Relationship between Poor Quality Sleep during Ramadan and Academic Performance among Students in Saudi Arabia

Adequate sleep is essential for improving cognitive function, memory retention, and academic performance. During Ramadan, many students suffer with the changes in mealtimes that lead to variations in caloric and nutrient intake and affect sleep quality. Disturbed and poor sleep results in Original Research Article Dighriri et al.; JPRI, 34(40B): 29-38, 2022; Article no.JPRI.87977 30 decreased academic performance and impaired judgment. This study aim was to assess the relationship between poor quality sleep during Ramadan and academic performance among students in Saudi Arabia. It also provided suggested strategies to improve students’ sleep quality and academic performance. It was a cross-sectional study, which was conducted by using an online questionnaire from April to May 2022. The questionnaire consisted of two components. The first portion contained demographic data, such as gender, age, and academic performance. The second section was devoted to the Pittsburgh Sleep Quality Index (PSQI).Study participants were students of both genders aged 18 and older. The survey was completed by 583 students, of whom 364 (62.4%) were female and only 219 (37.6%) were male. Almost all the participants were aged between 21–23 years. Four hundred and eight (70.0%) were single. The results of the PSQI overall score were that 460 students (78.9%) had poor sleep quality, whereas 123 (21.1%) had good sleep quality. Most of the students with poor academic performance had very bad sleep quality (45%), sleep latency of more than one hour (41.4%), sleep duration < 5 hours (43.2%), and sleep efficiency of <65% (52.3%). The majority of these students had sleep disturbances three or more times a week (43.2%), and they suffered dysfunction every day (43.2%). The results revealed an association between all the PSQI components and academic performance (p < 0.05) except sleep duration. The majority of students had poor sleep quality in Ramadan. We would recommend that students be made aware of the impact of poor sleep habits on academic performance, that students are taught skills, such as how to manage their time well and how to get a good night's sleep, and suggest that universities change the time that students study during Ramadan to fit their abilities.


INTRODUCTION
Fasting is a centuries-old practice described as abstention from food and liquids [1]. During Ramadan, Muslims fast from dawn until sunset for 29-30 days. Ramadan fasting restricts food, water, sexual activity, and smoking during the day and alters one's daily routine [2]. The predawn meal is consumed before dawn (suhoor), and the main course is consumed following sundown (iftar) [3]. During Ramadan, this shift in mealtimes could be attributed to the caloric and nutrient intake changes that affects dietary, social, and sleep habits [4,5]. Fasting in Ramadan may cause sleep deprivation. This is mainly because those who fast during the day eat more at night and sleep late, affecting their sleep quality and academic performance [6].
According to research conducted among Ramadan adherents, mental activities are reduced throughout the day and increase after sunset. A self-perceived capacity for mental activity follows a similar pattern [7]. In a study of 265 university students who followed the Ramadan fast, more than half of the subjects reported less activity, a decreased motivation to study, and a reduced capacity to concentrate [8].
Observing Ramadan comprises more than just fasting, but it seems likely that the fast is the primary factor affecting academic performance [9]. A previous study demonstrates the critical role of nutritional consumption in schoolchildren's cognitive functioning [10]. Adequate, high-quality sleep of optimal duration aids in memory processing and learning. It promotes the maintenance of concentration, executive cognition, sensorimotor integration, and memory processing [11].
Individual sleep patterns and habits vary according to age, occupational responsibilities, social engagements, psychiatric and somatic states, and unique physiological characteristics [12]. In the short term, disturbed and poor sleep results in impaired judgment, agitation, irritability, and difficulty comprehending information; in the long term, it can contribute to cardiometabolic problems and even higher mortality [13]. Students are one of the identified high-risk groups for developing sleep disorders. A previous study on sleep disturbances among medical students was conducted with varying results that depended on education level and geographic region. Around 90% of Chinese medical students experienced daytime disturbances [14]. Sleep deprivation has been linked to a decline in academic performance [15]. Research has shown that Pakistani students do not get enough sleep, which affects their academic performance [16].
To our knowledge, no study has been done in Saudi Arabia to assess the relationship between poor quality sleep during Ramadan and academic performance. Therefore, the aim of this study was to assess the relationship between poor quality sleep during Ramadan and academic performance among students in Saudi Arabia. It also provided suggested strategies to improve students' sleep quality and academic performance.

