Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis

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.

Methodologies and Wearable Devices to Monitor Biophysical Parameters Related to Sleep Dysfunctions: An Overview

Sleep is crucial for human health from metabolic, mental, emotional, and social points of view; obtaining good sleep in terms of quality and duration is fundamental for maintaining a good life quality. Over the years, several systems have been proposed in the scientific literature and on the market to derive metrics used to quantify sleep quality as well as detect sleep disturbances and disorders. In this field, wearable systems have an important role in the discreet, accurate, and long-term detection of biophysical markers useful to determine sleep quality. This paper presents the current state-of-the-art wearable systems and software tools for sleep staging and detecting sleep disorders and dysfunctions. At first, the paper discusses sleep's functions and the importance of monitoring sleep to detect eventual sleep disturbance and disorders. Afterward, an overview of prototype and commercial headband-like wearable devices to monitor sleep is presented, both reported in the scientific literature and on the market, allowing unobtrusive and accurate detection of sleep quality markers. Furthermore, a survey of scientific works related the effect of the COVID-19 pandemic on sleep functions, attributable to both infection and lifestyle changes. In addition, a survey of algorithms for sleep staging and detecting sleep disorders is introduced based on an analysis of single or multiple biosignals (EEG-electroencephalography, ECG-electrocardiography, EMG-electromyography, EOG-electrooculography, etc.). Lastly, comparative analyses and insights are provided to determine the future trends related to sleep monitoring systems.

Sleep alterations following COVID-19 are associated with both neuroinflammation and psychological disorders, although at different times

Introduction

By the end of 2019, severe acute respiratory syndrome coronavirus 2 rapidly spread all over the world impacting mental health and sleep habits. Insomnia, impaired sleep quality, and circadian rhythm alterations were all observed during the pandemic, especially among healthcare workers and in patients with acute and post-acute COVID-19. Sleep disruption may induce a pro-inflammatory state associated with an impairment of immune system function.

Objective

We investigated the relationship between sleep alterations, psychological disorders, and inflammatory blood biomarkers in patients with post-acute COVID-19.

Methods

We enrolled 47 subjects diagnosed with COVID-19 pneumonia at Santa Maria della Misericordia University Hospital (Udine, Italy) between March and May 2020. Selected patients were evaluated at 2 months (T1) and 10 months (T2) after discharge. Each time, we collected clinical interviews, neurological examinations, and self-administered questionnaires to assess sleep and life quality, anxiety, depression, and post-traumatic stress disorder. Blood biomarkers of endothelial activation, neuroinflammation, and inflammatory cytokines were also measured at each follow-up. Collected variables were analyzed using comparisons between groups and linear regression models.

Results

Prevalence of insomnia increased from 10.6% up to 27.3% after COVID-19. Poor sleep quality was found in 41.5% of patients at both study visits. At T1 follow-up, poor sleepers showed higher levels of neurofilament light chain, vascular cell adhesion molecule 1, and interleukin 10; no significant associations were found between sleep quality and psychological disorders. At T2 follow-up, lower sleep quality was associated with higher levels of vascular cell adhesion molecule 1 and interleukin 8, but also with higher scores for anxiety, depression, and post-traumatic stress disorder.

Conclusion

Our results suggest an association of poor sleep quality with both psychological disorders and neuroinflammation, although at different times, in previously hospitalized patients with moderate-to-critical COVID-19.

Parental burnout and sleep problems in Iranian mothers of primary school-aged children: Exploring the mediation effect of emotional schemas

OBJECTIVES

Sleep is crucial for mental well-being. Evidence suggests sleep problems in mothers can result from parental burnout. The possible mediators that link parental burnout to sleep problems have not been investigated. This study seeks to explore the mediational role of emotional schemas as psychological constructs, which relate parental burnout to sleep problems in mothers of school-aged children.

METHOD

A total of 224 mothers participated voluntarily in this cross-sectional study. Data were collected online. The participants completed Parental Burnout Assessment (PBA) scale, Mini Sleep Questionnaire-Persian Version (MSQ-P), and Leahy Emotional Schema Scale (LESS II). Structural equation modeling (SEM) was performed using the bootstrap method to assess the mediation model.

