Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

Socioeconomic Deprivation, Sleep Duration, and Mental Health during the First Year of the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) has had a rapid and sustained negative impact on sleep and mental health in the United States with disproportionate morbidity and mortality among socioeconomically deprived populations. We used multivariable and logistic regression to evaluate the associations among sleep duration, mental health, and socioeconomic deprivation (social deprivation index) in 14,676 Ohio residents from 1101 zip code tabulation areas from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey. Higher socioeconomic deprivation was associated with shorter sleep and poorer mental health after adjusting for covariates (age, sex, race, education, income, and body mass index) in the multivariable linear regression models. Those in the highest socioeconomically deprived areas had 1.6 and 1.5 times higher odds of short sleep (duration < 6 h) and poor mental health (>14 poor mental health days), respectively, in the logistic regression models. Previous researchers have focused on limited socio-environmental factors such as crowding and income. We examined the role of a composite area based measure of socioeconomic deprivation in sleep duration and mental health during the first year of COVID-19. Our results suggest the need for a broader framework to understand the associations among socioeconomic deprivation, sleep duration, and mental health during a catastrophic event.

Sleep During the COVID-19 Pandemic

PURPOSE OF REVIEW

We reviewed current evidence on the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep of different populations.

RECENT FINDINGS

Several studies demonstrated that sleep deprivation may cause immune system dysregulation, which deteriorates the course of COVID-19. The increased prevalence of sleep disorders among COVID-19 patients has been associated with more severe disease and worse clinical outcomes. Healthcare workers who were subjected to atypical workload and more nightshifts developed sleep disorders which associated with work-related errors and COVID-19 infection susceptibility. In general population, circadian misalignment and excessive stressors impaired sleep quality. Sleep dysfunction has been recorded due to the pandemic. It is essential to implement interventions in order to alleviate pandemic-related sleep disorders. Telemedicine, cognitive behavioral therapy, and sleep hygiene practices appear to be helpful. Psychotropic medication should be cautiously administered, while other pharmacological agents, such as melatonin, have shown promising results.

Increasing public concern on insomnia during the COVID-19 outbreak in China: An info-demiology study

Background

Since December 2019, an unexplained pneumonia has broken out in Wuhan, Hubei Province, China. In order to prevent the rapid spread of this disease, quarantine or lockdown measures were taken by the Chinese government. These measures turned out to be effective in containing the contagious disease. In spite of that, social distancing measures, together with disease itself, would potentially cause certain health risks among the affected population, such as sleep disorder. We herein conducted this web search analysis so as to examine the temporal and spatial changes of public search volume of the mental health topic of "insomnia" during COVID-19 pandemic in China.

Methods

The data sources included Baidu Index (BDI) to analyze related search terms and the official website of the National Health Commission of the People's Republic of China to collect the daily number of newly confirmed COVID-19 cases. Following a descriptive analysis of the overall search situation, Spearman's correlation analysis was used to analyze the relationship between the daily insomnia-related search values and the daily newly confirmed cases. The means of search volume for insomnia-related terms during the COVID-19 outbreak period (January 23rd, 2020 to April 8th, 2020) were compared with those during 2016-2019 using Student's t test. Finally, by analyzing the overall daily mean of insomnia in various provinces, we further evaluated whether there existed regional differences in searching for insomnia during the COVID-19 outbreak period.

Results

During the COVID-19 outbreak period, the number of insomnia-related searches increased significantly, especially the average daily the BDI for the term "1 min to fall asleep immediately". Spearman's correlation analysis showed that 6 out of the 10 insomnia-related keywords were significantly positively related to the daily newly confirmed cases. Compared with the same period in the past four years, a significantly increased search volume was found in 60.0% (6/10) insomnia-related terms during the COVID-19 outbreak period. We also found that Guangdong province had the highest number of searches for insomnia-related during the pandemic.

