The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees.

The aim of the present study was to evaluate the impact of Ramadan fasting on sleep quality and daytime sleepiness in team sport referees. Seventy-eight male amateur team sport referees (age: 31.1 ± 10.8 years) participated in this study. Participants responded to the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth sleepiness scale (ESS) questionnaires before (10-days prior) and during (last 7-days) the month of Ramadan.PSQI and ESS scores increased significantly during Ramadan (both p < .001, ES = 0.56 and 0.54, respectively) with 83.3% of participants scoring ≥5 in the PSQI. The percentage of participants suffering from severe excessive daytime sleepiness (ESS score ≥ 16) was 3.8% before vs. 7.7% during Ramadan (p < 0.001). Sleep duration decreased by ~ 1 h during Ramadan (p < .001, ES = 0.61) and was associated with a delay in bedtime of ~ 2 h (p < 0.001, ES = 0.7) and of wake-up time of ~ 1 h (p < 0.001, ES = 0.5). The score for daytime dysfunction and subjective sleep perception, as components of the PSQI, increased (both p < 0.001; ES = 0.79, ES = 0.57, respectively), whereas the score for the use of sleep medication decreased during vs. before Ramadan (p = 0.041, ES = 0.47). Ramadan fasting impaired sleep quality and increased daytime sleepiness in team sport referees. Future studies, using objective assessment tools, are warranted.

Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression.

OBJECTIVE: To evaluate the effect of observing Ramadan on athletes' sleep patterns. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The entire content of PubMed/MEDLINE and Web of Science. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Single-group, prepost and cross-over design studies conducted in athletes aged ≥18 years, training at least twice a week and published in English before 12 July 2018 were included. Studies assessing sleep quantity, quality, daytime sleepiness and/or daily naps based on objective or subjective methods were deemed eligible. STUDY APPRAISAL: The methodological quality was assessed using 'QualSyst'. RESULTS: Of 13 selected articles, 7 were of strong quality, 3 were moderate and 3 were weak. 11 studies evaluated total sleep time (TST); this decreased during Ramadan in 4 studies, increased in 1 and remained unchanged in 6. Pooled TST findings indicated a moderate effect size (- 0.97, SE=0.37, 95% CI -1.69 to -0.25, t=-2.64, p=0.01) with significant heterogeneity but no publication bias. Meta-regressions showed no effects of study year, age, sample size, type of sport or competition level, but there were effects of country (with France and Tunisia being the most affected countries and Turkey the least affected, Q=32.14, p<0.0001) and study design (Q=7.74, p=0.02). Four studies measured self-reported sleep quality and it decreased in three studies. One study of sleep architecture reported more frequent waking and more light sleep during Ramadan. Daily nap duration was increased in two studies, but daytime sleepiness remained unchanged in four studies. CONCLUSION: When athletes continue to train at least two times/week while observing Ramadan, TST is decreased compared with athletes' baseline levels.

Practical recommendations to improve sleep during Ramadan observance in healthy practitioners of physical activity.

BACKGROUND: During the month of Ramadan, many Muslims continue to exercise and/or to compete in sporting events. However, the combination of Ramadan observance (RO) and physical activity (PA) is likely to be associated with disrupted sleep-wake patterns. OBJECTIVES: to (i) evaluate the effects of RO on sleep patterns in practitioners of PA and (ii) provide some evidence-based practical recommendations to improve an active individual's sleep patterns during RO. METHODS: The entire content of two databases, PubMed/MEDLINE and Web of Science was searched for relevant articles through March, 25 2019. All accepted articles concerned healthy practitioners of PA and have assessed sleep quantity and/or quality and/or daily naps, whether based on objective or subjective methods. RESULTS: Thirteen studies evaluated total sleep time (TST) of active individuals in relation to RO; TST decreased in five studies, increased in one and remained unchanged in seven studies. Sleep quality was self-estimated in five studies, with three noting a decreased quality of sleep and two reporting no change. The duration of daily naps was increased in two studies. Conclusions and practical recommendations: Continuation of PA during RO did not decrease TST. However, no firm conclusions can be drawn regarding sleep quality/characteristic and daily naps durations. Sleep quantity and quality should be evaluated in order to counteract sleep disturbances. Physically active individuals should avoid large late night meal, and if possible take 20- to 30- minute daytime naps. A 10- minute shower at ∼40°C and a self-administered 6-min mindfulness induction video may be helpful immediately before bedtime. Tryptophan (1g/day) or melatonin (5- 8mg) supplements may also improve sleep characteristics.