Loughborough University
COVID Sleep Romdhani et al_ SporMed2022_MANUSCRIPT_R2_combined (2).pdf (8.43 MB)

COVID-19 lockdowns: a worldwide survey of circadian rhythms and sleep quality in 3911 athletes from 49 countries, with data-driven recommendations

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journal contribution
posted on 2022-07-04, 15:52 authored by M Romdhani, DE Rae, M Nédélec, A Ammar, H Chtourou, R Al Horani, H Ben Saad, N Bragazzi, G Dönmez, T Driss, HHK Fullagar, A Farooq, S Garbarino, O Hammouda, B Hassanmirzaei, K Khalladi, S Khemila, LJ Mataruna-Dos-Santos, I Moussa-Chamari, I Mujika, H Muñoz Helú, A Norouzi Fashkhami, LL Paineiras-Domingos, M Rahbari Khaneghah, Y Saita, K Trabelsi, JA Vitale, JA Washif, J Weber, N Souissi, Lee TaylorLee Taylor, K Chamari

Objective: In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed ‘lockdown’ from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors. 

Methods: In total, 3911 athletes [mean age: 25.1 (range 18–61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors. 

Results: Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p < 0.001). Pittsburgh Sleep Quality Index was predominantly influenced by sleep-onset latency (p < 0.001; + 29.8%), sleep efficiency (p < 0.001; − 21.1%), and total sleep time (p < 0.001; − 20.1%), whilst Insomnia Severity Index was affected by sleep-onset latency (p < 0.001; + 21.4%), bedtime (p < 0.001; + 9.4%), and eating after midnight (p < 0.001; + 9.1%). During lockdown, athletes reported fewer training sessions per week (− 29.1%; d = 0.99). Athletes went to bed (+ 75 min; 5.4%; d = 1.14) and woke up (+ 150 min; 34.5%; d = 1.71) later during lockdown with an increased total sleep time (+ 48 min; 10.6%; d = 0.83). Lockdown-mediated circadian disruption had more deleterious effects on the sleep quality of individual-sport athletes compared with team-sport athletes (p < 0.001; d = 0.41), elite compared with non-elite athletes (p = 0.028; d = 0.44) and older compared with younger (p = 0.008; d = 0.46) athletes. 

Conclusions: These lockdown-induced behavioral changes reduced sleep quality and increased insomnia in athletes. Data-driven and evidence-based recommendations to counter these include, but are not limited to: (i) early outdoor training; (ii) regular meal scheduling (whilst avoiding meals prior to bedtime and caffeine in the evening) with appropriate composition; (iii) regular bedtimes and wake-up times; and (iv) avoidance of long and/or late naps.



  • Sport, Exercise and Health Sciences

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Sports Medicine






1433 - 1448




  • AM (Accepted Manuscript)

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© The Author(s), under exclusive licence to Springer Nature Switzerland AG

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This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s40279-021-01601-y

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Deposit date: 27 June 2022