Sleep Patterns Among Athletes and Non-Athletes During Ramadan intermittent fasting: Systematic Review, Meta‑Analysis and Meta‑Regression
Keywords:
Sleep, Ramadan, Athlete, Meta-analysis, Public healthAbstract
Background. Ramadan fasting is a religious observance practiced regularly by Muslims and may have an effect on sleep quality, especially for athletes. Our systematic review with meta-analysis aims to identify the effect of Ramadan observance on the sleep patterns of athletes and non-athletes during Ramadan fasting over the teen years (2014-2024).
Study design. A systematic search of Scopus, Web of Science, and Pubmed, was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Methods. After a deep search in the three databases, we downloaded all the references that respected our request. all the references were imported into the COVIDENCE platform. Two independent researchers were designated to look for the criteria inclusion and to appraise each study. A third reviewer resolved conflicts if there is a divergence of judgment. Then, we obtained an Excel file that compiles all the data collected. The meta-analysis and meta-regression were compilated.
Results. 345 documents were found. Of these, 14 respected all the criteria. Our findings revealed that while sleep latency and di- sturbance remained unaffected by Ramadan, sleep duration and efficiency were negatively impacted, particularly among amateur athletes. Interestingly, the overall sleep quality, daytime dysfunction, and subjective sleep quality showed a positive impact from Ramadan, which was more evident among amateur athletes.
Conclusions. In the context of Ramadan fasting, these results suggest that Ramadan has a negative impact on the sleep patterns of athletes and non-athletes.
References
1. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med. 2016 Nov 15;12(11):1549-1561. doi: 10.5664/jcsm.6288. PMID: 27707447.
2. Bird SP. Sleep, Recovery, and Athletic Performance: A Brief Review and Recommendations. Strength Conditioning J. 2013;35(5): 43-47. doi: 10.1519/SSC.0b013e3182a62e2f.
3. Charest J, Grandner MA. Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin. 2020; Mar;15(1):41-57. doi: 10.1016/j.jsmc.2019.11.005. PMID: 32005349.
4. Thun E, Bjorvatn B, Flo E, Harris A, Pallesen S. Sleep, circadian rhythms, and athletic performance. Sleep Med Rev. 2015 Oct;23:1-9. doi: 10.1016/j.smrv.2014.11.003. Epub 2014 Nov 20. PMID: 25645125.
5. Mah CD, Mah KE, Kezirian EJ, Dement WC. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 2011 Jul 1;34(7):943-50. doi: 10.5665/SLEEP.1132. PMID: 21731144.
6. Schwartz J, Simon RD, Jr. Sleep extension improves serving accuracy: A study with college varsity tennis players. Physiol Behav. 2015 Nov. 1;151:541-4. doi: 10.1016/j.physbeh.2015.08.035. Epub 2015 Sep 1. PMID: 26325012.
7. Roky R, Chapotot F, Hakkou F, Benchekroun MT, Buguet A. Sleep during Ramadan intermittent fasting. Journal Sleep Res. 2001 Dec;10(4):319-27. doi: 10.1046/j.1365-2869.2001.00269.x. PMID: 11903862.
8. BaHammam A. Assessment of sleep patterns, daytime sleepiness, and chronotype during Ramadan in fasting and nonfasting individuals. Saudi Med J. 2005 Apr;26(4):616-22. PMID: 15900372.
9. Chaouachi A, Leiper JB, Chtourou H, Aziz AR, Chamari K. The effects of Ramadan intermittent fasting on athletic performance: recommendations for the maintenance of physical fitness. J Sport Sci. 2012;30 Suppl 1:S53-73. doi: 10.1080/02640414.2012.698297. Epub 2012 Jun 27. PMID: 22738880.
10. Aziz AR, Che Muhamed AM, Roslan SR, Ghulam Mohamed N, Singh R, Chia MYH. Poorer Intermittent Sprints Performance in Ramadan-Fasted Muslim Footballers despite Controlling for Pre-Exercise Dietary Intake, Sleep and Training Load. Sports (Basel, Switzerland). 2017 Jan;5(1):4. doi: 10.3390/sports5010004. PMID: 29910364.
11. Qasrawi SO, Pandi-Perumal SR, BaHammam AS. The effect of intermittent fasting during Ramadan on sleep, sleepiness, cognitive function, and circadian rhythm. Sleep Breath. 2017 Sep;21(3):577-86. doi: 10.1007/s11325-017-1473-x. Epub 2017 Feb 11. PMID: 28190167.
