Sleep in university students prior to and during COVID-19 Stay-at-Home orders

COVID-somnia: anxiety, insomnia, and poor sleep among second-line healthcare workers during COVID-19 pandemic

Background

Little information is available about the linkage between sleep affection and COVID-19. Preliminary reports and clinical observations focused on the appearance of related mental health issues, especially in healthcare workers (HCWs).

Methods

A cross-sectional study is conducted on the COVID-19 second-line HCWs using an English online survey prepared via Google forms. The survey focused on sociodemographic and profession-related characteristics (age, sex, smoking, history of previous sleep disorders or medications affecting sleep, comorbidities specialty, years of experience, and number of hours worked per week) and COVID-19-associated risks (being on the second line of COVID-19 management, following updates and news about COVID-19, and getting an infection with COVID-19 or having a colleague/friend who was infected with or died of COVID-19). Assessment of anxiety, insomnia, and sleep quality was done using the relevant diagnostic scales.

Results

This study included 162 second-line HCWs with a mean age of 34.36 ± 8.49 years. Although being in second lines, there was a high prevalence of anxiety (49.38%), insomnia (56.17%), and poor sleep quality (67.9%) during the pandemic. One condition was recently developed after the pandemic: insomnia in 6.6%, anxiety in 5.7%, and poor sleep in 16%. Two conditions were developed: insomnia and poor sleep in 21.7%, anxiety and poor sleep in 7.5%, and insomnia and anxiety in 10.4%. The three conditions were de novo experienced in 19.8%. A total of 22.4% of those who followed daily COVID-19 updates developed de novo combined anxiety, insomnia, and poor sleep. A total of 38.5% of participants that had been infected with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep. A total of 50% of participants who had a colleague/friend who died with COVID-19 developed de novo combined anxiety, insomnia, and poor sleep.

Conclusion

Although being in second lines, there was a high prevalence of anxiety, depression, and poor sleep concerning COVID-19-related factors.

How the 2020 US Presidential election impacted sleep and its relationship to public mood and alcohol consumption

OBJECTIVES

Major sociopolitical events can influence the general public's affective state and other affect-related processes, such as sleep. Here, we investigated the extent that the 2020 US presidential election impacted sleep, public mood, and alcohol consumption. We also explored the relationship between affect and sleep changes during the peak period of election stress.

PARTICIPANTS

US-residing (n = 437) and non-US-residing (n = 106) participants were recruited online for participation in the study.

METHODS

A non-representative, convenience sample responded to daily assessments of their affect, sleep, and alcohol consumption during a baseline period (October 1-13, 2020) and in the days surrounding the 2020 US Election (October 30-November 12, 2020).

RESULTS

Analyses determined changes within and between US and non-US participants. Election Day evoked significantly reduced sleep amount and efficiency, coupled with heightened stress, negative affect, and increased alcohol use. While US participants were significantly more impacted in a number of domains, non-US participants also reported reduced sleep and greater stress compared to baseline. Across participants, disrupted sleep on Election Night correlated with changes in emotional well-being and alcohol consumption on Election Day.

CONCLUSION

These results suggest that major sociopolitical events can have global impacts on sleep that may interact with significant fluctuations in public mood and well-being. Further, while the largest impact is on the local population, these results suggest that the effects can extend beyond borders. These findings highlight the potential impact of future sociopolitical events on public well-being.

Anti-COVID-19 measures threaten our healthy body weight: Changes in sleep and external synchronizers of circadian clocks during confinement

BACKGROUND & AIMS

Emergency measures in the face of the recent COVID-19 pandemic have been different among countries, although most have opted for confinement and restrictions on social contact. These measures have generated lifestyle changes with potential effects on individuals' health. The disturbances in daily routines due to confinement and remote work have impacted circadian rhythms and energy balance; however, the consequences of these disruptions have not been studied in depth. The objective was to evaluate the impact of 12-week confinement on body weight, considering changes in several external synchronizers of the biological clock.

METHODS

The participants, 521 university students (16-35 years), responded to 52 questions oriented to determine light exposure, sleep patterns, sedentary lifestyle, and eating times.

RESULTS

We found a reduction in sunlight exposure and sleep duration, an increment in sedentarism and screen exposure, and a delay in the timing of the main meals and sleep in the whole cohort. These behavioral changes were associated with a twofold increase in obesity. Subjects who increased their sedentary hours and shortened their sleep to a higher degree were those who gained more bodyweight. The most influential factors in body weight variation during confinement were sleep duration, physical activity (sedentarism), and light (timing of screen exposure). The mediation model explained 6% of the total body weight variation.

CONCLUSIONS

Results support a significant impact of confinement on several external synchronizers of the biological clock and on body weight. Health-related recommendations during the pandemic must include behavioral recommendations to mitigate the adverse effects on the biological clock.

A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19

The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.

COVID-related stress and substance use: examining the role of sleep disturbance

The current investigation employed a cross-sectional design to evaluate the associations of COVID-19 stress, sleep disturbance, and substance use among a national sample of 143 adults (57.3% male, Mage = 38.5 years, SD = 11.28), surveyed at a single time-point using Amazon's MTurk platform. We hypothesized that COVID-19-related stress would be indirectly related to substance use outcomes (i.e. number of substance classes used daily, number of alcoholic drinks per occasion, substance use coping motives; but not substance use enhancement motives) through sleep disturbance severity. As expected, results indicated that the models examining indirect effects were statistically significant for number of substance classes used daily and substance use coping motives. However, there was no evidence that sleep disturbance explained the relation between COVID-19-related stress and number of alcoholic drinks per occasion or substance use enhancement motives. These findings underscore the importance of sleep disturbance in efforts to better understand how COVID-19-related stress is associated with certain types of substance use behavior.

Higher Prevalence of Food Insecurity and Psychological Distress among International University Students during the COVID-19 Pandemic: An Australian Perspective

The COVID-19 pandemic and related disruptions have not only affected university students' learning and academic outcomes, but also other issues, such as food security status, mental health and employment. In Australia, international students faced additional pressures due to sudden border closures and lack of eligibility for government-provided financial support. This study explored the experiences of domestic and international university students residing in Australia during the early stages of the COVID-19 pandemic across a range of outcomes. A cross-sectional online survey was conducted between July and September 2020 at Macquarie University in Sydney, Australia. The online survey included food insecurity status, mental health (psychological distress), disruptions to study, employment and sleep. A total of 105 students (n = 66 domestic and n = 39 international) completed the survey. Respondents reported having food insecurity (41.9%) and psychological distress (52.2%, with high and very high levels), with international students reporting significantly higher food insecurity (OR = 9.86 (95% CI 3.9-24.8), p < 0.001) and psychological distress scores (t(90) = 2.68, 95% CI: 1.30 to 8.81, p = 0.009) than domestic students. About one quarter of all respondents reported disruptions to study and employment status around the time of the survey. When asked what government support should be provided for international students, 'financial aid' was the most frequently suggested form of support. This research may help governments and educational institutions design appropriate support, particularly financial and psychological, for both international and domestic university students.

Time perspective predicts levels of anxiety and depression during the COVID-19 outbreak: A cross-cultural study

The COVID-19 outbreak and governmental measures to keep the population safe had a great impact on many aspects of society, including well-being. Using data from N = 1281 participants from six countries (Argentina, France, Greece, Italy, Japan, and Turkey), we first explored differences in anxiety, depression (measured with the Hospital Anxiety and Depression Scale; HADS), and time perspectives (Zimbardo Time Perspective Inventory; ZTPI), between these countries during the first weeks of the pandemic. We observed that Turkish participants reported the highest levels of anxiety, and Japanese and Greek the lowest. For depression symptoms, the Japanese scored highest and Italians lowest. Next, for each country, we investigated how well the relatively time-stable personality traits of time perspectives, chronotype (reduced Morningness-Eveningness Questionnaire; rMEQ), and Big Five personality traits (short Big Five Inventory; BFI) predicted the levels of anxiety and depression (HADS). The regression analyses showed that negative attitudes towards the past predicted the levels of both anxiety and depression in most of the countries we analyzed. Additionally, in many countries, a Past Positive orientation negatively predicted depression whereas the Present Fatalistic subscale predicted anxiety and depression. The chronotype did not contribute additionally to the models. The Big Five traits (and particularly neuroticism) showed substantial incremental explanatory power for anxiety in some countries but did not consistently predict anxiety levels. For depression, the additional variance accounted for by including the BFI as predictors was rather small. Importantly, the ZTPI subscales were retained as significant predictors in the model still when the BFI and rMEQ were considered as potential predictors. Our results yield evidence that the ZTPI time perspectives are valuable predictors for anxiety and depression levels during the first period of the pandemic.