Conclusions

The surge in the number of confirmed cases during the COVID-19 pandemic has led to an increase in concern and online searches on this topic of insomnia. Further studies are needed to determine whether the search behavior truly reflect the real-time prevalence profile of relevant mental disorders, and further to establish a risk prediction model to determine the prevalence risk of psychopathological disorders, including insomnia, using insomnia-related BDI and other well-established risk factors.

Two years after lockdown: Longitudinal trajectories of sleep disturbances and mental health over the COVID-19 pandemic, and the effects of age, gender and chronotype

Since the first lockdown of Spring 2020, the COVID-19 contagion waves pervasively disrupted the sleep and mental health of the worldwide population. Notwithstanding the largest vaccination campaign in human history, the pandemic has continued to impact the everyday life of the general population for 2 years now. The present study provides the first evidence of the longitudinal trajectories of sleep disturbances and mental health throughout the pandemic in Italy, also describing the differential time course of age groups, genders and chronotypes. A total of 1062 Italians participated in a three-time-point longitudinal study covering two critical stages of the emergency (the first lockdown in April 2020 and the second partial lockdown in December 2020) and providing a long-term overview 2 years after the pandemic outbreak (April 2022). We administered validated questionnaires to evaluate sleep quality/habits, insomnia, depression, stress and anxiety symptoms. Analyses showed a gradual improvement in sleep disturbances, depression and anxiety. Conversely, sleep duration progressively decreased, particularly in evening-type and younger people. Participants reported substantial earlier bedtime and get-up time. Stress levels increased during December 2020 and then stabilised. This effect was stronger in the population groups apparently more resilient during the first lockdown (older people, men and morning-types). Our results describe a promising scenario 2 years after the pandemic onset. However, the improvements were relatively small, the perceived stress increased, and the re-establishment of pre-existing social/working dynamics led to general sleep curtailment. Further long-term monitoring is required to claim the end of the COVID-19 emergency on Italians' sleep and mental health.

Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period

BACKGROUND

Sleep is a complex, reversible process that is responsible for the modulation of various physiological mechanisms. COVID-19-related sleep disorders are affecting different populations with a heterogenous prevalence, yet high rates among infected patients are frequently reported. The aim of the study is to assess the prevalence of insomnia in the early post-COVID-19 recovery period and explore the differences in the results acquired by the Athens Insomnia Scale (AIS) by gender and selected infection severity parameters.

METHODS

The data presented in the paper come from a prospective, observational study on COVID-19 complications (SILCOV-19) consisting of 200 COVID-19 patients. The AIS was used for the quantitative measurement of insomnia symptoms based on ICD-10 criteria.

RESULTS

32% (n = 64) of all patients in the study group obtained results indicating sleep disturbances (>5 points on the scale), while 21.5% (n = 43) obtained results indicating insomnia (>10 points on the scale). The analysis of the results obtained by all patients in the AIS showed a significant correlation with the duration of symptoms (Spearman's rank-order: R = 0.18; p < 0.05), but not with the number of days spent in the hospital or age. Women achieved a higher score in overall AIS, as well as in questions assessing total sleep time, well-being the next day, physical and mental fitness the next day, and sleepiness during the day (p < 0.05).

CONCLUSIONS

the prevalence of insomnia in the early post-COVID-19 recovery period is high.

Poor Health Conditions among Brazilian Healthcare Workers: The Study Design and Baseline Characteristics of the HEROES Cohort

