Send to

Choose Destination
Sleep Breath. 2019 Dec 12. doi: 10.1007/s11325-019-01986-1. [Epub ahead of print]

Effect of diurnal fasting on sleep during Ramadan: a systematic review and meta-analysis.

Author information

Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.
Ministry of Health, Manama, Bahrain.
College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia.
The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.



The current meta-analysis aimed to obtain a more stable estimate of the effect size of Ramadan diurnal intermittent fasting (RDF) on sleep duration and daytime sleepiness.


Databases (Scopus, ScienceDirect, ProQuest Medical, PubMed/MEDLINE, Web of Science, EBSCOhost, Cochrane, CINAHL, and Google Scholar) were searched from database inception to the end of June 2019. The sleep quality measures analyzed were excessive daytime sleepiness (EDS) measured by the Epworth sleepiness scale (ESS) and total sleep time (TST). Subgroup analyses for age, sex, and levels of physical activity were conducted.


We identified 24 studies (involving 646 participants, median age 23.7 years, 73% men) conducted in 12 countries from 2001 to 2019. The results revealed that TST decreased from 7.2 h per night [95% confidence interval (CI) 6.7-7.8] before Ramadan to 6.4 h (95% CI 5.3-7.5) during Ramadan, while the ESS score increased slightly from 6.1 (95% CI 4.5-7.7) before Ramadan to 7.0 (95% CI 5.2-8.8) during Ramadan. Effect sizes on sleep quality measures during RDF demonstrated a moderate reduction in TST (number of studies, K = 22; number of subjects, N = 571, Hedges' g value of -0.43, 95% CI - 0.64 to -0.22, Q = 90, τ2 = 0.15, I2 = 78%, P < 0.001), while ESS score showed negligible effect on EDS (K = 9, N = 362, Hedges' g value of -0.06, 95% CI -0.43 to 0.28, Q = 21, τ2 = 0.13, I2 = 76%, P value = 0.001).


During the month of Ramadan, there is approximately a 1 hour reduction in TST and nearly a 1 point increase in the ESS score.


Caloric restriction; Diurnal intermittent fasting; Epworth sleepiness scale (ESS); Excessive daytime sleepiness (EDS); Ramadan; Total sleep time (TST)


Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center