Psychological and physical health behavior deviations in students amidst the COVID-19 pandemic

Objective: This study sought to understand how the pandemic impacted mental and physical health behaviors in University students. Methods: Undergraduate and graduate students were asked to answer questions on depression, anxiety, stress, sleep quality, and physical activity "prior to" and "during" the shutdown. Results: 457/960 (47.6%) completed the entire survey. Paired samples t-tests showed significant change in mental and physical health behaviors over time. Hierarchical regression models indicated that negative experiences during the shutdown were associated with depression, anxiety, stress, and sleep quality (all p's < .001), but not time spent exercising or sedentary behavior. In addition, positive experiences during the shutdown acted as a buffer. Conclusion: The COVID-19 pandemic shutdown negatively impacted University students. Significant mental and physical health consequences were observed. These effects may linger long past the re-opening of society, and it may be prudent to prepare for additional demand on campus resources.

Home monitoring of arterial pulse-wave velocity during COVID-19 total or partial lockdown using connected smart scales. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022;3:362-372. [PMID: 36712157 PMCID: PMC9384477 DOI: 10.1093/ehjdh/ztac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Aims

To investigate the impact of coronavirus disease 2019 lockdown on trajectories of arterial pulse-wave velocity in a large population of users of connected smart scales that provide reliable measurements of pulse-wave velocity.

Methods and results

Pulse-wave velocity recordings obtained by Withings Heart Health & Body Composition Wi-Fi Smart Scale users before and during lockdown were analysed. We compared two demonstrative countries: France, where strict lockdown rules were enforced (n = 26 196) and Germany, where lockdown was partial (n = 26 847). Subgroup analysis was conducted in users of activity trackers and home blood pressure monitors. Linear growth curve modelling and trajectory clustering analyses were performed. During lockdown, a significant reduction in vascular stiffness, weight, blood pressure, and physical activity was observed in the overall population. Pulse-wave velocity reduction was greater in France than in Germany, corresponding to 5.2 month reduction in vascular age. In the French population, three clusters of stiffness trajectories were identified: decreasing (21.1%), stable (60.6%), and increasing pulse-wave velocity clusters (18.2%). Decreasing and increasing clusters both had higher pulse-wave velocity and vascular age before lockdown compared with the stable cluster. Only the decreasing cluster showed a significant weight reduction (-400 g), whereas living alone was associated with increasing pulse-wave velocity cluster. No clusters were identified in the German population.

Conclusions

During total lockdown in France, a reduction in pulse-wave velocity in a significant proportion of French users of connected smart bathroom scales occurred. The impact on long-term cardiovascular health remains to be established.

Later school start time is associated with better academic performance, sleep-wake rhythm characteristics, and eating behavior

There are numerous studies which show that an early school start time has a negative impact on the sleep, well-being, and academic performance of students. There is not enough information on the association between school start time and eating disorders, however: the disruption of the circadian rhythm is known to be a risk factor for eating disorders. The aim of this study is to analyze the relationship between school start time (SST) and the sleep, well-being, academic performance, and eating behavior of children and adolescents. The study was conducted in April and May 2021 in two regions of Russia: the Komi Republic and Yekaterinburg. The online study involved the anonymous and voluntary participation of 6571 students in grades 6-11 (mean age: 14.5 ± 1.6 years, 60.1% female), who have morning classes. All participants were divided into three groups according to SST: 08:00 (n = 3661), 08:30 (n = 2020), and 09:00 (n = 890). Each participant of the study indicated their place of residence, SST, age, sex, height, weight, academic performance, and filled out the Munich Chronotype Questionnaire, the Zung Self-Rating Depression Scale, and the Yale Food Addiction Scale for Children. As a result of multiple regression analysis, it was shown that schoolchildren with SST of 09:00 wake up at a later time on school days (B = 0.432; ΔR² = 0.039), sleep more (B = 0.293; ΔR² = 0.004), have less pronounced social jetlag (B = -0.223; ΔR² = 0.005) and sleep loss (B = -0.292; ΔR² = 0.005), and higher academic performance (B = 0.113; ΔR² = 0.003) than schoolchildren with SST of 08:00. As a result of logistic regression analysis, it was found that the frequency of the detection of food addiction is ~30% lower in schoolchildren with SST of 09:00 (OR = 0.690; 95% CI = 0.485-0.981) than in their peers with SST of 08:00. Thus, an overly early SST in Russia has a negative impact on the sleep function, academic performance, and eating behavior of children and adolescents.

The Blursday database as a resource to study subjective temporalities during COVID-19

The COVID-19 pandemic and associated lockdowns triggered worldwide changes in the daily routines of human experience. The Blursday database provides repeated measures of subjective time and related processes from participants in nine countries tested on 14 questionnaires and 15 behavioural tasks during the COVID-19 pandemic. A total of 2,840 participants completed at least one task, and 439 participants completed all tasks in the first session. The database and all data collection tools are accessible to researchers for studying the effects of social isolation on temporal information processing, time perspective, decision-making, sleep, metacognition, attention, memory, self-perception and mindfulness. Blursday includes quantitative statistics such as sleep patterns, personality traits, psychological well-being and lockdown indices. The database provides quantitative insights on the effects of lockdown (stringency and mobility) and subjective confinement on time perception (duration, passage of time and temporal distances). Perceived isolation affects time perception, and we report an inter-individual central tendency effect in retrospective duration estimation.

Teaching and learning lifestyle medicine during COVID-19: how has living during a pandemic influenced students' understanding and attitudes to self-care and population health? A qualitative analysis

BACKGROUND

In 2019 a new Lifestyle Medicine (LM) module was introduced to the undergraduate medical curriculum at Imperial College London. Lifestyle Medicine is an emergent discipline which aims to tackle the increasing burden of non-communicable disease. Previous work has suggested that students value clinical teaching over traditional Public Health topics. Taking a constructivist view of learning, this paper assesses changes in medical students' attitudes towards Public Health and LM in response to living through a pandemic. We then make suggestions as to how this lived experience might be useful in teaching LM, and discuss the interaction between teaching, behaviour, and experience with consideration of self-determination theories in learning.

METHODS

First-year medical students were surveyed at the end of their first year of teaching and asked if living during the COVID-19 pandemic had changed the value they place on LM and if so, how. Thematic analysis was conducted on responses representing 71% (n = 216) of the year group.

RESULTS

Four themes were defined in the data: acknowledging importance; impact on behaviour; health inequalities and the wider determinants; and promoting Public Health and prevention. These themes highlight the distinct levels through which the pandemic has had an impact: from personal behaviour to population health.

CONCLUSIONS

This is the first study to look at the impact of living through a pandemic on attitudes to LM. Our results suggest that the pandemic has led to increased reflection on health behaviours. The lived-experience of COVID-19 may facilitate a better understanding of health inequalities and their impact, alongside the opportunities presented by effective LM interventions.

Increased sleep duration and delayed sleep timing during the COVID-19 pandemic

Many studies have examined how the 2019 Coronavirus Disease (COVID-19) has impacted sleep health. Early evidence suggests that lockdown policies worldwide have led to changes in sleep timing, duration, and quality; however, few studies have attempted to look at the longer-term effects across multiple countries in a large data set. This study uses self-reported data from 64,858 users of the Sleep As Android smartphone application from around the world over a 24-month period in 2019 to 2020. We found a significant but modest increase in time in bed (TIB), as well as a significant delay in sleep timing that was especially prominent on weekdays. While this effect persisted throughout the year, differences in sleep timing were more widespread and pronounced in the earlier months of the pandemic. We observed a small overall increase in TIB when comparing 2020 to 2019, but these changes depended on location and time of year, suggesting that sleep duration may have more closely tracked the progression of the pandemic in each country. Our findings suggest that pandemic-induced changes in lifestyle, such as remote work and lockdown policies, may have facilitated later sleep timing but that these changes may diminish as restrictions are lifted.