RESULTS

The findings of this research indicate a positive correlation exists between parental burnout, emotional schemas, and insomnia/hypersomnia. The mediation analysis confirmed parental burnout and insomnia/ hypersomnia are related indirectly through emotional schemas.

CONCLUSION

Implications of the findings is that when parental burnout is present, the psychological treatment of sleep problems may benefit from targeting emotional schemas. However, further research is needed to determine whether similar mediational effects are replicated.

Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care

Background: During the recent pandemic, Healthcare Professionals (HCPs) presented a significant prevalence of psychological health problems and sleep disturbances. The aim of this study was to assess the impact of COVID-19 on HCPs’ sleep and mental stress with a separate analysis for primary care HCPs. Methods: A cross-sectional observational study with an online anonymized, self-reported questionnaire was conducted in May 2020 (1st wave) and repeated in December 2020 (2nd wave). Patient health questionnaire-4 (PHQ-4), dimensions of anger reactions-5 (DAR-5) scale, 3-item UCLA loneliness scale (LS) and sleep condition indicator (SCI) were used. Results: Overall, 574 participants were included from the 1st wave, 514 from the 2nd and 469 were followed during both. Anxiety and depression were significantly higher during the 2nd wave vs. the 1st (32.8% vs. 12.7%, p < 0.001 and 37.7% vs. 15.8%, p < 0.001). During the 2nd wave, HCPs scored significantly higher in DAR-5 (9.23 ± 3.82 vs. 7.3 ± 3.3, p < 0.001) and LS (5.88 ± 1.90 vs. 4.9 ± 1.9, p < 0.001) with worse sleep quality SCI (23.7 ± 6.6 vs. 25.4 ± 3.2, p < 0.001). This was more evident in primary care HCPs. Significant correlations were found between SCI and PHQ4, DAR5 and LS. Conclusion: There is a need to support HCPs’ mental health and sleep, especially in those working in primary care.

Pandemic and student mental health: mental health symptoms among university students and young adults after the first cycle of lockdown in the UK

BACKGROUND

Early COVID-19 research suggests a detrimental impact of the initial lockdown on young people's mental health.

AIMS

We investigated mental health among university students and young adults after the first UK lockdown and changes in symptoms over 6 months.

METHOD

In total, 895 university students and 547 young adults not in higher education completed an online survey at T1 (July-September 2020). A subset of 201 university students also completed a 6 month follow-up survey at T2 (January-March 2021). Anxiety, depression, insomnia, substance misuse and suicide risk were assessed.

RESULTS

At T1, approximately 40%, 25% and 33% of the participants reported moderate to severe anxiety and depression and substance misuse risk, clinically significant insomnia and suicidal risk. In participants reassessed at T2, reductions were observed in anxiety and depression but not in insomnia, substance misuse or suicidality. Student and non-student participants reported similar levels of mental health symptoms. Student status was not a significant marker of mental health symptoms, except for lower substance misuse risk.Cross-sectionally, greater symptoms across measures were consistently associated with younger age, pre-existing mental health conditions, being a carer, worse financial status, increased sleep irregularity and difficulty since lockdown. Longitudinally, T2 symptoms were consistently associated with worse financial status and increased difficulty sleeping at T1. However, these associations were attenuated when baseline mental health symptoms were adjusted for in the models.

CONCLUSIONS

Mental health symptoms were prevalent in a large proportion of young people after the first UK lockdown. Risk factors identified may help characterise high-risk groups for enhanced support and inform interventions.

'COVID-Somnia' in healthcare workers during the pandemic

OBJECTIVES

Sleep disorders associated with COVID-19 pandemic are termed as 'COVID-somnia.' In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms.

METHODS

This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants' demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model.

RESULTS

A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores.

CONCLUSION

Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

Impairment of executive functions due to sleep alterations: An integrative review on the use of P300

Objective

Cognitive impairment due to sleep deprivation (SD) is an important global health concern as part of the growing rates of sleep disorders and sleep deprivation worldwide. Amongst the affected cognitive processes, the effects of SD on the executive functions (EFs) show diverse methods and inconclusive or contradictory results, highlighting the importance of further research in this field. Considering this scenario, we evaluate one of the most used methods for objectively evaluating EFs on SD: the event-related potential (ERP) P300.