12. Faris MAE, Jahrami HA, Alhayki FA, Alkhawaja NA, Ali AM, Aljeeb SH, et al. Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis. Sleep Breath. 2020 Jun;24(2):771-82. doi: 10.1007/s11325-019-01986-1. Epub 2019 Dec 12. PMID: 31832984.
13. Trabelsi K, Bragazzi N, Zlitni S, Khacharem A, Boukhris O, El-Abed K, et al. Observing Ramadan and sleep-wake patterns in athletes: a systematic review, meta-analysis and meta-regression. Br J Sports Med. 2020 Jun;54(11):674-80. doi: 10.1136/bjsports-2018-099898. Epub 2019 Jun 1. PMID: 31154342.
14. Trabelsi K, Ammar A, Glenn JM, Boukhris O, Khacharem A, Bouaziz B, et al. Does observance of Ramadan affect sleep in athletes and physically active individuals? A systematic review and meta-analysis. J Sleep Res. 2021 Oct 24:e13503. doi: 10.1111/jsr.13503. Epub 2021 Oct 24. PMID: 34693577.
15. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4. PMID: 2748771.
16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed). 2021 Mar 29;372:n71. doi: 10.1136/bmj.n71.
17. Kmet LM, Cook LS, Lee RC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research (AHFMR) /HTA Report (AHFMR); 2004. https://doi.org/10.7939/R37M04F16.
18. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 1986/09/01/;7(3):177-88. doi: 10.1016/0197-2456(86)90046-2. PMID: 3802833.
19. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. The Cochrane Collaboration; 2019. doi: 10.1002/9781119536604.
20. Morris SB. Estimating Effect Sizes From Pretest-Posttest-Control Group Designs. 2008;11(2):364-86. doi: 10.1177/1094428106291059.
21. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed). 2003 Sep 6;327(7414):557-60. doi: 10.1136/bmj.327.7414.557. PMID: 12958120.
22. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994 Dec;50(4):1088-101. PMID: 7786990.
23. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997 Sep 13;315(7109):629-34. doi: 10.1136/bmj.315.7109.629. PMID: 9310563.
24. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000 Jun;56(2):455-63. doi: 10.1111/j.0006-341x.2000.00455.x. PMID: 10877304.
25. Aziz AR, Che Muhamed AM, Ooi CH, Singh R, Chia MYH. Effects of Ramadan fasting on the physical activity profile of trained Muslim soccer players during a 90-minute match. Science and Medicine in Football. 2018 Jan;2(1):29-38. doi: 10.1080/24733938.2017.1393550.
26. Boukhris O, Hsouna H, Chtourou L, Abdesalem R, Bensalem S, Tahri N, et al. Effect of Ramadan fasting on feelings, dietary intake, rating of perceived exertion and repeated high intensity short-term maximal performance. Chronobiol Int. 2019 Jan 2;36(1):1-10. doi: 10.1080/07420528.2018.1513943. PMID: 30207750.
27. Boukhris O, Trabelsi K, Shephard RJ, Hsouna H, Abdessalem R, Chtourou L, et al. Sleep Patterns, Alertness, Dietary Intake, Muscle Soreness, Fatigue, and Mental Stress Recorded before, during and after Ramadan Observance. Sports (Basel). 2019 May 17;7(5):118. doi: 10.3390/sports7050118. PMID: 31109004.
28. Hsouna H, Abdessalem R, Boukhris O, Trabelsi K, Chtourou L, Tahri N, et al. Short-term maximal performance, alertness, dietary intake, sleep pattern and mood states of physically active young men before, during and after Ramadan observance. Plos One. 2019 Jun 4;14(6):e0217851. doi: 10.1371/journal.pone.0217851. PMID: 31163075.
29. L, Tahri N, et al. Short-term maximal performance, alertness, dietary intake, sleep pattern and mood states of physically active young men before, during and after Ramadan observance. Plos One. 2019 Jun 4;14(6):e0217851. doi: 10.1371/journal.pone.0217851. PMID: 31163075.
30. Aziz AR, Lim DSL, Sahrom S, Che Muhamed AM, Ihsan M, Girard O, et al. Effects of Ramadan fasting on match-related changes in skill performance in elite Muslim badminton players. Sci Sports. 2020 Oct;35(5):308.e1-.e10. doi: 10.1016/j.scispo.2019.07.014.