This study was conducted to describe the health conditions (the psychosocial aspects, sleep quality, and musculoskeletal symptoms) among Brazilian healthcare workers in the context of the pandemic. Workers answered an online questionnaire, including the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Pittsburgh Sleep Quality Index (PSQI), the Nordic Musculoskeletal Questionnaire (NMQ), and the Beck Depression Inventory (BDI). The most unfavourable psychosocial factors were work pace (61%; 95% CI: 52–69%), emotional work demands (75%; 95% CI: 67–82%), predictability (47%; 95% CI: 39–56%), work-family conflict (55%; 95% CI: 46–64%), burnout (86%; 95% CI: 78–91%), and stress (81%; 95% CI: 73–87%). Most workers (74%; 95% CI: 66–81%) were classified as poor sleepers. Musculoskeletal symptoms were frequent in the neck (64%; 95% CI: 55–72%), shoulders (62%; 95% CI: 54–70%), upper back (58%; 95% CI: 50–67%), and lower back (61%; 95% CI: 52–69%). Depressive symptoms were also highly prevalent (mild: 22%; 95% CI: 15–30%, moderate: 16%; 95% CI: 11–23%, severe: 8%; 95% CI: 4–14%). Most healthcare workers experience unfavourable psychosocial factors, poor sleep quality, as well as musculoskeletal and depressive symptoms. These findings underscore the urgent need to acknowledge and address psychological and physical distress to improve the personal and professional well-being of this population.

Planetary sleep medicine: Studying sleep at the individual, population, and planetary level

Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the "circadian landscape," with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities.

Was the Coronavirus Disease 2019 Pandemic Associated with an Increased Rate of Cracked Teeth?

INTRODUCTION

There is lack of data on whether the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in the etiology of pathosis in endodontic patients. The aim of this study was to determine the rate of cracks and other etiologic factors during the period of March 16th to May 31st in 2020 (COVID-19 initial outbreak) and 2021 (COVID-19 ongoing pandemic) compared with figures from the same period in 2019 (pre-COVID era) in 2 endodontists' practices.

METHODS

The etiologies of patients' chief complaints were determined from records of 2440 teeth (740 in 2019, 651 in 2020, and 1049 in 2021). Changes in the proportion of etiologic factors among all 3 periods were analyzed. The association between the rate of cracked teeth and patients' age and sex was determined using a logistic regression model.

RESULTS

The rates of all etiologies collectively during the studied periods showed a significant change (P < .0001). The rate of cracks significantly increased in 2020 (11.8%) (P = .0001) and 2021 (8%) (P = .0018) compared with 2019 (4.3%). The rate of persistent infections decreased in 2020 (22.3%) (P = .0013) and then increased in 2021 (27.5%) (P = .0153) compared with 2019 (30%). Cracked teeth were associated with the age group of 40-60 years (odds ratio [OR] = 1.882; 95% confidence interval [CI], 1.063-3.330) in 2020 and with age ranges of 40-60 years (OR = 2.051; 95% CI, 1.120-3.759) and >60 years (OR = 2.038; 95% CI, 1.050-3.956) and male sex (OR = 1.599; 95% CI, 1.019-2.510) in 2021.

CONCLUSIONS

The rate of cracked teeth increased during the initial outbreak of the COVID-19 pandemic and 1 year later. This study provided evidence on the association between the COVID-19 pandemic and changes in the rate and presentation of endodontic etiologic factors.

A Social Media Outage Was Associated with a Surge in Nomophobia, and the Magnitude of Change in Nomophobia during the Outage Was Associated with Baseline Insomnia

We examined the immediate impact of a social media outage on nomophobia and associated symptoms using a longitudinal cohort design. Data were collected at two timepoints, baseline (T1) and during the social media outage of 4 October 2021 (T2). T1 was collected in August–September 2021 as part of the baseline of an ongoing study. The nomophobia questionnaire (NMP-Q), Generalized Anxiety Disorder-7 scale (GAD-7), and Athens insomnia scale (AIS) were administered to 2706 healthy participants from the general Bahraini population (56% females, mean age 33.57 ± 11.65 years). Approximately one month later, during the social media outage, 306 of the study participants were opportunistically assessed using the NMP-Q. At baseline, we found that nomophobia levels strongly correlated positively with both insomnia (p = 0.001) and anxiety symptoms (p = 0.001). This is the first report to examine the impact of a social media outage on nomophobia. Our findings indicate that symptoms of nomophobia increased significantly during a social media outage. Baseline insomnia scores predicted a surge in the global scores of nomophobia symptoms during a social media outage.