Methods

Our study provides a comprehensive review on the use of P300 for evaluating executive functions in sleep alterations on subjects of all ages, as well as an analysis on the efficiency of P300 as an assessment method for executive functions compared to traditional neurocognitive batteries. We review the benefits of P300 application for multiple sleep/wake alterations, whether evoked in laboratory or as part of pre-existing sleep disorders.

Results

We assess the diverse protocols used to elicit and complement P300, the most identified alterations in amplitude and latency, and suggest new lines of study that could benefit from P300 within the field.

Conclusion

We conclude that P300 is a valuable asset for evaluating executive dysfunction under sleep deprivation both as a standalone protocol and in conjunction with subjective methods, with consistently significant results in assessing executive dysfunction in a diversity of subjects and etiologies.

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.

SARS-CoV-2 infection is associated with increased odds of insomnia, RLS and dream enactment behavior

BACKGROUND

Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable.

METHODS

This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered.

RESULTS

Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03-1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42-2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98-3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21-2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection.

CONCLUSION

SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS.

The successful rehabilitation of a 75-year-old female with debilitating long COVID: A case report

A 75-year-old previously healthy female became severely ill, functionally dependent, and required long-term home oxygen therapy, after recovery from coronavirus disease 2019 (COVID-19) with acute respiratory failure and extensive pulmonary fibrosis. After two months of respiratory muscle training and a comprehensive cardiopulmonary rehabilitation program, her dyspnea, physical performance, pulmonary function parameters, and activities of daily living rapidly improved. This Case highlights the importance of a timely active rehabilitation program for COVID-19 survivors experiencing the long-term effects of coronavirus (long COVID).

Quality of Sleep and Work Productivity among White-Collar Workers during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has disrupted routine sleep and work patterns in the general population. We conducted an anonymous online survey among white-collar workers from various finance, IT and technology companies in Lithuania to define factors associated with worse sleep quality and diminished productivity during a COVID-19 lockdown. Materials and Methods: Employees of selected companies in Lithuania completed an anonymous questionnaire online that included the Pittsburgh Sleep Quality Index (PSQI), The Sleep Locus of Control (SLOC), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ). Respondents also provided information about their sleep hygiene, physical activity and alcohol use. Results: Data of 114 respondents (56, 49.1% male) were used for analysis. Among them, 49 (43.0%) suffered from poor sleep and 29 (25.4%) had clinically relevant levels of anxiety. However, there were only negligible levels of absenteeism in the sample (a median of zero hours of work lost over the past month). In a stepwise linear regression model (F(5,108) = 11.457, p < 0.001, R2adj = 0.316), high levels of anxiety, daily hours spent using the screen, use of electronic devices in the bedroom, smoking in the evening, and COVID-19-related changes in appetite were associated with worse sleep quality. Absenteeism was associated with physical activity of moderate intensity and decreased self-reported productivity during the pandemic (F(2,111) = 7.570, p = 0.001, R2adj = 0.104). However, there was no strong relationship between sleep-related variables (i.e., sleep hygiene, sleep locus of control, quality of sleep) or levels of anxiety and measures of work productivity. Conclusions: Our findings suggest that while bad sleep hygiene, anxiety, and changes in appetite are associated with worse sleep quality among white-collar workers during the pandemic, work productivity may remain high irrespective of disrupted sleep.

Impact of the COVID-19 pandemic on the mental health of hospital staff: An umbrella review of 44 meta-analyses

BACKGROUND

Hospital staff is at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. However, the literature lacks an overall and inclusive picture of mental health problems with comprehensive analysis among hospital staff during the COVID-19 pandemic.

OBJECTIVES

To ascertain the prevalence of anxiety, depression and other mental health outcomes as reported in original articles among hospital staff during the COVID-19 pandemic.

DESIGN

A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published meta-analyses of observational studies evaluating the prevalence of mental health problems in hospital staff during the pandemic.