31. Hsouna H, Boukhris O, Trabelsi K, Abdessalem R, Ammar A, Glenn JM, et al. A Thirty-Five-Minute Nap Improves Performance and Attention in the 5-m Shuttle Run Test during and outside Ramadan Observance. Sports (Basel). 2020 Jul; 8(7): 98. doi: 10.3390/sports8070098. PMID: 32664557.
32. Hsouna H, Boukhris O, Trabelsi K, Abdessalem R, Ammar A, Irandoust K, et al. Effects of 25-Min Nap Opportunity during Ramadan Observance on the 5-m Shuttle Run Performance and the Perception of Fatigue in Physically Active Men. Int J Environ Res Public Health. 2020 Apr 30;17(9):3135. doi: 10.3390/ijerph17093135. PMID: 32365914.
33. Lipert A, Kozłowski R, Rasmus P, Marczak M, Timler M, Timler D, et al. Sleep Quality and Performance in Professional Athletes Fasting during the Month of Ramadan. Int J Environ Res Public Health. 2021 Jul 27; 18(13): 6890. doi: 10.3390/ijerph18136890. PMID: 34198990.
34. Saddoud A, Khacharem A, H’Mida C, Trabelsi K, Boukhris O, Ammar A, et al. Ramadan Observance Is Associated with Impaired Kung-Fu-Specific Decision-Making Skills. Int J Environ Res Public Health. 2021 Jul 9; 18(14). 7340. doi: 10.3390/ijerph18147340. PMID: 34299791.
35. Boukhris O, Hill DW, Ammar A, Trabelsi K, Hsouna H, Abdessalem R, et al. Longer Nap Duration During Ramadan Observance Positively Impacts 5-m Shuttle Run Test Performance Performed in the Afternoon. Front Physiol. 2022 Feb 9;13:811435. doi: 10.3389/fphys.2022.811435. PMID: 35222079.
36. El-Jaziz A, Lofti S. How do chronotype and sleep patterns impact young athletes’ aerobic performance during Ramadan intermittent fasting? Ann Ig. 2023 Nov-Dec;35(6):683-94. doi: 10.7416/ai.2023.2574. PMID: 37796472.
37. EL-jaziz A, Lotfi S. Chronotype, sleep, and perceived exertion during intermittent fasting in young athletes. Swiss Sports & Exercise Medicine 2023;36(4). doi: 10.34045/SEMS/2023/36.
38. El-Jaziz A, Lotfi S. Chronotype, Aerobic Performance, and Sleep Quality of Young Athletes Before and During Ramadan Observance. Sleep Med Res. 2023;14(2):98-104. doi: 10.17241/smr.2023.017241.
39. Lipert A, Kozłowski R, Rasmus P, Marczak M, Timler M, Timler D, et al. Sleep Quality and Performance in Professional Athletes Fasting during the Month of Ramadan. Int J Environ Res Public Health. 2021 Jun 27;18(13). doi: 10.3390/ijerph18136890. PMID: 34198990.
40. Chtourou H, Chtourou L, Trabelsi K, Tahri N, Souissi N. Possible gastrointestinal disorders for athletes during Ramadan: an overview. Biol Rhythm Res. 2018 Jan;49(1):51-60. doi: 10.1080/09291016.2017.1333196.
41. Drew M, Vlahovich N, Hughes D, Appaneal R, Burke LM, Lundy B, et al. Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games. Br J Sports Med. 2018 Jan;52(1):47-53. doi: 10.1136/bjsports-2017-098208. Epub 2017 Oct 22. PMID: 29056598.
42. Nakajima K. Unhealthy eating habits around sleep and sleep duration: To eat or fast? World J Diabetes. 2018 Nov 15;9(11):190-4. doi: 10.4239/wjd.v9.i11.190. PMID: 30479684.
43. Chamari K, Briki W, Farooq A, Patrick T, Belfekih T, Herrera CP. Impact of Ramadan intermittent fasting on cognitive function in trained cyclists: a pilot study. Biol Sport. 2016 Mar;33(1):49-56. doi: 10.5604/20831862.1185888. Epub 2015 Dec 30. PMID: 26985134.
44. Maughan RJ, Shirreffs SM. Hydration and performance during Ramadan. J Sports Sci. 2012 Jun;30 Suppl 1:S33-S41. doi: 10.1080/02640414.2012.688140. Epub 2012 May 18. PMID: 22594964.
45. Herrera CP. Total sleep time in Muslim football players is reduced during Ramadan: a pilot study on the standardized assessment of subjective sleep-wake patterns in athletes. J Sports Sci. 2012;30 Suppl 1:S85-91. doi: 10.1080/02640414.2012.676666. Epub 2012 Apr 10. PMID: 22489547.