The prevalence of insomnia in different COVID-19 policy phases: Longitudinal evidence from ITA.LI - Italian Lives

BACKGROUND

This study investigated changes in the prevalence of insomnia in Italy during COVID-19, starting from the first lockdown period (8 March 2020). We hypothesized that lockdown precipitated increased prevalence of insomnia symptoms relative to the pre-pandemic period; b) the gradual relaxation of containment measures - post-lockdown period (Phase 2 and Phase 3) - reduced insomnia severity, leading to a relative recovery of pre-pandemic levels; and c) we tested age-related heterogeneity in sleep responses, with an expected higher increase in insomnia in younger and middle-age groups.

METHODS

Analyses drew on a subsample (N = 883) of respondents to ITA.LI - Italian Lives, a recently established panel study on a probability sample of individuals aged 16 + living in Italy. To estimate patterns of change in insomnia, we first fitted a random-effects ordered logistic model on the whole sample. We then added an interaction term between policy phases and the respondent age to test whether the relationship between insomnia and policy phases differed across age groups. Analyses accounted for survey non-response weights.

RESULTS

The fraction of respondents reporting moderate ("somewhat" + 0.159, S.E. 0.017) or severe ("very much" + 0.142, S.E. 0.030) sleep disturbances significantly increased during Phase 1. The prevalence of insomnia followed an inverted U-shaped curve across policy phases, with further increases from baseline levels ("somewhat" + 0.168, S.E. 0.015; "very much" + 0.187, S.E. 0.030) during Phase 2, followed by a relative reduction in Phase 3, although it remained significantly higher than in the pre-pandemic period ("somewhat", + 0.084, S.E. 0.016; "very much", + 0.045, S.E. 0.010). There were significant age-related differences in insomnia patterns, as the discrete change from pre-pandemic levels in the probability of not suffering from insomnia was negative and significant for the younger age group (- 0.269, S.E. 0.060) and for respondents aged 35-54 (- 0.163, S.E. 0.039).

CONCLUSION

There is reason to believe that the emergency policy response to the COVID-19 crisis may have had unintended and possibly scarring effects in terms of increased prevalence of insomnia. The hardest hit were young adults and, to a lesser extent, the middle-aged; however, older respondents (55 +) remained resilient, and their insomnia trajectory bounced back to pre-pandemic levels.

Do healthy habits regulate the relationship between psychosocial dysfunction by COVID-19 and bidimensional mental health?

COVID-19 has affected mental health and well-being. Lifestyles are relevant to understand the impact of psychosocial dysfunctions. The objective was to examine the role of healthy habits in the relations between psychosocial dysfunction and psychological well-being/distress during COVID-19. Participants completed measures of psychosocial dysfunction, healthy habits, life satisfaction, well-being, depression, and anxiety symptoms. Psychosocial dysfunction was associated with distress symptoms, while health habits were associated with well-being. Healthy habits were mediators: greater psychosocial dysfunction was associated with less healthy habits, which in turn were associated with lower overall well-being, and greater depression. Programs addressing healthy habits can be of great utility.

Sleep Quality Worsens While Perceived Stress Improves in Healthcare Workers over Two Years during the COVID-19 Pandemic: Results of a Longitudinal Study

The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) (p = 0.03, Cohen's d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) (p = 0.001, Cohen's d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.

