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Influence of Ramadan Observance on Sleep Pattern and Wakefulness at Work among Medical Trainer in Tunisia

Sameh Msaad, Nada Kotti, Sourour Abid, Mounira Hajjaji, Samia Sellami, Samy Kammoun, Ilhem Yangui and Arbi Masmoudi

Introduction: Muslims practice intermittent Islamic fasting all over the globe each year during Ramadan. This practice induces several changes that may affect work performance. The aim of this study is to evaluate the impact of fast during Ramadan on eating behaviors, sleep habits, daytime sleepiness, and professional life.

Methods: Target population was medical trainees who were working since at least 4 months at the beginning of the study. They were invited to complete an anonymous self-administered questionnaire during and apart from Ramadan.

Results: Two hundred forty-three subjects (243) had correctly completed the questionnaire (mean age = 26.81 ± 2.17 years and sex-ratio = 0.69). During Ramadan, all Alcohol drinkers had stopped drinking (p<0.001), and daily tobacco consumption had significantly dropped from 14.82 ± 8.26 to 11.67 ± 8.64 cigarettes during Ramadan (0.002). Consumption of both coffee and tea was significantly reduced from 2.44 ± 1.3 to 1.03 ± 0.71 and from 1.06 ± 0.59 to 0.77 ± 0.66 cups a day, respectively (p<0.0001). The average number of meals per day dropped from 2.92 ± 0.49 before Ramadan to 1.79 ± 0.58 during Ramadan (p = 0.032). The average bedtime was significantly delayed until to 3.80 ± 5.37 am, while it was at 9.7 ± 10.93 pm during the previous month (p<0.0001). The percentage of subjects who went to bed after midnight also had significantly increased from 57.1% to 93.1% (p<0.001). The degree of dissatisfaction about sleep quality had substantially increased from 18.9% at baseline to 54.7% during Ramadan (p<0.0001). Fasted Trainees found more difficult getting up in the mornings (74.1% versus 79% respectively, p<0.0001). The percentage of trainees who often arrived late for work or missed it increased significantly, from 3.7% at baseline to 11.9% during Ramadan (p<0.0001). The majority (81.1%) reported feeling extra sleepy during the daytime of Ramadan month as compared to 60.1% during the previous month (p<0.0001). It was also noted a higher frequency of digestive disorders (46.9% versus 29.6%, <0.001), morning headaches (15.2% versus 6.6%), excessive nervousness (65% versus 57.6%, p<0.001) and concentration and memory disturbances (88.9% versus 77%, p<0.001). Both daily and weekly working hours had significantly decreased during the month of Ramadan (p<0.001). Trainees started their daily work 15 minutes later and left 20 minutes earlier, which results in 35 less minutes worked per day, and around 3 and half hours less per week. Most of participants (88.1%) thought that Ramadan had a negative effect on their sleeping pattern and affected their daytime functioning. Although, the percentage of those who took sedative-hypnotics for sleep disorders had significantly dropped from 7% at baseline to 3.3% during this month (p = 0.0001).

Conclusion: The present study showed that Ramadan is associated with several changes in eating behaviors and sleep habits. These changes resulted in sleep pattern impairment, increased daytime sleepiness and reduced work performance. Healthy sleep and eating habits with a suitable work rhythm should be recommended to Fasted medical trainees to minimize the impact of Ramadan on their wellbeing and professional life.