46. Bahammam AS, Almushailhi K, Pandi-Perumal SR, Sharif MM. Intermittent fasting during Ramadan: does it affect sleep? J Sleep Res. 2014 Feb;23(1):35-43. doi: 10.1111/jsr.12076. Epub 2013 Aug 12. PMID: 23937329.
47. Khemila S, Romdhani M, Farjallah MA, Abid R, Bentouati E, Souissi MA, et al. Effects of Ramadan fasting on the diurnal variations of physical and cognitive performances at rest and after exercise in professional football players. Front Psychol. 2023 Mar 28;14:1148845. doi: 10.3389/fpsyg.2023.1148845. PMID: 37057155.
48. Romdhani M, Ammar A, Trabelsi K, Chtourou H, Vitale JA, Masmoudi L, et al. Ramadan Observance Exacerbated the Negative Effects of COVID-19 Lockdown on Sleep and Training Behaviors: A International Survey on 1,681 Muslim Athletes. Front Nutr. 2022 Jun 30;9:925092. doi: 10.3389/fnut.2022.925092. PMID: 35845770.
49. Reed DL, Sacco WP. Measuring Sleep Efficiency: What Should the Denominator Be? J Clin Sleep Med. 2016 Feb;12(2):263-6. doi: 10.5664/jcsm.5498. PMID: 26194727.
50. Aziz AR, Wahid MF, Png W, Jesuvadian CV. Effects of Ramadan fasting on 60 min of endurance running performance in moderately trained men. Br J Sports Med. 2010 Jun;44(7):516-21. doi: 10.1136/bjsm.2009.070425. PMID: 20519256.
51. Bouhlel H, Shephard RJ, Gmada N, Aouichaoui C, Peres G, Tabka Z, et al. Effect of Ramadan observance on maximal muscular performance of trained men. Clin J Sport Med. 2013 May;23(3):222-7. doi: 10.1097/JSM.0b013e318275d213. PMID: 23160275.
52. Leiper JB, Junge A, Maughan RJ, Zerguini Y, Dvorak J. Alteration of subjective feelings in football players undertaking their usual training and match schedule during the Ramadan fast. J Sports Sci. 2008 Dec;26 Suppl 3:S55-S69. doi: 10.1080/02640410802538176. PMID: 19085453.
53. Almeneessier AS, BaHammam AS. How does diurnal intermittent fasting impact sleep, daytime sleepiness, and markers of the biological clock? Current insights. Nat Sci Sleep. 2018 Dec 7;10:439-52. doi: 10.2147/NSS.S165637. PMID: 30573998.
54. Faris AE, Jahrami HA, Alsibai J, Obaideen AA. Impact of Ramadan diurnal intermittent fasting on the metabolic syndrome components in healthy, non-athletic Muslim people aged over 15 years: a systematic review and meta-analysis. Br J Nutr. 2020 Jan;123(1):1-22. doi: 10.1017/S000711451900254X. PMID: 31581955.
55. Bahammam A. Sleep pattern, daytime sleepiness, and eating habits during the month of Ramadan. Sleep Hypnosis. 2003;5:165-74.
56. Trabelsi K, Masmoudi L, Ammar A, Boukhris O, Khacharem A, Jemal M, et al. The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees. J Sports Sci. 2021 Nov;39(21):2411-7. doi: 10.1080/02640414.2021.1935672. Epub 2021 Jun 15. PMID: 34128455.
57. Zerguini Y, Kirkendall D, Junge A, Dvorak J. Impact of Ramadan on physical performance in professional soccer players. Br J Sports Med. 2007 Jun;41(6):398-400. doi: 10.1136/bjsm.2006.032037. Epub 2007 Jan 15. PMID: 17224435.
58. Trabelsi K, Moalla W, Boukhris O, Ammar A, Elabed K, Hakim A, et al. Effects of Practicing Physical Activity During Ramadan Fasting on Health-Related Indices: An Updated Brief Review. Int J Sport Stud Health. 2018;1(3):e83789. doi: 10.5812/intjssh.83789.
59. Sadeghirad B, Motaghipisheh S, Kolahdooz F, Zahedi MJ, Haghdoost AA. Islamic fasting and weight loss: a systematic review and meta-analysis. Public Health Nutr. 2014 Feb;17(2):396-406. doi: 10.1017/s1368980012005046.
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