REVIEW METHODS

Systematic searches were conducted in PubMed/Medline, CINAHL, EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The random effects model was used for the meta-analysis, and the I² index was employed to assess between-study heterogeneity. Publication bias using Egger test and LFK index was examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was applied for the quality assessment of systematic reviews, while we used GRADE to rate the quality of evidence.

RESULTS

Forty-four meta-analyses from 1298 individual studies were included in the final analysis, encompassing the prevalence of 16 mental health symptoms. One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% to 32.7%) and depression (Prevalence: 28.4%, 95% CI:25.5% to 31.3%) symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping disorders. Fear-related symptoms, reduced well-being, poor quality of life, and acute stress symptoms had the highest prevalence among hospital staff. However, the quality of evidence in these areas varied from low to very low. Nurses suffered more often from sleep problems and symptoms of anxiety and depression than doctors, whereas doctors reported a higher prevalence of acute stress and post-traumatic disorders. The burden of anxiety, depression, and sleep disorders was higher among female employees than their male counterparts. Remarkably, acute stress and insomnia affected more than half of first-line medical staff.

CONCLUSIONS

The prevalence of mental health problems among hospital staff during the COVID-19 pandemic is generally high, with anxiety, depression and insomnia symptoms representing the most robust evidence based on a large dataset of prevalence meta-analyses. However, there is no strong confidence in the body of evidence for each outcome assessed.

REGISTRATION

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TWEETABLE ABSTRACT

The COVID-19 pandemic is having a major impact on the mental health of hospital staff. The need for support must be different for nurses and doctors @eldi12345.

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 of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

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.

Pre-gelled Electrode Grid for Self-Applied EEG Sleep Monitoring at Home

The need for diagnostic capabilities for sleep disorders such as sleep apnea and insomnia far exceeds the capacity of inpatient sleep laboratories. Some home monitoring systems omit electroencephalography (EEG) because trained personnel may be needed to apply EEG sensors. Since EEG is essential for the detailed evaluation of sleep, better systems supporting the convenient and robust recording of sleep EEG at home are desirable. Recent advances in EEG acquisition with flex-printed sensors promise easier application of EEG sensor arrays for chronic recordings, yet these sensor arrays were not designed for sleep EEG. Here we explored the self-applicability of a new sleep EEG sensor array (trEEGrid) without prior training. We developed a prototype with pre-gelled neonatal ECG electrodes placed on a self-adhesive grid shape that guided the fast and correct positioning of a total of nine electrodes on the face and around the ear. Positioning of the sensors was based on the results of a previous ear-EEG sleep study (da Silva Souto et al., 2021), and included electrodes around the ear, one eye, and the chin. For comparison, EEG and electrooculogram channels placed according to the American Academy of Sleep Medicine criteria, as well as respiratory inductance plethysmography on thorax and abdomen, oxygen saturation, pulse and body position were included with a mobile polysomnography (PSG) system. Two studies with 32 individuals were conducted to compare the signal quality of the proposed flex-printed grid with PSG signals and to explore self-application of the new grid at home. Results indicate that the new array is self-applicable by healthy participants without on-site hands-on support. A comparison of the hypnogram annotations obtained from the data of both systems revealed an overall substantial agreement on a group level (Cohen’s κ = 0.70 ± 0.01). These results suggest that flex-printed pre-gelled sensor arrays designed for sleep EEG acquisition can facilitate self-recording at home.

Impacts of COVID-19 Pandemic on Dietary Consumption among Chinese Residents: Evidence from Provincial-Level Panel Data

