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 ( = 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: () Pittsburgh sleep quality index (PSQI); () insomnia severity index (ISI); () bespoke questions about training, napping, and eating behaviors, and () 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 < 0.001). Compared to non-Muslim ( = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both < 0.001), but not pre-lockdown ( > 0.05). Muslim athletes reported longer ( < 0.001; = 0.29) and later ( < 0.001; = 0.14) daytime naps, and an increase in late-night meals ( < 0.001; = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ = 222.6; < 0.001) and training volume (χ = 342.4; < 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.