Study Design and Area
We did a cross-sectional study in Saudi Arabia between April and May 2022 to assess sleep quality during Ramadan and academic performance among Saudi students.

Identification of Study Participants
Study participants were students of both genders, aged 18 and older, from various colleges and majors. Students under 18 years of age were excluded. The online Raosoft calculator was used to estimate that there were 583 students in the sample. Participation in the research was voluntary, and the privacy of all research participants was protected by an anonymous questionnaire. Participants could withdraw from the study at any time without any explanation. Moreover, there were no incentives for participants. The survey was only accessible to individuals who agreed to informed consent. A participant needed approximately six minutes to complete the survey.

The Data Collection Process
We collected data by using an electronic questionnaire in both Arabic and English. We were using a method known as "convenient and snowball sampling." The questionnaire was sent to Saudi Arabian students through social media between April and May. The structured questionnaire consisted of two components. The first portion contained demographic data, such as gender, age, and academic performance. The second section was devoted to the Pittsburgh Sleep Quality Index (PSQI). PSQI is an effective metric for determining sleep quality and pattern. Sleep quality is rated on seven different dimensions: subjective sleepiness, sleep quality, sleep latency, sleep length, sleep efficiency in the habitual state, sleep disruptions, utilization of sedatives, and daytime dysfunction. Scores range from zero to a maximum of 21. The sum of the scores for all seven components is referred to as the "global PSQI score." A global PSQI score of more than 5 indicates poor sleep quality, and 5 and less indicates good sleep quality [17].

Data Statistical analysis
The data was entered and analyzed using the Statistical Package for Social Sciences (SPSS) program. Demographic data was categorized and expressed in terms of frequencies and percentages. All PSQI values were compared to academic performance. The chi-square test determined the association between the PSQI score and academic performance. Significant was defined as a p-value < 0.05.
The causes that led to a decreased quality of sleep in Ramadan were: study performance during Ramadan (32.60%), caffeine drinks such as coffee and tea (24.00%), performing Islamic worship until late at night (20.10%), fasting during the day of Ramadan (15.80%) and others (7.50%) (Fig. 2).

