Ramadan fasting in patients with primary adrenal insufficiency: evaluation of the risk of complications, quality of life and sleep, and associated factors

PURPOSE: The study aimed to evaluate the risk of complications, quality of life (QoL) and quality of sleep (QoS) during Ramadan fasting (RF) in patients with primary adrenal insufficiency (PAI) and determine the associated factors. METHODS: It was an interventional, randomised, crossover, self-controlled study, including 30 patients with PAI. We evaluated the prevalence of complications, QoL using the Addison's disease Quality of Life questionnaire (AddiQoL), and QoS using the Pittsburgh Sleep Quality Index (PSQI), outside and during RF. Patients also underwent biological investigations and continuous glucose monitoring outside and during RF. RESULTS: The mean age was 45 ± 9 years, the median disease duration was 7 years, and the median daily dose of hydrocortisone was 20 mg, and fludrocortisone was 50 µg. The prevalence of complications was 67% during RF and 23% outside RF (p = 0.001). Disease duration ≤ 8 years (aOR = 19.7, 95%CI: 1.2-317.0, p = 0.036) and an AddiQoL global score (GS) before RF ≤80 (aOR = 83.9, 95%CI: 1.2-5729, p = 0.040) were independently associated with the occurrence of complications during RF. There was no significant difference in QoL and QoS between before and during RF. Lower AddiQoL GS before RF and the occurrence of complications during RF were associated with worse QoL and QoS during RF. The prevalence of hypoglycemia was not different in patients with or without complications, worse QoL or QoS. CONCLUSION: Ramadan fasting increased the prevalence of complications and did not impair overall QoL and QoS. Shorter disease duration and lower baseline AddiQoL GS were associated with adverse outcomes.Retrospectively registered on 'Clinical Trials' on February 28th, 2024, under the identifier:NCT06299020.