An interventional study of Culturally Adapted Sleep Hygiene Education Program in Sleep Disruption, Sleep Hygiene and Ramadan Fasting, sponsored by The Higher Institute of Sport and Physical Education of Sfax. Completed at 1 site in Tunisia. Open to male participants aged 18 Years to 30 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-06-12.
Sponsored by The Higher Institute of Sport and Physical Education of Sfax · Not applicable, Interventional, and Other
Ramadan fasting often disrupts sleep patterns, which can affect alertness and physical performance in student-athletes. This study tested whether a brief sleep education program designed for Ramadan could help improve sleep quality and maintain performance.
Sixty-four male sport-science students who planned to fast during Ramadan were randomly assigned to one of two groups. The first group received a 45-minute educational session about sleep hygiene specifically adapted to Ramadan practices (timing of sleep around evening and pre-dawn meals, managing light exposure, limiting caffeine and screen time before bed). They also received weekly text message reminders and completed short weekly checklists about their sleep habits. The second group continued their usual routines without any intervention.
Participants wore activity monitors on their wrist to track sleep throughout the study. They also completed computerized tests of attention and reaction time, as well as physical performance tests (jumping, handgrip strength, agility) before Ramadan and during the final week of fasting.
The researchers found that students who received the sleep education maintained better sleep duration and quality during Ramadan compared to those who did not receive the program. They also showed better attention, faster reaction times, and better preservation of physical performance. This suggests that simple, culturally-adapted sleep education can help student-athletes maintain their health and performance during Ramadan.
This pilot randomized controlled trial investigated the effects of a culturally adapted sleep hygiene education program on objectively measured sleep, psychomotor vigilance, and physical performance during Ramadan in male sport-science students.
STUDY DESIGN AND PARTICIPANTS:
Sixty-four male sport-science students (aged 18-30 years) from the Higher Institute of Sport and Physical Education of Sfax, Tunisia, who intended to observe Ramadan fasting, were randomly allocated to either an intervention group (n=32) or a control group (n=32). Randomization was performed using computer-generated block randomization with allocation concealment via sealed envelopes.
INTERVENTION:
Participants in the intervention group received a single 45-minute educational session during the week preceding Ramadan. The session addressed sleep hygiene strategies specifically adapted to Ramadan constraints, including: (1) maintaining consistent sleep schedules compatible with suhoor (pre-dawn meal) and iftar (evening meal) timing, (2) managing evening light exposure and screen use, (3) regulating caffeine intake, (4) optimizing the sleep environment, and (5) planning sleep consolidation strategies. Participants received written educational materials and weekly text message reminders (Monday and Thursday) throughout Ramadan. Adherence was monitored using weekly self-report checklists returned each Saturday. The control group received no intervention and maintained their usual daily habits.
OUTCOME MEASURES:
Primary outcomes were sleep parameters assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline (approximately 2 weeks before Ramadan) through week 4 of Ramadan. Derived parameters included total sleep time, sleep efficiency, and wake after sleep onset (WASO). A minimum of 5 valid nights was required for analysis.
Secondary outcomes assessed at baseline and Ramadan week 4 included:
COVARIATES:
Baseline values of all outcome variables were included as covariates. Additional covariates assessed at baseline included chronotype (reduced Morningness-Eveningness Questionnaire), daily caffeine intake (cups/day), and evening screen exposure (minutes in the last hour before bedtime).
STATISTICAL ANALYSIS:
Changes in sleep parameters were analyzed using linear mixed-effects models with group, time, and group × time interaction as fixed effects, and participant as a random effect. Baseline values were included as covariates. For cognitive and physical performance outcomes at week 4, analysis of covariance (ANCOVA) was used with group as the fixed factor and baseline values as covariates. Effect sizes were reported as partial eta squared (η²p) for ANCOVA models and Hedges' g for adjusted between-group comparisons. Statistical significance was set at p \< 0.05.
STUDY PERIOD:
Data collection occurred from February 10, 2025 (baseline) to March 31, 2025 (end of Ramadan 1446 AH, corresponding to March 1-30, 2025 in Tunisia).
ETHICAL CONSIDERATIONS:
The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. The protocol was reviewed by the Institutional Scientific Committee of ISSEPS Sfax and determined to be exempt from formal external ethics committee review under Tunisian regulations governing minimal-risk behavioral research.