Psychological Distress among Hospitalized COVID-19 Patients in Denmark during the First 12 Months of the Pandemic

This study aimed to investigate psychological distress among patients hospitalized with a COVID-19 diagnosis in Denmark during the first 12 months of the pandemic and to assess changes in psychological distress in the three months following discharge. A single-center prospective observational survey study among patients hospitalized with a COVID-19 diagnosis between May 2020 and May 2021 was conducted. Participants completed a survey at three time points: at admission, and 1 and 3 months after discharge. Psychological distress was assessed by validated scales measuring symptoms related to depression, anxiety, stress, insomnia, post-traumatic stress disorder (PTSD), and health-related quality of life (HRQoL). In total, 95 patients were included. At admission, the proportion of patients with symptoms of depression was 43%, symptoms of anxiety 32%, moderate/high level of stress 39%, insomnia 52%, and probable/positive PTSD 19%. The burden of symptoms related to depression and anxiety decreased significantly over time, while there was no significant change over time in stress, insomnia, or PTSD. Suboptimal levels of physical and mental HRQoL were detected at admission but improved over time. Patients hospitalized due to COVID-19 during the first year of the pandemic experienced considerable levels of psychological distress at admission, with some improvements within 3 months after discharge.

The COVID-19 pandemic and sleep medicine: a look back and a look ahead

The coronavirus disease 2019 (COVID-19) pandemic is a reminder that global infectious disease outbreaks are not new and they have the potential to cause catastrophic morbidity and mortality, disrupt health care delivery, demand critical decision making in the absence of scientific certainty, interrupt trainee education, inflict economic damage, and cause a spike in demand for health care services that exceeds societal capacity. In this article, we look back at how the sleep medicine community adapted to challenges imposed by the COVID-19 pandemic. To mitigate viral transmission perhaps the single most effective and efficient adaptation was the rapid adoption of telemedicine. Many additional strategies were taken up virtually overnight, including more home sleep apnea testing, reconsideration of potential risks of positive airway pressure therapy, a reduction or cessation of laboratory services, and deployment of workers to provide frontline care to infected patients. During some periods, critical shortages in essential personal protective equipment, respiratory assist devices, and even oxygen added to logistical challenges, which were exacerbated by persistent financial threats and insufficient staffing. Through ongoing innovation, resiliency, and adaptability, breakthroughs were made in assigning staff responsibilities and designing workflows, using clinical spaces, obtaining legislative support, and achieving professional society collaboration and guidance so that the missions of providing health care, teaching, and academic pursuits could continue. Here we summarize what we have learned through these critical months and highlight key adaptations that deserve to be embraced as we move forward.

CITATION

Khosla S, Beam E, Berneking M, et al. The COVID-19 pandemic and sleep medicine: a look back and a look ahead. J Clin Sleep Med. 2022;18(8):2045-2050.

Sleep Quality Impairment Is Associated With Pandemic Attitudes During the Coronavirus Disease 2019 (COVID-19) Circuit Breaker Lockdown in England: A Cross-Sectional Study

Objectives

The COVID-19 pandemic has been associated with sleep quality impairment and psychological distress, and the general public has responded to the pandemic and quarantine requirements in a variety of ways. We aimed to investigate whether sleep quality is low during a short-term (circuit break) quarantine restriction, and whether sleep quality is associated with respondents' overall attitudes to the pandemic using a validated scale.

Design and Setting

Online cross-sectional study in England in November 2020.

Participants

The study included 502 respondents over the age of 18.

Measurements

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and pandemic attitudes were assessed using the Oxford Pandemic Attitudes Scale–COVID-19 (OPAS-C), a validated 20-item, 7-domain scale that assesses pandemic-related stress, fear, loneliness, sense of community, sense of exaggerated concern, non-pharmaceutical interventions, and vaccine hesitancy. Unadjusted and multivariable logistic regression odds ratios of association were assessed between the dependent variable of poor sleep quality (PSQI&gt;5) and risk factors, including OPAS-C score, age, sex, educational status, and income.

Results

The mean (SD) PSQI score was 7.62 (3.49). Overall, 68.9% of respondents met criteria for poor sleep quality using the PSQI cutoff of &gt;5. The mean (SD) OPAS-C score was 60.3 (9.1). There was a significantly increased odds of poor sleep quality in the highest vs. lowest OPAS-C quartiles (OR 4.94, 95% CI [2.67, 9.13], p &lt; 0.0001). Age, sex, income, political leaning, employment status, and education attainment were not associated with poor sleep quality.