Sağlık Bilimleri Öğrencilerinin Covid-19’a Yönelik Bilgi Düzeyleri ve Sağlık Davranışlarına Etkisinin İncelenmesi

Amaç: Araştırmanın amacı sağlık bilimleri öğrencilerinin COVID-19 salgını ile ilgili bilgi düzeylerini saptamak ve sağlık davranışları üzerindeki etkisini incelemektir. Gereç ve Yöntemler: Çalışma, çevrimiçi anket yöntemi ile bir üniversitenin Sağlık Bilimleri Fakültesi ve Sağlık Hizmetleri Meslek Yüksekokuluna kayıtlı 345 öğrenci ile yapılmıştır. Çalışma verileri, Ocak-Şubat 2021 tarihlerinde on-line anket formu kullanılarak toplanmıştır. Anket formu katılımcıların demografik özelliklerine dair soruların yanı sıra sağlık bilgi düzeyi; COVID-19 salgınına yönelik sağlık davranışına etkisi olmak üzere 24 sorudan oluşmaktadır. Veri analizinde, tanımlayıcı istatistik testleri ile sayı, yüzde dağılımları, ortalama ve standart sapma değerleri hesaplanmıştır. Grup içi ortalamalarının karşılaştırılmasında One-Way Anova testi kullanılmıştır. Bulgular: Çalışmaya katılan öğrencilerin yaş ortalaması 21.65±3.35 olup % 79.7’si kadındır. Katılımcıların %74.21’i COVID-19 hakkında 2019 öncesi bilgisinin olmadığı, %91.3’ünün kendisi veya ailesinden birilerinin COVID-19’a yakalanması konusunda endişe duyduğu, %86.37’si pandemi sürecinin bulaşıcı hastalıkları önlemeye yönelik aşı uygulaması konusunda farkındalık kazandırdığını, %63.2 ‘si pandemi sürecinde ellerinizi yıkama süresinde değişiklik olduğunu, % 76.8’i televizyon kanallarında yer alan haberlerden bilgi edindiğini bildirdi. COVID-19 öncesi-sonrası günlük uyku ,sıvı alımı gibi sağlık davranışları arasında istatistiksel olarak ileri düzeyde anlamlı farklılık olduğu saptanmıştır (p

COVID-19 Pandemic-Related Sleep and Mental Health Disparities among Students at a Hispanic and Minority-Serving Institution

Background: The COVID-19 pandemic has impacted nearly all sectors of our population, including college students, who continue to share disproportionate rate of disparities. In this study, we aimed to identity key sleep health characteristics, including markers for obstructive sleep apnea, as well as its relation to mental health, physical health, and academic performance. Methods: A cross-sectional study design with online survey dissemination was used. Descriptive, bivariate, and multivariable binary logistic regression analyses were conducted among a predominantly minority population. Results: Results show that nearly 78% of the population reported that the pandemic impacted their mental or physical health, while over 83% reported daytime tiredness/fatigue/sleepiness, and another 61% reported sleeping less than seven hours during weekdays. Among other associations, pandemic-related poor sleep health, including sleeping less than seven hours, was associated with daytime tiredness/fatigue/sleepiness, psychological distress, as well as low mental health and physical health. A severe marker for obstructive sleep apnea, having stopped breathing during sleep, was also associated with psychological distress during the pandemic. Conclusions: Sleep health interventions are critical for optimizing college student health and well-being, including improving mental health outcomes.

Impact of the COVID-19 pandemic on the physical and psychological health of female college students in Japan

The spread of COVID‐19 has dramatically changed our lives. This study aimed to examine the lifestyles of female college students, focusing on physical activity, sleep status, and anxiety status during the pandemic (a state of emergency) in Japan. 184 female college students completed two questionnaires, anthropometric measurements, and daily activity log and diet record: 115 and 69 participants before and during the pandemic, respectively. Findings showed a significant decrease in physical activity: physical activity levels fell from “normal” to “low” and the daily step counts decreased by half, from 8671 to 4640. In addition, the results from the questionnaires revealed that half of the participants were at risk of having sleep disturbances, and their cycles became more nocturnal, which may have caused higher anxiety states and lower sleep quality during the pandemic. In addition, anxiety states worsened, with 100% of the participants experiencing high anxiety during the pandemic. Monitoring lifestyle disturbances during the pandemic is needed for the development of interventions to improve health among young women.

Circadian rhythms in infectious diseases and symbiosis

Timing is everything. Many organisms across the tree of life have evolved timekeeping mechanisms that regulate numerous of their cellular functions to optimize timing by anticipating changes in the environment. The specific environmental changes that are sensed depends on the organism. For animals, plants, and free-living microbes, environmental cues include light/dark cycles, daily temperature fluctuations, among others. In contrast, for a microbe that is never free-living, its rhythmic environment is its host's rhythmic biology. Here, we describe recent research on the interactions between hosts and microbes, from the perspective both of symbiosis as well as infections. In addition to describing the biology of the microbes, we focus specifically on how circadian clocks modulate these host-microbe interactions.

Le sommeil des étudiants français en période de COVID-19 : influence des deux premiers confinements sur la quantité et la qualité de sommeil

La pandémie de la COVID-19 a entraîné deux périodes de confinement pendant l’année 2020 qui ont amené à des modifications des habitudes de vie. L’objectif de notre étude est d’évaluer l’impact des confinements sur la quantité (i.e., horaires et temps passé au lit) et la qualité (i.e., difficultés et parasomnies) du sommeil chez des étudiants français. Au cours du premier et du second confinement, les étudiants ont été invités à répondre à un questionnaire en ligne composé de 23 questions. Ce questionnaire s’intéressait aux horaires réels et idéaux de lever et de coucher, au temps passé au lit, ainsi qu’aux parasomnies et difficultés liées au sommeil. Les résultats obtenus ont montré que les étudiants dormaient plus tardivement et passaient plus de temps au lit le week-end qu’en semaine, ces effets étant plus marqués pendant le premier confinement que pendant le second. La majorité des étudiants a rapporté avoir un sommeil de mauvaise qualité, des difficultés d’endormissement, des réveils précoces, ainsi qu’une sensation de manque de sommeil. Les parasomnies les plus fréquentes se sont caractérisées par des épisodes de cauchemars et de somniloquie. Les difficultés liées au sommeil et les parasomnies rapportées étaient plus importantes pendant le second confinement qu’au cours du premier. La dette de sommeil était toujours présente au cours des confinements. Les difficultés de sommeil et les parasomnies rapportées ont témoigné d’un sommeil de mauvaise qualité chez les étudiants durant ces périodes. Des hypothèses explicatives ainsi que des perspectives de prévention quant à l’hygiène du sommeil sont discutées.

Effect of the Coronavirus Disease 2019 Lockdown on Lifestyle Factors in Japanese Patients with Inflammatory Bowel Disease

Objective To examine the effect of the coronavirus disease 2019 (COVID-19) lockdown on lifestyle factors and psychological stress in patients with inflammatory bowel disease (IBD). Methods A retrospective study was conducted on patients with IBD in Japan 2 months after the initiation of the first state of emergency (June 16 to August 21, 2020). A self-reported questionnaire was used to collect data, and lifestyle factors and psychological stress levels before and after the state of emergency were compared. Patients Patients with IBD who were followed up regularly at Osaka City University Hospital from June 16 to August 21, 2020, were included and were classified into elderly (≥65 years old) and non-elderly groups (<65 years old). Results The study sample comprised 451 responders (241, ulcerative colitis; 210, Crohn's disease; 0, COVID-19). The sleep duration increased, whereas the exercise, working, and walking durations decreased during the COVID-19 lockdown. The proportion of patients with psychological stress due to COVID-19, those with an inability to exercise, and those staying indoors increased significantly during COVID-19 lockdown. Lifestyle factors changed more markedly in non-elderly patients, those who were more stressed due to COVID-19, those with the inability to exercise, and those staying indoors during COVID-19 lockdown. Among elderly patients, no significant changes were identified in stress-causing factors. Conclusion The COVID-19 lockdown affected lifestyle factors and psychological stress in patients with IBD, particularly non-elderly patients. These findings may be helpful in suggesting favorable lifestyle changes for patients with IBD.

The effects of the COVID-19 pandemic on weight loss in participants in a behavioral weight-loss intervention

OBJECTIVE

This study aimed to assess the effects of the COVID-19 pandemic on weight loss, physical activity, and sleep in adults with overweight or obesity participating in a 39-week weight-loss intervention.

METHODS

Participants (n = 81, 85% female, mean [SD] age 38.0 [7.8] years, BMI 34.1 [5.7] kg/m2 ) were enrolled in 3 separate cohorts. Cohorts 1 and 2 were studied prior to the pandemic (pre-COVID cohorts). Cohort 3 (COVID cohort) transitioned to a virtual intervention at week 6, when "stay-at-home" orders were implemented in Colorado. Weight was assessed at baseline, week 12, and week 39 with clinic scales before the pandemic and home scales during the pandemic. Diet was assessed with Likert scales at weeks 4, 8, and 12. Physical activity and sleep were assessed at baseline and week 12 with actigraphy.