DISCUSSION
We assessed the relationship between poor quality sleep during Ramadan and academic performance among students in Saudi Arabia.
Our findings indicate an association between poor quality sleep during Ramadan and academic performance. The majority of students had poor sleep quality, compared to (21.1%) who had good sleep quality. We suggest that poor sleep quality in Ramadan is due to fasting during the day, a change in diet, and drinking a lot of caffeine at night. The study compared excellent and poor academic performance of students to good sleep quality (37.3% vs. 9.9%) and poor sleep quality (62.7% vs. 90.1%) respectively. It was revealed that students who had poor academic performance suffered from poor quality sleep. We suggest poor sleep quality decreases cognitive function, memory retention, and the ability to concentrate and think, therefore reducing academic performance among students. Past studies reported that Pakistani medical students have low sleep quality, which has a significant impact on their academic performance. Adequate sleep is required to replenish students during the day and aid in learning and memory processing [18]. Abdullah Al-Khani et al. revealed that over two-thirds of the students slept poorly [19]. Of the students in Lebanon, 37.1% sleep poorly, as do 55.7% of students in Egypt [20,21]. Previous research has shown that the quality and length of sleep not only affects health and behavior, but also academic performance [22].
Adequate and effective sleep is important for academic performance and memory. Students must get enough sleep in order to function effectively in the classroom. In this study, most students with poor academic performance had disturbances three or more times a week, and they suffered from dysfunction every day. The results revealed an association between all PSQI very poor sleep quality, sleep latency of more than one hour, sleep duration of less than five hours, and sleep efficiency of less than 65%. Also, the majority of these students had sleep disturbances three or more times a week, and   The study's performance during Ramadan they suffered from dysfunction every day. The result revealed an association between all the PSQI components and academic performance (p < 0.05) except sleep duration, which was not statistically significant in association with academic performance (p > 0.05). Moyazzem Hossain et al. reported that subjective sleep quality, sleep disruptions, and the usage of sleeping drugs were all statistically significant. Subjective sleep quality, sleep length, and daytime dysfunction were all positively related to academic achievement; however, sleep latency, habitual sleep efficiency, sleep disturbances, and the use of sleeping drugs were all negatively related to students' academic performance [23]. Previous research has found that academic performance is related to the time of sleep and wakefulness but not associated with total sleep duration [24]. Mohammed A. Alsaggaf et al. reported that poor academic performance was linked to a higher frequency of insomnia symptoms, including the inability to sleep within 30 minutes of going to bed and numerous nightly awakenings [25]. Alapin et al. reported that poor quality sleep impacts general performance and focus [26].
The majority of participants in this study studied from morning to afternoon; (14.4%) in the morning only; (7.7%) from afternoon to evening; and (17.5%) at different times. Participants' preferred study times during Ramadan were the evening only (38.6%) and the morning only (37.0%). We suggest that in Ramadan, many students suffer from shifts in mealtimes that can affect dietary and social well-being and cause sleep deprivation. However, this is mainly because those who fast during the day eat more at night and go to sleep late, which affects their academic performance. Therefore, the majority of respondents preferred to study in the evening only or in the morning only. Past studies have revealed that fasting had a deleterious impact on both behavior and academic performance. According to 61% of students, activity was the most affected. Study desire and concentration skills were affected in 54% and 53% of students respectively [8].
In this study, the common causes that led to a decreased quality of sleep in Ramadan were: study performance during Ramadan; caffeine drinks such as coffee and tea; performing Islamic worship until late at night; and fasting during the day of Ramadan. Zeinab Afifi reported that during Ramadan, people stayed up late watching TV, listening to the radio, praying, or reading the Koran. They must then rise for the suhoor (predawn) supper [8].
We recommend that it is critical to create and implement effective interventions in the study setting to improve academic success and healthy living among university students. The interventions may concentrate on the following areas: making students aware of the consequences that their poor sleep habits have on their academic performance; and providing students with alternative skills to deal with academic burdens, such as good time management and maintaining good class attendance. Furthermore, the intervention may encourage excellent sleep hygiene in order to lessen the impact of behavioral factors on an individual's sleep. Students should understand the significance of sleep quality and how it affects their mental health and academic performance. Moreover, we recommend creating college regulations that encourage healthier and more appropriate sleep among students, which can have a significant impact on their performance and overall health.
This study has certain strengths and weaknesses that should be noted. The study's strength is that it is the first study in Saudi Arabia to assess the relationship between poor quality sleep during Ramadan and academic performance, which may help future studies. We also collected a huge number of questionnaires, with 583 respondents. The study limitations were that other elements that can contribute to poor academic achievement were not taken into consideration or were ignored, such as exam stress and exam complexity. Also, it is a crosssectional study that only shows a link and does not prove cause and effect.

CONCLUSION
The study revealed an association between poor quality sleep during Ramadan and academic performance among students. The majority of students had poor sleep quality in Ramadan. Most students with poor academic performance had very poor sleep quality, sleep latency of more than one hour, sleep duration of less than five hours, and sleep efficiency of less than 65%. The majority of these students had sleep components and academic performance, except sleep duration. The majority of respondents preferred to study in the evening only or in the morning only during Ramadan. The common causes that led to a decreased quality of sleep in Ramadan were: the study's performance during Ramadan; caffeine drinks such as coffee and tea; performing Islamic worship until late at night; and fasting during the day in Ramadan. We recommend making students aware of the consequences of their poor sleep habits on their academic performance and to provide students with necessary skills, such as good time management and excellent sleep hygiene. Students should understand the significance of sleep quality and how it affects their mental health and academic performance. Moreover, we recommend creating college regulations that encourage healthier and more appropriate sleep among students, which can have a significant impact on their performance and overall health. We also suggest that universities change the times that students' study during Ramadan to fit their abilities.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).

CONSENT
As per international standard or university standard, participants' written consent has been collected and preserved by the author(s).