The COVID-19 pandemic has profoundly affected people’s daily lives, including their dietary behaviors. Using a panel data set of 31 provinces from 2015 to 2020, this study employed two-way fixed effects (FE) models to examine the impacts of the COVID-19 pandemic on dietary consumption among Chinese residents. The results showed that the COVID-19 pandemic positively affected residents’ consumption of grain, eggs, dairy, and white meat (poultry and aquatic products), while it had a negative effect on individuals’ red meat consumption in both urban and rural areas. These results were robust to different measures of the COVID-19 pandemic, including the number of confirmed cases, suspect cases, and dead cases. Comparatively, the changes in food consumption induced by the COVID-19 pandemic were more prominent for Chinese residents who lived in rural areas than urban areas. In addition, compared to their counterparts, the dietary consequences of the pandemic were more pronounced for residents living in the eastern region and regions with a high old-age dependency ratio and low illiteracy rate. Furthermore, the estimation results of the quantile regression model for panel data suggested that the COVID-19 pandemic had relatively larger impacts on the dietary consumption of Chinese residents at lower quantiles of food consumption compared with those at higher quantiles. Overall, the results of this study suggested that Chinese residents had a healthier diet after the outbreak of the COVID-19 pandemic. We discussed possible mechanisms, including health awareness, income, food supply and prices, and other behavioral changes during COVID-19 (e.g., physical activity and cooking). To further improve residents’ dietary behaviors and health, our study proposed relevant measures, such as increasing residents’ dietary knowledge, ensuring employment and income, and strengthening the food supply chain resilience during the pandemic.

Investigating The Impacts of Working at Home Among Offıce Workers With Neck Pain on Health Status, Depression and Sleep Quality During COVID-19 Pandemic

OBJECTIVE

This study aimed to assess the effect of workplace and ergonomic features on neck pain intensity, sleep problems, depression and health status at office workers during COVID-19 pandemic.

METHODS

One-hundred and thirty-nine office workers with neck pain who are 18-55 years of age were enrolled in the study. Sociodemographic features including ergonomic features of workplace were evaluated. The Beck Depression Inventory (BDI), the Nottingham Health Profile (NHP), the Pittsburgh Sleep Quality Index (PSQI), the Neck Pain and Disability Scale (NPDS) were administered to all patients.

RESULTS

All participants was grouped based on workplace into Group 1 (working in office n = 84) and Group 2(working at home n = 55). There was a statistically significant difference between the groups according to rate of absence of back support, flexible back (respectively p = 0.020 and p = 0.029). The scores of the Neck Pain and Disability Index scores of the participants who work with a computer more than 3 hours without break was higher in Group 2 than ın Group 1, and the differences between groups were found statistically significant (p = 0.001).

CONCLUSIONS

The health related quality of life was worse and neck pain intensity was severe in working at home group than working in office group.Trial registration:ClinicalTrials.gov identifier: NCT05074407..

Mental Health Impact of the COVID-19 Pandemic on Mexican Population: A Systematic Review

The COVID-19 pandemic has had an impact on mental health in the general population, but no systematic synthesis of evidence of this effect has been undertaken for the Mexican population. Relevant studies were identified through the systematic search in five databases until December, 2021. The selection of studies and the evaluation of their methodological quality were performed in pairs. The Newcastle-Ottawa Scale (NOS) was used for study quality appraisal. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD42021278868). This review included 15 studies, which ranged from 252 to 9361 participants, with a total of 26,799 participants. The findings show that COVID-19 has an impact on the Mexican population’s mental health and is particularly associated with anxiety, depression, stress and distress. Females and younger age are risk factors for development mental health symptoms. Mitigating the negative effects of COVID-19 on mental health should be a public health priority in Mexico.

Factors Associated with the Level of Physical Activity in Middle-Aged Colombian People during Lockdown in Response to COVID-19: A Cross-Sectional Study

(1) Background: Due to the pandemic caused by COVID-19, mandatory confinement was declared, which generated a decrease in the practice of physical activity (PA). Based on this problem, it was proposed to study the associations between PA in relation to depressive symptoms, quality of sleep, and the quality of life of middle-aged people who work in the university context during compulsory confinement as a result of COVID-19. (2) Methods: A total of 336 middle-aged people (48 ± 6.67) participated in this analytical cross-sectional study. The variable levels of PA, quality of sleep, symptoms of depression, and quality of life were measured with the International Physical Activity Questionary (IPAQ), the Pittsburgh Sleep Quality Index (PSQI), the Zung Self-Rating Depression Scale (ZSDS), and the SF-12v2 questionnaire, respectively. (3) Results: A logistic regression model was used to analyze the relationships between the level of PA and depressive symptoms (OR = 2.053), total sleep duration (OR = 0.495), sleep disturbances (OR = 2.414), quality of sleep (OR = 2.471), use of sleep medication (OR = 0.348), daytime dysfunction (OR = 1.809), general health (OR = 0.949), and physical functioning (OR = 0.987). (4) Conclusions: In middle-aged people, during compulsory confinement, being insufficiently active is a risk for depressive symptoms and disturbances in sleep quality.