RESULTS

Participants in the COVID cohort reported greater dietary adherence (p = 0.004) and lost more weight than those in the pre-COVID cohorts at week 12 (-7.7 [3.3] kg vs. -3.7 [3.0] kg, p < 0.001) and week 39 (-8.5 [4.4] kg vs. -2.8 [4.6] kg, p < 0.001). Energy intake did not differ between cohorts (p = 0.51). The COVID cohort increased both sedentary time while awake and time in bed at night.

CONCLUSIONS

Although the pandemic caused disruptions for the COVID cohort, participants still achieved weight loss with continued behavioral support.

Self-tracking via smartphone app: Potential tool for athletes’ recovery self-management?

Self-tracking technologies are possible approaches to support recovery self-management activities for athletes. These may have become even more appealing due to stay-at-home restrictions as part of the 2020 pandemic regulations. This study examined user behaviour of smartphone and wearable technologies among 217 athletes (29% women, M age = 26.9 ± 7 years). The online survey comprised demographic questions and standardised questionnaires to assess usage of technologies, sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), attitudes about sleep (Dysfunctional Beliefs and Attitudes about Sleep Scale), bedtime procrastination (Bedtime Procrastination Scale), and self-control (Brief Self-Control Scale). Fitness apps (46.5%) were more popular than sleep apps (15.7%) followed by nutrition apps (12%). The correlation between sleep apps and the other two apps indicate that non-users of sleep apps are probably also non-users of fitness or nutrition apps. Wearables were more frequently used to track fitness activities (36.9%) than sleep (17.5%). Considering sex, type of sport, competition participation, and training volume, no remarkable characteristics among users versus non-users of sleep apps were identified. There were also no significant differences among sleep indices between sleep app users and non-users. However, self-control was highest among sleep app users compared to non-users (d = 0.58). Despite 34.1% being identified as poor sleepers, behavioural sleeping patterns were within normal range. The results imply that athletes are not as attracted to self-tracking technologies as expected, which makes them less vulnerable to unsubstantiated feedback and inappropriate interventions by those tools. This serves as a starting point to explore the potential of self-tracking ambulatory assessment for physical activity and sleep behaviour of athletes in the post-pandemic era.

Assessing the Relationships between Internet Addiction, Depression, COVID-19-Related Fear, Anxiety, and Suspicion among Graduate Students in Educational Administration: A Structural Equation Modeling Analysis

This study aims to examine the relationships between Internet addiction, depression, COVID-19-related fear, anxiety, and suspicion in graduate students. A total of 482 students pursuing a master’s degree in educational administration participated in the study, which was designed according to the relational survey model. The data of the study were collected using online questionnaires, and the proposed hypotheses were tested and analyzed using structural equation modeling (SEM). The results of the study revealed that COVID-19-related suspicion positively and significantly predicted COVID-19-related fear and anxiety. In this context, the increased suspicion of graduate students due to COVID-19 also increased their fear and COVID-19-related anxiety, and this increased the possibility that they would exhibit depressive behaviors. However, a positive and significant relationship was found between COVID-19-related suspicion and depression. This result confirms that the increased suspicion of the participant students due to COVID-19 led to an increase in their depression scores. SEM results have shown a positive relationship between fear and anxiety related to COVID-19 and Internet addiction, and that the increase in students’ anxiety and fear levels also increases their Internet addiction levels. In addition, the results of the study revealed that depression has a negligible indirect effect on the relationship between COVID-19-related fear, anxiety, and suspicion and Internet addiction. In conclusion, the proposed hypothetical model is confirmed after having examined the relationships among depression, Internet addiction, COVID-19-related fear and anxiety, and suspicion.

Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

Objectives

To characterize objective sleep patterns among U.S. adults before and during the COVID-19 pandemic, and to assess for associations between adverse mental health symptoms and (1) sleep duration and (2) the consistency of sleep timing before and during the pandemic.

Design

Longitudinal objective sleep-wake data during January-June 2020 were linked with mental health and substance use assessments conducted during June 2020 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

Setting

Adult users of WHOOP—a commercial, digital sleep wearable.

Participants

Adults residing in the U.S. and actively using WHOOP wearable devices, recruited by WHOOP, Inc.

Intervention

The COVID-19 pandemic and its mitigation.

Measurements

Anxiety or depression symptoms, burnout symptoms, and new or increased substance use to cope with stress or emotions.

Results

Of 4912 participants in the primary analytic sample (response rate, 14.9%), we observed acutely increased sleep duration (0.25 h or 15 m) and sleep consistency (3.51 points out of 100) and delayed sleep timing (onset, 18.7 m; offset, 36.6 m) during mid-March through mid-April 2020. Adjusting for demographic and lifestyle variables, participants with persistently insufficient sleep duration and inconsistent sleep timing had higher odds of adverse mental health symptoms and substance use in June 2020.

Conclusions

U.S. adult wearable users displayed increased sleep duration, more consistent sleep timing, and delayed sleep onset and offset times after the COVID-19 pandemic onset, with subsample heterogeneity. Associations between adverse mental health symptoms and pre- and mid-pandemic short sleep duration and inconsistent sleep timing suggest that these characteristics warrant further investigation as potential modifiable mental health and substance use risk factors.

A Circadian Hygiene Education Initiative Covering the Pre-pandemic and Pandemic Period Resulted in Earlier Get-Up Times in Italian University Students: An Ecological Study

The aims of the present study were to obtain sleep quality and sleep timing information in a group of university students and to evaluate the effects of a circadian hygiene education initiative. All students of the University of Padova (approximately 64,000) were contacted by e-mail (major campaigns in October 2019 and October 2020) and directed to an ad hoc website for collection of demographics and sleep quality/timing information. Participants (n = 5,740) received one of two sets of circadian hygiene advice (“A regular life” or “Bright days and dark nights”). Every month, they were then asked how easy it had been to comply and provided with the advice again. At any even month from joining, they completed the sleep quality/timing questionnaires again. Information on academic performance was obtained post hoc, together with representative samples of lecture (n = 5,972) and examination (n = 1,800) timings, plus lecture attendances (n = 25,302). Fifty-two percent of students had poor sleep quality, and 82% showed signs of social jetlag. Those who joined in October 2020, after several months of lockdown and distance learning, had better sleep quality, less social jetlag, and later sleep habits. Over approximately a year, the “Bright days and dark nights” advice resulted in significantly earlier get-up times compared with the “A regular life” advice. Similarly, it also resulted in a trend toward earlier midsleep (i.e., the midpoint, expressed as clock time, between sleep onset and sleep offset) and toward a decrease in the latency between wake-up and get-up time, with no impact on sleep duration. Significant changes in most sleep quality and sleep timing variables (i.e., fewer night awakenings, less social jetlag, and delayed sleep timing during lock-down) were observed in both advice groups over approximately a year, mostly in association with pandemic-related events characterizing 2020. Early chronotype students had better academic performances compared with their later chronotype counterparts. In a multivariate model, sleep quality, chronotype and study subject (science and technology, health and medical, or social and humanities) were independent predictors of academic performance. Taken together, these results underlie the importance of designing circadian-friendly university timetables.

Impact of pandemic lockdown on learning behaviour and sleep quality in German students

Background

This study addresses the effects of the coronavirus disease 19 (COVID-19) restriction measures on sleep and bedtime habits of N = 637 German university students.

Methods

The questionnaire was distributed online during two different time periods in 2020 (February 27–March 21) and in 2021 (February 27–March 27). The first data collection phase was immediately before the first strict lockdown to contain the COVID-19 pandemic in Germany, and the second data collection phase was during the second lockdown. The survey was composed of validated questionnaires and additional questions regarding the changes in sleep/bedtimes and the status of lectures during the lockdown phase.

Results

The average Pediatric Daytime Sleepiness Scale (PDSS) score in the sample decreased during the lockdown phase, corresponding to the fact that students were less burdened with daytime sleepiness. Moreover, the sample had earlier rise and earlier bedtimes on free days during the lockdown period. Furthermore, the increase in flexible learning times brought about by the pandemic negatively impacted the students’ lifestyle and increased irregularities in sleeping habits.

Conclusion

Significant changes in sleeping patterns seem to be attributable to the pandemic lockdown as found in this self-reported student survey. While daytime sleepiness decreased and earlier overall bedtimes were noted, the impact on the irregularity of sleeping and learning patterns seems to be the most notable finding, as this affects overall quality of life and learning performance. Further studies are needed to validate these findings.

