC, Teheran, Iran.
²⁸ Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
²⁹ Departamento de Fisioterapia, Instituto Multidisciplinar de Reabilitação e Saúde, Universidade Federal da Bahia, Salvador, Brazil.
³⁰ Department of Sports and Regenerative Medicine, Juntendo University, Tokyo, Japan.
³¹ Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, Tunisia.
³² Sports Performance Division, National Sports Institute of Malaysia, Kuala Lumpur, Malaysia.
³³ Neurocognition and Action-Biomechanics, Bielefeld University, Bielefeld, Germany.
³⁴ Institute for Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany.
³⁵ Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland.
³⁶ School of Sport, Exercise and Health Sciences, National Center for Sport and Exercise Medicine (NCSEM), Loughborough University, Loughborough, United Kingdom.
³⁷ Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.
³⁸ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy.
³⁹ Post-Graduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.

Abstract

Objective: To investigate the effect of 1) lockdown duration and 2) training intensity on sleep quality and insomnia symptoms in elite athletes. Methods: 1,454 elite athletes (24.1 ± 6.7 years; 42% female; 41% individual sports) from 40 countries answered a retrospective, cross-sectional, web-based questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: 1) Pittsburgh sleep quality index (PSQI); 2) Insomnia severity index (ISI); bespoke questions about 3) napping; and 4) training behaviors. The association between dependent (PSQI and ISI) and independent variables (sleep, napping and training behaviors) was determined with multiple regression and is reported as semi-partial correlation coefficient squared (in percentage). Results: 15% of the sample spent < 1 month, 27% spent 1-2 months and 58% spent > 2 months in lockdown. 29% self-reported maintaining the same training intensity during-lockdown whilst 71% reduced training intensity. PSQI (4.1 ± 2.4 to 5.8 ± 3.1; mean difference (MD): 1.7; 95% confidence interval of the difference (95% CI): 1.6-1.9) and ISI (5.1 ± 4.7 to 7.7 ± 6.4; MD: 2.6; 95% CI: 2.3-2.9) scores were higher during-compared to pre-lockdown, associated (all p < 0.001) with longer sleep onset latency (PSQI: 28%; ISI: 23%), later bedtime (PSQI: 13%; ISI: 14%) and later preferred time of day to train (PSQI: 9%; ISI: 5%) during-lockdown. Those who reduced training intensity during-lockdown showed higher PSQI (p < 0.001; MD: 1.25; 95% CI: 0.87-1.63) and ISI (p < 0.001; MD: 2.5; 95% CI: 1.72-3.27) scores compared to those who maintained training intensity. Although PSQI score was not affected by the lockdown duration, ISI score was higher in athletes who spent > 2 months confined compared to those who spent < 1 month (p < 0.001; MD: 1.28; 95% CI: 0.26-2.3). Conclusion: Reducing training intensity during the COVID-19-induced lockdown was associated with lower sleep quality and higher insomnia severity in elite athletes. Lockdown duration had further disrupting effects on elite athletes' sleep behavior. These findings could be of relevance in future lockdown or lockdown-like situations (e.g., prolonged illness, injury, and quarantine after international travel).

Keywords: highly-trained athletes; home-confinement duration; pandemic (COVID-19); sleep disturbance; training load.

Copyright © 2022 Romdhani, Fullagar, Vitale, Nédélec, Rae, Ammar, Chtourou, 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, Souissi, Trabelsi, Washif, Weber, Zmijewski, Taylor, Garbarino and Chamari.