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.

Changes and correlates of screen time in adults and children during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Screen time has increased as a result of the COVID-19 pandemic, and several correlates have been associated with these increases. These changes, however, have not been aggregated. It was the aim of this review to (a) aggregate changes in screen time in adults and children, and (b) report on variables in relation to screen time during the COVID-19 pandemic.

METHODS

A systematic review of major databases was undertaken for studies published from inception to 06/12/2021, using a pre-published protocol (PROSPERO ID: CRD42021261422). Studies reporting (a) screen time pre-versus-during the pandemic, (b) screen time percentage change, or (c) correlates of screen time during the pandemic were included. A random effects meta-analysis was undertaken with subgroup analysis by age group and type of screen time.

FINDINGS

After review, 89 studies (n = 204,734; median age=20·6; median female=53·3%) were included. The majority of studies were cross-sectional. With regards to total screen time, primary aged children (6-10 years) reported largest increases (1·4 hrs/day; 95%CI 1·1-1·7), followed by adults (>18 years; 1·0 hrs/day; 95%CI 0·7-1·2), adolescents (11-17 years; 0·9 hrs/day; 95%CI 0·3-1·5), and young children (0-5 years; 0·6 hrs/day 95%CI 0·3-0·9 hrs/day). For leisure screen time (non-work/non-academic), primary aged children reported largest increases (1·0 hrs/day 95%CI 0·8-1·3), followed by adults (0·7hr/day 95%CI 0·3-1·2), young children (0·6 hrs/day; 95%CI 0·4-0·8), with adolescents reporting the lowest increase (0·5 hrs/day 95%CI 0·3-0·7). Several correlates were associated with reported increases in screen time, including adverse dietary behaviours, sleep, mental health, parental health, and eye health.

INTERPRETATION

Pooled evidence suggest that primary aged children reported the highest increase in both total and leisure screen time during COVID-19. It is recommended that screen time should be reduced in favour of non-sedentary activities. This study has the potential to inform public health policy and future guidance regarding screen time, and to inform future research in this area.

FUNDING

No funding was received for this study.

Retirement Center Worker Sleep Health Assessment During the COVID-19 Pandemic

BACKGROUND

Sleep health disturbances can increase risks for workplace injury, error, and poor worker health. Essential workers have reported sleep disturbances since the COVID-19 pandemic onset, which may jeopardize their health and safety. The aims of this project were to assess sleep health among Continuing Care Retirement Community (CCRC) workers, examine potential differences between worker types, and describe the self-perceived impact of COVID-19 on workers' workload and sleep.

METHODS

Through an academic-practice partnership, this needs assessment used a cross-sectional design that collected self-report data during fall 2020 from CCRC workers. Guided by the Workplace Health Model, survey questions included work characteristics, sleep health, and COVID-19 impact on sleep and workload.

FINDINGS

Ninety-four respondents completed the survey across multiple departments. Respondents (n = 34, 36.2%) reported sleeping below recommended hours on workdays. The majority scored above the population mean on Patient-Reported Outcomes Measurement (PROMIS) measures of sleep disturbance (n = 52, 55.3%), sleep-related impairment (n = 49, 52.1%), and fatigue (n = 49, 52.1%). Differences in workday total sleep time and fatigue were noted among shift workers versus nonshift workers, with shift workers reporting less sleep and more fatigue. Shorter sleep duration was noted among respondents working shifts 10 or more hours compared with those working 8 hours. Pandemic-related workload increase was reported by 22.3% (n = 21) of respondents, with 17% (n = 16) noting more than one type of workload change. Since COVID-19 onset, 36.2% (n = 34) reported no sleep changes and 35.1% (n = 33) reported sleeping less. A medium, positive relationship was found between increased changes in work due to COVID-19 and increased difficulties sleeping (r = .41, n = 73, p = .000).