Impacts of the psychological stress response on nonsuicidal self-injury behavior in students during the COVID-19 epidemic in China: the mediating role of sleep disorders

Background

The sudden outbreak of COVID-19 had a great impact on the physical and mental health of people all over the world, especially for students whose physical and mental development was not yet mature. In order to understand the physical and mental conditions of students during the epidemic period and provide a theoretical basis for coping with psychological problems in public health emergencies, this study explored the mediating role of sleep disorders in the effect of the psychological stress response (PSR) on non-suicidal self-injury (NSSI), along with the moderating role of emotional management ability (EMA).

Methods

The SRQ-20, Pittsburgh Sleep Quality Index, NSSI Behavior Questionnaire, and Emotional Management Questionnaire were used to investigate the mental health of Chinese students in April 10–20 (Time point 1, T1) and May 20–30 (Time point 2, T2), 2020. A total of 1,955 students (Mage = 19.64 years, 51.4% male) were examined at T1 and 342 students (Mage = 20.06 years, 48.2% male) were reassessed at T2.

Results

Overall, the detection rate of PSR and NSSI were 17.60% (n = 344) and 24.90% (n = 486) respectively in the T1 sample, and were 16.37% (n = 56) and 25.44% (n = 87), in the T2 sample. We also found that sleep disorders played a mediating role in the effect of PSR on NSSI in the T1 and T2 samples. In addition, EMA was shown to regulate the effect of PSR on sleep disorders and the effect of sleep disorders on NSSI in the T1 samples.

Conclusion

We found that PSR resulting from public health emergency might lead to NSSI behaviors in individuals. PSR may also cause sleep disorders, which can bring about NSSI. However, these effects were also moderated by the EMA. This research expands our understanding of PSR and NSSI in students during the pandemic.

Postpartum sleep health in a multiethnic cohort of women during the COVID-19 pandemic in New York City

OBJECTIVE/DESIGN

Cross-sectional study to examine the determinants of sleep health among postpartum women during the COVID-19 pandemic in New York City (NYC).

SETTING/PARTICIPANTS

A subset of participants recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N = 62 non-Hispanic White, N = 17 African American, N = 107 Hispanic).

MEASUREMENTS

Data on maternal sleep, COVID-19 infection during pregnancy, sociodemographic, behavioral, and psychological factors were collected via questionnaire at 4 months postpartum. Self-reported subjective sleep quality, latency, duration, efficiency, disturbances, and daytime dysfunction were examined as categorical variables (Pittsburgh Sleep Quality Index [PSQI]). Associations between sleep variables and COVID-19 status, time of the pandemic, sociodemographic, behavioral, and psychological factors were estimated via independent multivariable regressions.

RESULTS

Mothers who delivered between May-December 2020, who delivered after the NYC COVID-19 peak, experienced worse sleep latency, disturbances and global sleep health compared to those who delivered March-April 2020, the peak of the pandemic. Maternal depression, stress and COVID-19-related post-traumatic stress were associated with all sleep domains except for sleep efficiency. Maternal perception of infant's sleep as a problem was associated with worse global PSQI score, subjective sleep quality, duration, and efficiency. Compared to non-Hispanic White, Hispanic mothers reported worse global PSQI scores, sleep latency, duration and efficiency, but less daytime dysfunction.

CONCLUSIONS

These findings provide crucial information about sociodemographic, behavioral, and psychological factors contributing to sleep health in the postpartum period.

Age and chronotype influenced sleep timing changes during the first wave of the COVID-19 pandemic

Social restrictions necessary to reduce the spread of coronavirus disease 2019 (COVID-19) profoundly changed how we socialised, worked and, for students, attended classes. Interestingly, significant sleep pattern shifts occurred in the context of pandemic-related social restrictions. Whether age and chronotype influenced these sleep pattern changes remains poorly understood. In this pre-registered (https://osf.io/4a3fx), web-based study, United States residents reported, in one-time assessments, demographic information, self-reported chronotype using the reduced Morningness-Eveningness Questionnaire, and pre-pandemic and pandemic first wave sleep timing using the Ultrashort Munich Chronotype Questionnaire. Participants reported sleep phase delays, reduced social jetlag (SJL) and reduced social sleep restriction (SSR) during the first wave of the pandemic compared to pre-pandemic. Pandemic-related changes in SJL and SSR varied with participants' age and self-reported chronotype. Young adults reported the greatest reductions in SJL and young adults and individuals with evening chronotypes reported the greatest reductions in SSR. We conclude that these groups may have been the most vulnerable to social-biological sleep timing desynchrony under pre-pandemic social, occupational, and educational schedules.

The associations of parental COVID-19 related worries, lifestyles, and insomnia with child insomnia during the COVID-19 outbreak

The impacts of the Coronavirus Disease 2019 (COVID‐19) pandemic on sleep health have been studied extensively. However, little is known about sleep problems within the family system during the pandemic. This study aimed to examine the influence of the COVID‐19 pandemic on insomnia in both adults and children, and to explore whether parental COVID‐19 related worries, lifestyles, and insomnia were associated with child insomnia. A total of 1355 parent–child dyads (39.2% fathers, mean age 38.37 years, SD = 5.34; 52.7% boys, mean age 12.47 years, SD = 1.67) were recruited from Jiangxi province in China from 4 to 18 February 2020. Data on insomnia, COVID‐19 related worries, physical activity, and screen time were collected using online questionnaires. Path analysis showed that COVID‐19 related worries and screen time were positively associated with insomnia in both parents and children; while children's physical activity was negatively related to children's insomnia. Parents' insomnia, COVID‐19 related worries, physical activity, and screen time were positively associated with children's insomnia, COVID‐19 related worries, physical activity, and screen time, respectively. Bootstrap tests showed that parents' worries were positively associated with children's insomnia via parents' insomnia and children's worries; parents' physical activity was negatively associated with children's insomnia via children's physical activity, parents' screen time was positively associated with children's insomnia via parents' insomnia and children's screen time. Both parental and child sleep are affected by the pandemic. Parental insomnia, stress reaction, and lifestyles contribute to child insomnia. Child sleep health may be maintained or improved by family bonds, home exercise, and sleep schedules.

Changes in sleep habits during the lockdown for the COVID-19 pandemic in the population and people attending a morning or an afternoon shift in Monterrey, Mexico

To fight the Covid-19 pandemic, most countries implemented a lockdown that involved restricting the activity and confining the population to their homes. The objective of this paper is to analyze the impact of the lockdown on sleep in people from the population of Monterrey, Mexico, and people attending a morning or afternoon work or study shift after more than a month adaptation period. Participants were 861 residents from Monterrey, Mexico, who completed an anonymous 20-minute web-based survey. The survey asked for information about sleep habits both before and during the lockdown. In Mexico, a national lockdown was declared on March 23rd, 2020. Data collection began 38 days after the start of the lockdown, from April 30th to May 23rd, 2020, allowing enough time for the participants to adjust to the new conditions. The lockdown affected the sleep of the population, producing a phase delay of the sleep-wake cycle, a reduction of sleep duration, as well as an increase in sleep latency and in time awake during night sleep, resulting in a reduction of sleep efficiency. People attending an afternoon shift also showed a phase delay and a reduction in sleep quality during the lockdown. In conclusion, the lockdown produced a delay of sleep and a reduction of sleep quality of the population, even in people with an afternoon shift. It is necessary to design and implement better strategies in the fight against the pandemic, without compromising the wellbeing of the population.

Influencing Factors on College Students' Willingness to Spread Internet Public Opinion: Analysis Based on COVID-19 Data in China

Following COVID-19 outbreak, Internet public opinion has tended to proliferate. From a theoretical perspective, however, the spread law of Internet public opinion in major epidemic prevention and control may provide optimization strategies on how best to channel Internet public opinion. Specifically, this article aims at exploring key factors affecting our theoretical understanding on the spread of Internet public opinion on a major epidemic situation amongst college students. A questionnaire survey on college students was conducted via online research data collection platform located in Changsha, China, amassing three hundred and nineteen valid questionnaires. Smart PLS was applied to verify a theoretical model vis-à-vis the reliability and validity of the measuring instrument. Results show that adult attachment and social motivation have significant positive influences on the consciousness of social participation. Evidently, adult attachment, emotional orientation and risk perception also have significant positive influences on emotional motivation. Emotional motivation plays a mediating role in the relationship between affective disposition and dissemination willingness. Additionally, social motivation, consciousness of social participation and emotional motivation significantly influence one's dissemination willingness in a positive way. The consciousness of social participation plays a mediating role in the relationship between social motivation and dissemination willingness. Social motivation plays a moderating role in the relationship between risk perception and dissemination willingness. Altogether, theoretical rationalization to enhance understanding and guide the initiation and spread of Internet public opinion of major public health emergencies accurately has now been provided by this work.