Conclusions

More than two-thirds of respondents met criteria for poor sleep quality. The odds of poor sleep quality increased in a dose-response relationship with pandemic attitudes (such as higher levels of pandemic-related stress, fear, or loneliness). The association between poor sleep quality and pandemic attitudes suggests opportunities for public health and sleep medicine interventions, and highlights the need for further research.

The effect of COVID-19 pandemic on sleep-related problems in adults and elderly citizens: An infodemiology study using relative search volume data

COVID-19 has had a substantial national impact in South Korea, causing negative psychological responses including sleep-related problems. Literature indicates sleep problems among the general population have been reported to be as high as around 35.7% during the first 8 months of COVID-19. Therefore, the aim of this study was to investigate the impact of COVID-19 pandemic on sleep problems among the general population using relative search volume (RSV) data, and whether there are any differences by age and time periods spanning before and during the pandemic. RSV data was collected from the most commonly used search engine in South Korea, NAVER. Search terms were grouped into 4 categories: insomnia, other sleep disorders, sleeping pills, and sleeping pill side effects. Time points were divided into 4 periods, each 7 months long: 7 months before COVID-19 (T0), first confirmed COVID-19 case to 7 months after (T1), 7 to 14 months (T2), and 14 to 21 months (T3). A 2x4 factorial Analysis of Variance was conducted to investigate main effects and interactions between age and time periods. Main effects and interaction effects of age and time periods were significant for all search term groups. For all search terms, both age groups showed dramatic increase from T0 to T1. In age group 60 or above, RSV continued to increase for other sleep disorders and sleeping pill. Insomnia and sleeping pill side effects showed decreasing trend at T3. In general, sudden increase in RSV after occurrence of COVID-19 followed by slow decline were observed. However, for age group 60 or above, RSV values of other sleep disorders and sleeping pills continued to increase, suggesting slower recovery of psychological impact with increasing age. Overall, the results underscore the importance of implementing preventive measures for monitoring sleep problems during the pandemic, especially in the elderly.

Sleep dissatisfaction is a potential marker for nomophobia in adults

INTRODUCTION

NOMOPHOBIA is a term used to describe an anxiety disorder in which people fear being disconnected from their mobile phones. Strong associations between nomophobia and insomnia have previously been documented. However, there is no clear explanation for this relationship between the two disorders. The present study was designed to first determine the diagnostic precision of the Insomnia Severity Index (ISI) various components in detecting or classifying nomophobia; and second, examine the diagnostic performance of the identified ISI components in classifying nomophobia.

METHODS

From a previous study 549 participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), and the ISI. The sample was divided into two parts so that each part represented the original sample, using a 40% (n = 209) allocation for sample 1 and 60% (n = 340) for sample 2. To determine common components between nomophobia and insomnia, an exploratory factor analysis was performed using sample 1 to determine the diagnostic precision of the ISI's various components in detecting or classifying nomophobia. A test of the ISI and a cut-off value (ISI-4 ≥2) was then conducted on Sample 2 to determine whether they would accurately identify significant nomophobia.

RESULTS

Sleep dissatisfaction was a common component of insomnia and nomophobia. Sleep dissatisfaction had excellent diagnostic accuracy in detecting individuals with nomophobia (sensitivity 75.13%, specificity 100%, Youden' index 0.75, area under curve 0.88).

CONCLUSION

Questioning patients sleep dissatisfaction may serve as a marker for both nomophobia and insomnia, both of which may demand more comprehensive evaluation.

