Comparison of Sleep Quality and Quality of Life Before and During Ramadan Fasting Among Healthy Adult Population in Kuala Nerus, Terengganu
Authors: Elias Nurul Ain Farhana , Shahruzi Norsyafiqah Syazwana , Che Taha Che Suhaili 
Published: November 2022

Ramadan is a tenet of Islam and requires four weeks of continuous fasting during daylight hours. Muslims are prohibited from eating, drinking, taking medication, and engaging in sexual activities during the fasting period [1]. Nowadays, the non-Muslim community also has a negligible effect from the arising trend of intermittent diet approach in the replacement of traditionally common dietary strategies but the evidence of to which extent this dietary approach might benefit them is remain questionable [2]. The comorbid stress and fear of being infected and the effect of long COVID will affect the quality of life [3]. This is a novel health condition associated with physical or mental deterioration, fatigue, and cold which refers to “post-COVID conditions (PCC)” following COVID-19 infection [4]. Moreover, the consumption of late meals after performing Taraweeh might increase the nocturnal body temperature which leads to delayed bedtime sleep5. Therefore, this study aims to determine the comparison of sleep quality and quality of life among the healthy adult population in the period before Ramadan and during Ramadan and also to find out the possible correlation between these two parameters.

This cross-sectional study was conducted on 106 healthy adult populations in Kuala Nerus. The majority (91.5%) of the respondents were aged 19 to 25 years old and 88 (83.0%) of the respondents were female while the rest, 18 (17.0%) were male. Assessment of sleep quality and quality of life was done in two-time intervals before Ramadan (BR) and during Ramadan (DR). Sleep quality; subjective sleep quality, sleep latency, duration of sleep, habitual sleep efficiency, sleep disturbances, sleep medication consumption, and daytime dysfunction were assessed by using PSQI-M, meanwhile, the SF-36 Malay version was used to evaluate the quality of life; physical functioning, role of limitation due to physical health, role of limitation due to emotional problem, energy/fatigue, emotional well-being, social functioning, pain, and general health. All outcomes were measured twice; before Ramadan (one to two weeks prior to Ramadhan month) and during Ramadan (week 2 to 4 of Ramadhan month).

There was a significant improvement in overall sleep quality from the global PSQI score during Ramadan as compared to before Ramadan (6.3±2.0 vs 7.5±2.2, p<0.001) followed by sleep latency (min) (0.9±0.6 vs 1.3±0.6, p<0.001), sleep efficiency (%) (0.4±0.6 vs 0.8±0.9, p<0.001) and sleep disturbances (AU) (M=0.8±0.5 vs 1.0±0.5). The rest sleep quality components were not statistically significant. Quality of life in terms of role limitations due to emotional problems during Ramadan is significantly improved than before Ramadan (84.3±24.4 vs 73.9±38.5, p= 0.010). Meanwhile, the other domains were non-statistically significant (Table 1).
This study provides evidence on the benefit of practicing Ramadan fasting among a healthy adult population where sleep quality is statistically significantly higher during Ramadan as well as a statistically significant increase in the role limitation due to emotional problems. The greatest correlation is observed between the global PSQI score and pain which indicate the lower the global PSQI score, the absent the feeling of pain and limitation due to pain in the past 4 weeks during Ramadan. A wider population is suggested for future studies to better understand the benefit of Ramadhan Fasting on overall health.