Changes in Physical Activity and Depressive Symptoms During COVID-19 Lockdown: United States Adult Age Groups

This study investigates: (1) the changes in three major health-related factors—physical activity, non-physical-activity health behavior (i.e., diet quality, alcohol consumption, smoking, sleep quality), and depressive symptoms, and (2) how changes in physical activity were associated with changes in one’s depressive symptoms among young adults, middle-aged adults, and older adults while controlling non-physical-activity health behavior and sociodemographic characteristics among young, middle-aged, and older adults before and after the COVID-19 outbreak lockdown in the United States. A total of 695 participants completed an online questionnaire via MTurk, and participants were asked to recall their physical activity, depressive symptoms, and non-physical-activity health behavior status in January and May of 2020. The IPAQ-SF was used to evaluate individuals’ physical activity, while the CES-D-10 was used to assess depressive symptoms. Covariates included non-physical-activity health behavior and sociodemographic factors. A Bayesian significance testing of changes was used to examine significant changes in physical activity, non-physical-activity behavior, and depressive symptoms in each age group while Bayesian regression analysis was employed to examine how the changes in physical activity were associated with respondents’ depressive symptoms while controlling for individual NHB and sociodemographic characteristics. The results showed that the participants tended to maintain their physical activity levels after the lockdown despite significant increases in sitting time among young and older adults. Decreases in moderate physical activity frequency were associated with a higher level of depressive symptoms (R² = 17.1%). Although young and middle-aged cohorts experienced fewer differences in depressive symptoms compared to their counterparts in the older group, we found no significant heterogeneity effects in the relationships of interest across all age groups. Considering different influences of physical activity on depressive symptoms depending on different levels of activity and ages, more randomized clinical trials with program-based intervention studies should be conducted with different physical activity programs for different age populations.

Sleep, Diet, Physical Activity, and Stress during the COVID-19 Pandemic: A Qualitative Analysis

The COVID-19 pandemic has changed routines and habits, raising stress and anxiety levels of individuals worldwide. The goal of this qualitative study was to advance the understanding of how pandemic-related changes affected sleep, diet, physical activity (PA), and stress among adults. We conducted semi-structured, qualitative interviews with 185 participants and selected 33 interviews from a represented sample based on age, race, and gender for coding and analysis of themes. After coding for thematic analysis, results demonstrated four primary themes: sleep, diet, PA, and stress. Sleep sub-themes such as poorer sleep quality were reported by 36% of our participants, and 12% reported increased an frequency of vivid dreams and nightmares. PA was decreased in 52% of our participants, while 33% experienced an increase and 15% experienced no change in PA. Participants also reported having an improved diet, mostly among women. Stress was elevated in 79% of our participants and was more likely to be discussed by women. Many participants reported how stress was involved in precipitating health behavior change, especially for sleep. Increased stress was also linked to elevated anxiety and depression among participants. The results of this qualitative study demonstrate how managing stress could have a beneficial effect on promoting health behaviors and mental health during the COVID-19 pandemic and beyond.

Sleep disorders and COVID-19

This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.

European university students' mental health during Covid-19: Exploring attitudes towards Covid-19 and governmental response

The effects of Covid-19 have been felt worldwide and one population that are of increasing concern are university students. University students have endured unique and drastic changes to their everyday and academic lives. It is important to understand how university students in different parts of the world have been affected by the Covid-19 pandemic and how it has affected their mental health? A cross-sectional study was conducted during the first wave of Covid-19, in May 2020 with 2,006 university students from the UK, Italy, Germany and Spain. Participants were recruited online and were asked to complete a series of standardised measures of psychological distress, anxiety, flourishing and wellbeing. Attitudes towards Covid-19 were measured using a new scale. The factor structure and reliability of this new scale was confirmed using this European sample. Results indicated that all university students were suffering from poor mental health, considerably below pre-pandemic norms. There were many geographical differences in the way that university students perceived the Covid19 pandemic, in terms of their fears, anxieties, loneliness and positivity. There were also significant mental health comparisons between students from the UK, Italy, Germany and Spain. Student beliefs that their government had provided effective leadership during the Covid-19 pandemic were strongly related to numerous mental health outcomes. A picture of university students' mental health is provided and discussed. Geographical comparisons are discussed, as are the implications for practice and future directions.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02854-0.

Changes in sleep behavior, sleep problems, and psychological distress/health-related quality of life of young Japanese individuals before and during the COVID-19 pandemic

Social restrictions during the coronavirus disease (COVID-19) pandemic have impacted sleep behavior and sleep problems, and their related daytime functioning in young adults. However, no studies have examined such changes in young individuals from countries with mild infection intensity and social restrictions. Therefore, we focused on sleep behaviors and sleep issues in young people in Japan. This study was conducted before and after the pandemic (October 2019 and May 2020, respectively). In total, 2,222 (1,371 students and 851 workers) individuals participated and completed anonymous Web-based questionnaires concerning demographic characteristics, sleep behaviors, sleep problems using the Japanese version of the Epworth Sleepiness Scale (JESS) and the Athens Insomnia Scale (AIS-J), psychological distress using the Japanese version of the Kessler Psychological Distress Scale, and health-related quality of life (HRQoL) evaluated with the Short Form-8 (SF-8). A significantly delayed sleep phase was observed in the second survey compared to the first (p < .001) and was more pronounced in students than in workers (p < .001). The total sleep time, social jetlag degree, and JESS, AIS-J, and SF-8 scores were significantly improved after the pandemic (p < .001, p < .001, p < .001, p < .001, p < .05, and p < .001, respectively). Careful monitoring of whether these modest changes can lead to adjustment concerns is needed.

Morningness-eveningness preference and shift in chronotype during COVID-19 as predictors of mood and well-being in university students

It is suggested that social obligations, such as early work/school starts, have a disadvantageous impact on sleep behavior that can further transfer to mental health problems. Lockdown as a result of the COVID-19 pandemic created a unique opportunity to research human sleep-wake behavior in naturalistic conditions of decreased social obligations. This study aimed to test whether a change in habitual sleep-wake timing (shift in chronotype) during the COVID-19 lockdown impacted mood and well-being, and whether the impact differs according to morningness-eveningness preference. University students (N = 1011; Mean_age = 21.95 ± 1.95 years) filled out self-report questionnaires containing measures of chronotype (midpoint of sleep) before and during the COVID-19 lockdown, morningness-eveningness preference, mood, and well-being. The impact of morningness-eveningness preference and shift in chronotype was tested via multiple regression analyses. Results showed that participants shifted their chronotype in line with their morningness-eveningness preference, and that shift toward earlier sleep-wake timing was related to better moods and well-being. Moreover, higher levels of positive mood (vigor) and well-being were found in individuals who shifted their sleep-wake timing earlier and were higher on morningness.

COVID-19 Infection, the COVID-19 Pandemic, and Changes in Sleep

The objective of this study was to investigate the differences in sleep patterns among individuals with and without laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 test results and self-reported measures recalling sleep habits prior to and during the pandemic were collected from May 2020 to March 2021 among 1,848 individuals in The Arizona CoVHORT Study. We used linear and logistic regression to model the association between test status, presentation of symptoms, and time since test result with sleep duration and trouble sleeping, respectively. Mixed models were used to investigate change in sleep duration prior to the pandemic compared to during the pandemic. Overall, 16.2% of the sample were SARS-CoV-2 positive, 64.3% were SARS-CoV-2 negative, and 19.5% were untested for SARS-CoV-2. Independent of SARS-CoV-2 infection status, all participants slept longer during the pandemic compared to pre-pandemic (Δ SARS-CoV-2 positive: 77.7 min, 95% CI 67.9, 87.5; Δ SARS-CoV-2 negative: 13.4 min, 95% CI 8.4, 18.3). However, SARS-CoV-2 positive participants slept 60.9 min longer (95% CI 49.1, 72.8) than SARS-CoV-2 negative participants in multivariable-adjusted models and had greater odds of trouble sleeping three or more times per week since the start of the pandemic (OR: 1.34 95% CI 1.02, 1.77) This greater odds of trouble sleeping persisted for participants who reported sleep habits > 30 days after their positive SARS-CoV-2 (OR: 2.11 95% CI 1.47, 3.03). Sleep patterns among non-hospitalized individuals with COVID-19 were altered following infection, regardless of the presentation of symptoms and time since infection.