Dreaming during the COVID-19 pandemic: A narrative review

According to several influential models, dreams can be affected by state- and trait-like factors, sleep features, and diurnal experiences. The COVID-19 pandemic globally affected daily habits, emotional experiences, and sleep. Previous studies suggested an influence of collective traumatic events on dreaming. Starting from these premises, several studies assessed the effect of the pandemic on dreams. This paper aims to review findings concerning the oneiric activity during the COVID-19 pandemic. We report pandemic-related changes in dreams and nightmares, and we consider the possible factors associated with dreaming. Moreover, we provide results about changes in the oneiric activity in different phases of the pandemic. The reviewed findings suggest a pandemic-related enhancement of dream and nightmare frequency, emotional intensity, and distressing contents, modulated by modifications in restrictive measures and associated with diurnal experiences, emotional status, and sleep pattern. We highlight several methodological issues and a large heterogeneity in the present literature, limiting results’ generalizability. However, we provide possible interpretations of the most consistent findings in light of the main theoretical frameworks about dreaming.

Sleep quality and patterns of young West Balkan adults during the third wave of COVID-19 pandemic: a cross-sectional study

OBJECTIVES

To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic.

DESIGN AND SETTING

Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February-August 2021).

PARTICIPANTS

Young adults of Bosnia and Herzegovina, Croatia and Serbia.

RESULTS

Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0-30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms.

CONCLUSIONS

During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

A high proportion of clinicians experienced common anxiety, insomnia and depression during the COVID-19 pandemic. This study examined the item-level association of comorbid anxiety and insomnia symptoms among clinicians who suffered from depressive symptoms during the late stage of the COVID-19 pandemic using network analysis (NA).

METHODS

Clinicians with depressive symptoms (with a Patients Health Questionnaire (PHQ-9) total score of 5 and above) were included in this study. Anxiety and insomnia symptoms were measured using the Generalized Anxiety Disorder Scale - 7-item (GAD-7) and Insomnia Severity Index (ISI), respectively. Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. Expected influence (EI) was used to measure the centrality of index.

RESULTS

Altogether, 1729 clinicians were included in this study. The mean age was 37.1 [standard deviation (SD)=8.04 years], while the mean PHQ-9 total score was 8.42 (SD=3.33), mean GAD-7 total score was 6.45 (SD=3.13) and mean ISI total score was 8.23 (SD=5.26). Of these clinicians, the prevalence of comorbid anxiety symptoms (GAD-7≥5) was 76.8% (95% CI 74.82-78.80%), while the prevalence of comorbid insomnia symptoms (ISI≥8) was 43.8% (95% CI: 41.50-46.18%). NA revealed that nodes ISI7 ("Interference with daytime functioning") (EI=1.18), ISI4 ("Sleep dissatisfaction") (EI=1.08) and ISI5 ("Noticeability of sleep problem by others") (EI=1.07) were the most central (influential) symptoms in the network model of comorbid anxiety and insomnia symptoms in clinicians. Bridge symptoms included nodes PHQ3 ("Sleep") (bridge EI=0.55) and PHQ4 ("Fatigue") (bridge EI=0.49). Gender did not significantly influence the network structure, but "having the experience of caring for COVID-19 patients" significantly influenced the network structure.

CONCLUSION

Central symptoms and key bridge symptoms identified in this NA should be targeted in the treatment and preventive measures for clinicians suffering from comorbid anxiety, insomnia and depressive symptoms during the late stage of the COVID-19 pandemic.

Tiredness, depression, and sleep disorders in frontline healthcare workers during COVID-19 pandemic in Vietnam: A field hospital study

BACKGROUND

The COVID-19 outbreak witnessed in the autumn of 2021 led to unprecedented changes in healthcare systems in some emerging countries. Many field-hospitals, temporary sites of care for COVID-19 patients, were built around the country and followed by the healthcare workers who were mobilized. This study aimed to measure sleep disorders, depression, and fatigue in volunteers working at field hospitals during the COVID-19 outbreak.

