Background: Sleep deprivation is associated with a reduction in sustained alertness and increased risk of road traffic crashes. Sleep deprivation has been reported in Muslims who observe daily intermittent fasting during the holy month of Ramadan. Epidemiological studies from Muslim countries, UAE and Saudi Arabia, show an increase in road traffic crashes during Ramadan. Aim: To determine the effect of Ramadan fasting on sleep and sustained attention levels in order to understand driving hazard during daylight hours. Methods: This was a quasi-experimental design in which sleep and sustained attention were compared between fasting Muslims (n=9) and non-fasting (n=9) subjects. Each subject maintained a sleep diary and completed the computerized rapid visual processing (RVP) task to evaluate sustained attention. The RVP was conducted at 4:00 PM on three different occasions (before Ramadan, 1st week of Ramadan and 3rd week of Ramadan). Results: In fasting subjects total sleep time before Ramadan (7.2±0.5h) was not different during Ramadan (7.4±0.3h, p=0.708); this was the same for non-fasting subjects (7.8±0.3h vs. 7.5±0.4h respectively, p=0.291). The mean latency to correct response on the RVP task before Ramadan (417.3±23.7 ms) was reduced at the end of Ramadan (368.7±23.7 ms, p=0.002) in fasting subjects only. Total misses were insignificantly greater in fasting subjects (4.3±1.2) than non-fasting subjects (2.8±1.2 p=0.348) at the end of Ramadan. False alarms remained unchanged in both groups. Conclusion: In this study, Ramadan fasting had no adverse impact on sleep or sustained attention. These results suggest that habitual sleep quantity is necessary to maintain daytime sustained attention levels in those fasting during Ramadan.


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