This trial was registered retrospectively at ClinicalTrials.gov.
126 studies on the registry are indexed under Sleep Hygiene; 32 are open to participants now.
This study's enrollment of 64 is close to the median of 66 across 113 interventional studies indexed under Sleep Hygiene.
Browse Sleep Hygiene studies →The Higher Institute of Sport and Physical Education of Sfax is the lead sponsor of 8 studies on the registry; none are open to participants now.
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Exclusion Criteria:
Participants receive a single 45-minute culturally adapted sleep hygiene education session prior to Ramadan, followed by written materials, weekly adherence checklists, and bi-weekly SMS reminders throughout Ramadan.
Behavioral: Culturally Adapted Sleep Hygiene Education Program
Participants receive no sleep hygiene education or reminders and are instructed to maintain their usual daily routines and sleep habits throughout the Ramadan period.
A structured educational session addressing sleep scheduling relative to suhoor/iftar, evening light and screen exposure management, caffeine intake regulation, and sleep environment optimization. Delivered as a single 45-minute session before Ramadan, supplemented with written guidelines, weekly self-report checklists, and bi-weekly SMS reminders.
Total Sleep Time
Total sleep time in minutes per night, assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline (approximately 2 weeks before Ramadan) through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Time frame: Baseline and Ramadan week 4
Sleep Efficiency
Sleep efficiency percentage (ratio of total sleep time to time in bed × 100), assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Time frame: Baseline and Ramadan week 4
Wake After Sleep Onset (WASO)
Wake after sleep onset in minutes per night, assessed continuously using wrist actigraphy (ActiGraph wGT3X-BT) from baseline through week 4 of Ramadan. A minimum of 5 valid nights required for analysis at each time point.
Time frame: Baseline and Ramadan week 4
Psychomotor Vigilance - Lapses
Number of lapses (reaction times ≥500 milliseconds) on the 10-minute Psychomotor Vigilance Test (PVT), assessed at baseline and Ramadan week 4.
Time frame: Baseline and Ramadan week 4
Countermovement Jump Height
Lower-limb explosive power assessed by countermovement jump (CMJ) height in centimeters. Best performance of 3 maximal trials retained for analysis.
Time frame: Baseline and Ramadan week 4
Squat Jump Height
Lower-limb explosive power assessed by squat jump (SJ) height in centimeters. Best performance of 3 maximal trials retained for analysis.
Time frame: Baseline and Ramadan week 4
Handgrip Strength
Maximal handgrip strength in kilograms measured using a handgrip dynamometer. Best performance of 3 maximal contractions with dominant hand retained for analysis.
Time frame: Baseline and Ramadan week 4
Agility Performance
Change-of-direction agility test performance time in seconds. Best performance of 2 trials retained for analysis.
Time frame: Baseline and Ramadan week 4
Psychomotor Vigilance - Mean Reaction Time
Mean reaction time in milliseconds on the 10-minute Psychomotor Vigilance Test (PVT), assessed at baseline and Ramadan week 4 under standardized conditions.
Time frame: Baseline and Ramadan week 4
Plan to share: Yes — De-identified participant data will be made available. This includes demographic and anthropometric data, objective sleep outcomes derived from actigraphy (total sleep time, sleep efficiency, wake after sleep onset), psychomotor vigilance test (PVT) results (mean reaction time, lapses), and physical performance test results (countermovement jump, squat jump, handgrip strength, and agility).
Supporting information: Study protocol, Statistical analysis plan, Informed consent form
Time frame: Data will be available within 3 months following the publication of the results in a peer-reviewed journal and will remain available for 5 years.
Access criteria: Data can be requested by researchers with a specific, scientifically sound research proposal. Requests should be submitted via email to the corresponding author (kais.elabed@gmail.com). A data use agreement may be required prior to sharing.
Ran from Feb 2025 to primary completion in Mar 2025, 1 month.
Of 75 non-industry interventional studies with no phase under Sleep Hygiene, half reached primary completion within 8 months of starting (the median), counting those still running; a quarter within 3 and three quarters within 18. This study's 1 month is below that.
Counting every sponsor, half of 79 studies reached it within 8 months; a quarter within 4 and three quarters within 18.
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This study is completed, as verified in Jun 2026. You cannot join it, but the record below documents what was studied.
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The Higher Institute of Sport and Physical Education of Sfax