Nightmares in People with COVID-19: Did Coronavirus Infect Our Dreams?

INTRODUCTION

A growing number of studies have demonstrated that the coronavirus disease-19 (COVID-19) pandemic has severely affected sleep and dream activity in healthy people. To date, no investigation has examined dream activity specifically in COVID-19 patients.

METHODS

As part of the International COVID-19 Sleep Study (ICOSS), we compared 544 COVID-19 participants with 544 matched-controls. A within-subjects comparison between pre-pandemic and pandemic periods computed separately for controls and COVID-19 participants were performed on dream recall and nightmare frequency (DRF; NF). Also, non-parametric comparisons between controls and COVID-19 participants were carried out. Further, we compared psychological measures between the groups collected during pandemic. Ordinal logistic regression to detect the best predictors of NF was performed.

RESULTS

We found that people reported greater dream activity during the pandemic. Comparisons between controls and COVID-19 participants revealed a) no difference between groups concerning DRF in the pre-pandemic period and during the pandemic; b) no difference between groups concerning nightmare frequency in the pre-pandemic period; and c) COVID-19 participants reported significantly higher NF than controls during pandemic (p = 0.003). Additionally, we showed that a) anxiety, depression, post-traumatic stress-disorder (PTSD) symptom scores were higher in COVID-19 participants than controls; and b) quality of life and health as well as wellbeing (WHO-5) scores were significantly higher in controls than COVID-19 participants. Finally, ordinal logistic regression indicates that DRF (p < 0.001), PTSD (p < 0.001), anxiety (p = 0.018), insomnia (p = 0.039), COVID-19 severity (p = 0.014), sleep duration (p = 0.003) and age (p = 0.001) predicted NF.

DISCUSSION

Our work shows strong associations between increased nightmares in those reporting having had COVID-19. This suggests that the more that people were affected by COVID-19, the greater the impact upon dream activity and quality of life.

Life before and after COVID-19: The 'New Normal' Benefits the Regularity of Daily Sleep and Eating Routines among College Students

After the COVID-19 lockdown, a 'new normal' was established, involving a hybrid lifestyle that combined face-to-face with virtual activity. We investigated, in a case-control study, the impact of the 'new normal' on daily sleep and eating routines, compared with pre-pandemic conditions. To do this, we propose using social and eating jet lag as markers of the regularity in daily routines. Additionally, we studied whether the 'new normal' had an impact on the body mass index (BMI), diet quality, and other health-related variables. This study included 71 subjects in the pre-pandemic group, and 68 in the 'new normal' group (20-30 years). For all participants, we evaluated social and eating jet lag, BMI, diet and sleep quality, eating behaviors, physical activity, and well-being. General linear models were used to compare outcome variables between pre-pandemic and 'new normal' groups. The results revealed that the 'new normal' was associated with greater regularity in daily sleep and eating routines (-0.7 h of social jet lag (95% CI: -1.0, -0.4), and -0.3 h of eating jet lag (95% CI: -0.5, -0.1)), longer sleep duration on weekdays (1.8 h (95% CI: 1.5, 2.2)), and lower sleep debt (-1.3 h (95% CI: -1.7, -0.9)). Regarding BMI and other health-related variables, we observed that these variables were similar between 'new normal' and pre-pandemic groups. These findings indicate that the 'new normal' had a positive impact on daily sleep and eating routines. Additionally, our results indicated that the 'new normal' offered college students a more sustainable lifestyle, which was associated with more hours of sleep during the week and lower sleep debt. This, in the long run, could have a positive impact on BMI and overall health.

Changes in sleep patterns of college students in Israel during COVID-19 lockdown, a sleep diaries study

To prevent and reduce the spread of COVID-19, governments around the world apply social restrictions and lockdowns. Such lockdowns significantly alter daily routine and habits. A growing body of research indicates that lockdowns affect sleep and circadian rhythms. The current study further explores this effect using sleep logs for a relatively long duration including lockdown and post-lockdown periods in Israel. For two consecutive months, both during lockdown and during post-lockdown periods, from March 13th, 2020 to May 12th, 2020, Israeli students were asked to fill out daily sleep logs in which they report their sleep and wake times. The participants were also asked to fill out the Morningness–Eveningness Questionnaire (MEQ) in the beginning of the study. Data show increase in sleep duration and a delayed midsleep point during lockdown, compared to post-lockdown periods, both on workdays and on weekends. An interaction between chronotype and lockdown was also observed; morning types sleep more both during lockdown and during post-lockdown periods. Interestingly, the midsleep point of late chronotypes is later during both workdays and weekends even during lockdown when social constrains on sleep time are in part removed. Overall, the current results based on detailed and relatively long-term sleep logs analysis confirm previous work using limited measures, such as one-time questionnaires. A lockdown period affects sleep–wake behavior: during lockdown people sleep duration is increased and their sleep onset is delayed. Nevertheless, the circadian preference of individuals is conserved across conditions.

Social Isolation and Sleep: Manifestation During COVID-19 Quarantines

Although researchers have investigated the impact of social isolation on well-being, the recent quarantines due to COVID-19 resulted in a social isolation environment that was unique to any examined in the past. Because sleep is one of the endogenous drives that impacts short and long-term health and well-being, it is important to consider how social isolation during the COVID-19 government-mandated quarantines affected sleep and sleep habits. A number of researchers have addressed this question during the last 2 years by examining several concepts related to possible changes in sleep during the quarantines. To best understand these recent results, the current mini review provides a background on the pre-pandemic literature on the effects of social isolation and loneliness with a focus on sleep and then summarizes the recent literature on sleep and sleep habits. In general, sleep was negatively impacted for many people during the pandemics but not all. One group that seemed to benefit from the pandemic in terms of sleep patterns, were younger people who could more easily adapt their sleep times to match their internal chronobiology. Given the potential broad impact of sleep on health and well-being, better understanding how social isolation impacts sleep is an important consideration for individuals, work organizations, and governments.

Sleep Pattern Changes and the Level of Fatigue Reported in a Community Sample of Adults During COVID-19 Pandemic

PURPOSE

The study aimed to (a) assess the sleep pattern changes and the level of fatigue among COVID positive adults (b) determine the association of sociodemographic and lifestyle factors (age, gender, marital status, occupation, income, exercise, nap, diet, and comorbidities) on sleep pattern and level of fatigue c) examine the relationship between sleep and fatigue, and between sleep problems, sleep quality and fatigue, among a community sample of COVID-19 affected adults.

METHODS

A non-experimental, descriptive, cross-sectional survey design was used. Participants were adults, between 18 and 63 years (n = 782), who tested positive for COVID-19 infection using RT-PCR or Antigen test, confined to home quarantine/under observation, and without any complications. Data was collected using the socio-demographic-sleep and related activity questionnaire, Fatigue Assessment Scale, and Sleep Quality Scale.

RESULTS

A majority of the participants reported either mild to moderate sleep quality problems (97.31%) and 377 of them (48.21%) reported fatigue levels. A significant association between sleep quality and fatigue with gender, and lifestyle factors such as sleep duration, food intake, napping, exercise pattern, and influence of COVID-19 on livelihood after being affected with COVID-19, and time of experiencing sleep problems after COVID-19 infection (all, p ˂ 0.01) were observed, as well as age with sleep quality. Poor sleep quality and fatigue were significantly correlated with each other, and also with sleep problems before being affected with COVID-19 (p = 0.000).

CONCLUSIONS

The study has shown that COVID-19 has an effect on an individual's demographic factors and a multitude of lifestyle factors, and highlights the need for post-COVID-19 monitoring even after recovery from the disease.

Sleeping in a bubble: factors affecting sleep during New Zealand's COVID-19 lockdown

New Zealand (NZ) enforced a rigorous lockdown in response to the outbreak of COVID-19 in 2020. Infection rates remained remarkably low, yet social and personal routines were affected. Factors associated with reporting worsening sleep were explored using an anonymous online survey launched during New Zealand's 2020 lockdown. Participants were 723 adults aged 20-85 years (median: 45 years, 82% women). Bed and wake times occurred significantly later compared to pre-lockdown estimates and resulted in shorter social jetlag (15 min). During lockdown, 54.5% were identified as "poor sleepers" [i.e. score > 5 on the Pittsburgh Sleep Quality Index (PSQI)]. Overall, 45% rated their sleep quality to worsen compared to pre-lockdown, 22% reported an improvement. Reports of worsening sleep were significantly related to increased sleep latency, reduced sleep efficiency, and heightened PSQI scores compared to those with better sleep or no change. Subjectively worse sleep was significantly associated with less time engaging in physical activity, less exposure to daylight, and social interactions compared to pre-lockdown estimates (p < .05). Logistic regression models identified significant relationships between having more vivid dreams and worsening sleep. Worse sleepers also had increased likelihoods of reporting poorer mood and they also scored higher for anxiety compared to those with no change or improved sleep during lockdown (p < .05). Pandemic-related restrictions contributed to poorer self-reported sleep which was linked to deterioration of mood. Negative affect was comparatively lower than reported elsewhere. These findings provide unique insights to the psychosocial impact of the initial COVID-19 lockdown in New Zealand, where the disease outbreak remained low.

