COVID-19 Lockdowns: A Worldwide Survey of Circadian Rhythms and Sleep Quality in 3911 Athletes from 49 Countries, with Data-Driven Recommendations

Abstract

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. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01601-y.

Examining Psychosocial Factors and Community Mitigation Practices to Limit the Spread of COVID-19: Evidence from Nigeria

“…One of the key messages is that most individuals, irrespective of background, including general populations, students, and athletes, were affected by the pandemic, psychologically, physiologically, and physically. For example, the pandemic had impacts such as altered sleep and circadian rhythms [ 4 , 5 ] and training activities [ 6 ] across the world. Other community mitigation strategies include the cancellation or suspension of events, changes to funeral services, and clear communication from health authorities on how to avoid fake news, rumors, and panic [ 4 ].…”

Regression Analysis of Perceived Stress among Elite Athletes from Changes in Diet, Routine and Well-Being: Effects of the COVID-19 Lockdown and “Bubble” Training Camps

“…Lifestyle changes during COVID-19 lockdowns have influenced both sleeping and dietary patterns, through circadian misalignment, causing alterations in eating and sleeping behaviours [ 16 , 17 ]. During lockdown, movement restrictions have limited food choices, led to unfavourable food choices and increased food consumption [ 18 ].…”

Prevalence and Risk Factors of Poor Sleep Quality in Collegiate Athletes during COVID-19 Pandemic: A Cross-Sectional Study

“…Other recent studies have proven the significant decrease in the number of workouts per week during the lockdown compared to before the pandemic [ 26 ]. However, the COVID-19-induced phase delay with shift to later sleeping hours on working days as well as weekend days, elegantly shown by Facer-Childs et al and Romdhani et al, seemed to play the major role in the deterioration of sleep quality [ 28 , 29 ]. Athletes with an evening chronotype, compared to a morning chronotype, were more affected by these changes.…”

“…Romdhani et al investigated, in 3911 athletes (mean age: 25, female: 45%, team-sport: 63%, elite: 37%), COVID-19 mediated changes in training habits, circadian rhythms, sleep patterns, and eating behaviors to determine their link with sleep quality (PSQI) [ 29 ]. They found that the current period of lockdown led to a phase delay in the athlete’s circadian rhythms (longer sleep onset latency, later bedtime, and nocturnal eating) and reduced sleep quality.…”