METHODS

This was a cross-sectional study. The self-report questionnaire was used for each study subject. Sleep characters, including STOP's elements were questioned. Healthcare workers' burnout was detected by using Pichot's questionnaire.

RESULTS

One hundred front-line healthcare workers (FHWs), predominantly last year and graduated medical students, were included in the study (86% female subjects). The mean sleep-time of FHWs before, while working, and during the isolation period after working at COVID-19 field hospitals were: 7.78 ± 1.48, 5.71 ± 1.40, and 8.78 ± 2.31 h per day, respectively. Burnout was not a crucial issue for these volunteer subjects. The mean scores of Pichot's Fatigue Scale and Pichot's Depression Scale, measured after 4 weeks working at field hospitals, were 4.18 ± 5.42 and 2.54 ± 3.36, respectively. Thirteen participants were suspected of depression. The fatigue scores decreased significantly in the group who claimed short sleep latency. The factor that increased the depression score was "anxious feeling" (p = 0.001). Other significant factors were "short sleep latency," "observed sleep apnea," "tiredness, daily sleepiness" and "snoring."

CONCLUSION

Appropriate work schedule, better sleep conditions, and mental health support could be helpful for FHWs. The mandatory 2 weeks of isolation after working in field hospitals provided opportunity for FHWs' recovery.

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.

Translation, validity and reliability of the Danish version of the Adolescent Insomnia Questionnaire

Background: The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of Danish adolescents. Methods: The AIQ underwent a process of forward-backward translation and pilot testing. Subsequently, data were collected at baseline and two-week follow-up from adolescents aged 11-19, who completed both the AIQ and an available adult measure of insomnia (the Athens Insomnia Scale, AIS). The internal consistency, test-retest reliability and convergent validity were assessed. Exploratory factor analysis was conducted to identify the latent factors underlying the questionnaire. Results: At baseline 185 adolescents (18% males and 82% females, mean age 16.0 years) and 102 (55.1%) at two-week follow-up completed the questionnaires. The AIQ showed excellent internal consistency for the total score (Cronbach's a: 0.88) and good convergent validity with the AIS total score (Pearson's correlation value= 0.86, P<0.001). The test-retest reliability at two weeks was very satisfactory (ICC coefficient = 0.89; 95% CI 0.84, 0.92). Results from the exploratory factor analysis identified a three-model solution corresponding to the same three-model solution identified within the original development sample. Conclusions: The Danish version of the AIQ demonstrated satisfactory psychometric properties in terms of internal consistency, test-retest reliability and validity, which supports its use as a screening tool for the identification of insomnia symptoms in adolescents, including Danish-speaking adolescents.

Translation, validity and reliability of the Danish version of the Adolescent Insomnia Questionnaire

Background: The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of Danish adolescents. Methods: The AIQ underwent a process of forward-backward translation and pilot testing. Subsequently, data were collected at baseline and two-week follow-up from adolescents aged 11-19, who completed both the AIQ and an available adult measure of insomnia (the Athens Insomnia Scale, AIS). The internal consistency, test-retest reliability and convergent validity were assessed. Exploratory factor analysis was conducted to identify the latent factors underlying the questionnaire. Results: At baseline 185 adolescents (18% males and 82% females, mean age 16.0 years) and 102 (55.1%) at two-week follow-up completed the questionnaires. The AIQ showed excellent internal consistency for the total score (Cronbach's a: 0.88) and good convergent validity with the AIS total score (Pearson's correlation value= 0.86, P<0.001). The test-retest reliability at two weeks was very satisfactory (ICC coefficient = 0.89; 95% CI 0.84, 0.92). Results from the exploratory factor analysis identified a three-model solution corresponding to the same three-model solution identified within the original development sample. Conclusions: The Danish version of the AIQ demonstrated satisfactory psychometric properties in terms of internal consistency, test-retest reliability and validity, which supports its use as a screening tool for the identification of insomnia symptoms in adolescents, including Danish-speaking adolescents.