Lifestyle changes during the first and second waves of the COVID-19 pandemic in medical college students: are there gender-related differences?

BACKGROUND AND AIMS

The COVID-19 pandemic has seriously affected young people. The present study aims to explore the effects of COVID-19 on lifestyle in 500 undergraduate students both during the acute phase of the pandemic (so-called "first wave") and during the second spread of infections (so-called "second wave"). Gender differences were also explored.  Methods and results. During the first wave we found weight gain in 48.6% of subjects, a switch to an unhealthy diet (43%), and an increase in the amount of food introduced (35%). Interestingly, women showed higher intake of food in order to cope, while men privileged higher wine consumption as a coping mechanism. We observed a sharp reduction in physical activity, increased sedentary behaviours and deterioration in sleep quality. Stress correlates with eating to cope (r=0.86; p<0.001); drinking to cope (r=0.83; p<0.001). Contrary to expectations, the second wave led to a situation similar to the first. We have detected a further deterioration in quality of sleep (67% vs 77%; p<0.01) and also a reduction in sleeping time (68.6% vs 77.7; p<0.01).

CONCLUSIONS

The long pandemic has led to unhealthy lifestyle changes in the student population of our municipality in Northern Italy. There are gender differences in lifestyle modifications developed during the pandemic that suggest a different response to stress. Moreover, the persistence of pandemic-related stress due to the "second wave" has severely affected the lifestyle habits of undergraduate student.

Association of Delayed Sleep/Wake Rhythm with Depression During the First COVID-19 Lockdown in France

PURPOSE

The containment of the population during the COVID-19 pandemic led to the emergence or recurrence of psychiatric conditions and sleep disorders. The influence of sleep/wake rhythm on mental health is well known. The objective of our study was to evaluate the link between the shift in sleep/wake rhythm and the presence of depressive symptoms during the March to May 2020 lockdown in the French population.

PARTICIPANTS AND METHODS

Participants (n = 2513) were recruited via newspapers and social networks in March 2020. We evaluated i) the chronotype before and during the lockdown, assessed by the change in mid-sleep time on work-free days corrected for sleep debt on workdays (delta MSFsc); ii) morningness-eveningness circadian preference (Horne & Ostberg questionnaire); iii) depressive symptoms (Patient Health Questionnaire-9, PHQ-9). The delta MSFsc and the PHQ-9 score were compared between circadian preference types. A multivariate model adjusted for age, sex, circadian preference, housing type, and marital status was used to assess the influence of delta MSFsc on the PHQ-9 score in the whole population.

RESULTS

The population consisted of 77% women, of median (IQR) age 39 (30-48) years. Compared with the pre-lockdown period, the median (IQR) MSFsc was shifted by 30 (0-66) min during the lockdown, with a significant difference between evening [60 (15-120) min], morning [15 (0-46) min] and neutral [30 (0-70) min] circadian type individuals, p < 0.001. One-third of all participants had moderate to severe depressive symptoms (PHQ-9 ≥ 10). A 1-hour shift in MSFsc was associated with a 0.50-point increase [95% CI (0.28; 0.72), p < 0.001] in the PHQ-9.

CONCLUSION

A phase delay in the chronotype was observed in the general population during lockdown. Such disruption was associated with depressive symptoms but the direction of the relationship remains hypothetical. The impact on mental health of preventive measures targeting the sleep/wake rhythm in this context needs further evaluation.

Sleep Quality, Insomnia Symptoms, and Depressive Symptomatology among Italian University Students before and during the Covid-19 Lockdown

The COVID-19 pandemic led world authorities to adopt extraordinary measures to counteract the spread of the virus. The Italian government established a national lockdown from 9 March to 3 May 2020, forcing people in their homes and imposing social distancing. During the pandemic emergency, university students emerged as a vulnerable category. Indeed, higher rates of sleep problems and mental disorders were reported in this population. However, these outcomes were derived from cross-sectional investigations adopting retrospective assessments. Retrospective evaluations suffer from different biases, putatively leading to erroneous outcomes. To overcome this limitation, we adopted a between-subject approach comparing a sample of 240 Italian undergraduate university students assessed in 2016 (mean age ± standard deviation, 20.39 ± 1.42, range 18–25; 80.42% females), with an age/gender-matched sample of university students assessed during the third week of lockdown in Spring 2020. We evaluated sleep quality, insomnia symptoms, and depressive symptomatology using validated questionnaires. We found worse sleep quality, a delayed bedtime, and more severe insomnia and depression symptoms in the students sampled under COVID-19 restrictive measures. We suggest paying special attention to this at-risk population during the current pandemic emergency and applying preventive and supportive interventions to limit the exacerbation of sleep and psychological problems.

Subjective sleep quality before and during the COVID-19 pandemic in a Brazilian rural population

OBJECTIVES

Prior studies have examined sleep during the coronavirus disease 2019 (COVID-19) pandemic, but have few compared sleep measured both during and prior to COVID. We examined the impact of the COVID-19 pandemic on subjective sleep quality in general and separately by gender and age (<50 vs. ≥50 years). Further, we compared sleep quality between those who did and did not follow quarantine orders.

METHODS

This sample is from the Baependi Heart Study, a family-based cohort of adults in South-eastern Brazil. Longitudinal data were from 417 individuals who completed the Pittsburgh Sleep Quality Index (PSQI) twice: between January 2010 and September 2014 (pre-COVID) and during the COVID-19 stay-at-home order March-June, 2020. Cross-sectional analysis included 800 participants.

RESULTS

Mean (±SD) PSQI scores were significantly higher during than before COVID-19 (5.7 ± 3.8 vs. 5.0 ± 3.3, p < .01). This increase was significant among women and among adults ≥50 years but not in men or younger adults. The significant increase in PSQI was only observed in those who quarantined during COVID-19 (5.9 ±3.7 vs. 5.2 ±3.4, p < .01) and not those who did not quarantine (5.0 ± 3.7 vs. 4.5 ± 3, p = .12). In cross-sectional analyses, individuals who quarantined had higher PSQI scores than nonquarantined individuals (6.1 ± 3.9 vs. 5.0 ± 3.5, p < .01). The quarantine status-dependent differences were significant for women (6.4 ± 4 vs. 5.2 ± 3.7, p < .01) and older adults (6.6 ± 0.1 vs. 5.5 ± 3.3, p = .04). Differences by quarantine status were attenuated after adjusting for age and gender.

CONCLUSIONS

Subjective sleep quality declined during the COVID-19 pandemic, particularly among women, older adults, and those compliant to quarantine orders.

The impact of sleep, physical activity and sedentary behaviour on symptoms of depression and anxiety before and during the COVID-19 pandemic in a sample of South African participants

During lockdowns associated with the COVID-19 pandemic, individuals have experienced poor sleep quality and sleep regularity, changes in lifestyle behaviours, and heightened depression and anxiety. However, the inter-relationship and relative strength of those behaviours on mental health outcomes is still unknown. We collected data between 12 May and 15 June 2020 from 1048 South African adults (age: 32.76 ± 14.43 years; n = 767 female; n = 473 students) using an online questionnaire. Using structural equation modelling, we investigated how insomnia symptoms, sleep regularity, exercise intensity/frequency and sitting/screen-use (sedentary screen-use) interacted to predict depressive and anxiety-related symptoms before and during lockdown. We also controlled for the effects of sex and student status. Irrespective of lockdown, (a) more severe symptoms of insomnia and greater sedentary screen-use predicted greater symptoms of depression and anxiety and (b) the effects of sedentary screen-use on mental health outcomes were mediated by insomnia. The effects of physical activity on mental health outcomes, however, were only significant during lockdown. Low physical activity predicted greater insomnia symptom severity, which in turn predicted increased depressive and anxiety-related symptoms. Overall, relationships between the study variables and mental health outcomes were amplified during lockdown. The findings highlight the importance of maintaining physical activity and reducing sedentary screen-use to promote better sleep and mental health.