CONCLUSION/APPLICATION TO PRACTICE

Proper sleep health is essential to workplace safety and worker health. By assessing sleep health during a crisis, occupational health nurses can identify opportunities to support worker health and safety, through sleep education, monitoring for sleepiness and fatigue, ensuring countermeasures are available (e.g., caffeine), and assessing for opportunities to change organizational policies.

COVID-19 hardships and self-reported sleep quality among American adults in March and April 2020: Results from a nationally representative panel study

OBJECTIVE

To analyze the association between coronavirus disease 2019 (COVID-19) hardships and self-reported sleep troubles in a nationally representative sample of adults in the United States.

DESIGN

Prospective study in March and April 2020.

SETTING

Population-based.

PARTICIPANTS

About 8130 respondents who participated in the Pew Research Center's American Trends Panel in March and April of 2020.

MEASUREMENTS

Self-reported sleep troubles were defined as a report of 3 or more days per week with trouble sleeping in March and April (separately). Respondents were asked about COVID-19 stressors such as COVID-19 Threat and COVID-19-specific hardships including pay cuts/hours reductions, job loss, and childcare difficulties. Logistic regression models were fit to test associations between COVID-19 hardships and sleep troubles adjusted for sociodemographic covariates (age, gender, race/ethnicity, region, marital status, nativity, education, income, health insurance, and past diagnosis of mental health problems).

RESULTS

Reported sleep troubles increased from March (29.0%) to April (31.4%). For March, we found that COVID threat, losing a job, getting a pay cut, and difficulty with childcare were separately associated with sleep troubles. In April, COVID-19 threat and difficulty with childcare, but not losing a job or getting a pay cut were associated with sleep troubles even after additionally accounting for reported sleep troubles in March.

CONCLUSIONS

We found that COVID-19-specific stressors, especially a broad measure of COVID-19 Threat and stress over childcare, were associated with sleep troubles in March and April. These findings identified novel stressors related to COVID-19, which may affect the sleep of the American population.

High sleep fragmentation parallels poor subjective sleep quality during the third wave of the Covid-19 pandemic: An actigraphic study

Studies on sleep during the Covid-19 pandemic have mostly been conducted during the first wave of contagion (spring 2020). To follow up on two Italian studies addressing subjective sleep features during the second wave (autumn 2020), here we assess sleep during the third wave (spring 2021) in a sample of healthy adults from Campania (Southern Italy). Actigraphic data (on 2 nights) and the Pittsburgh Sleep Quality Index were collected from 82 participants (40 F, mean age: 32.5 ± 11.5 years) from 11 March to 18 April 2021, when Campania was classified as a "red zone", i.e. it was subjected to strict restrictions, only slightly looser than those characterizing the first national lockdown (spring 2020). Although objective sleep duration and architecture appeared in the normal range, the presence of disrupted sleep was indexed by a relevant degree of sleep fragmentation (number of awakenings ≥ 1 min: 12.7 ± 6.12; number of awakenings ≥ 5 min: 3.04 ± 1.52), paralleled by poor subjective sleep quality (Pittsburgh Sleep Quality Index global score: 5.77 ± 2.58). These data suggest that the relevant subjective sleep impairments reported during the first wave could have relied on subtle sleep disruptions that were undetected by the few objective sleep studies from the same period. Taken together with sleep data on previous phases of the pandemic, our findings show that the detrimental effects on sleep determined by the initial pandemic outbreak have not abated across the subsequent waves of contagion, and highlight the need for interventions addressing sleep health in global emergencies.

The potential impact of Covid-19 on CNS and psychiatric sequels

Due to its high prevalence and fatality, the current Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) virus, which first emerged in China in 2019, quickly spread around the world and immediately became a serious global health concern. Although respiratory issues were initially the most prominent symptom of coronavirus disease 2019 (COVID-19), it became obvious rapidly that COVID-19, like many other coronavirus family members, could affect the central nervous system (CNS). During the pandemic, CNS involvement expressed itself in a variety of forms, including insomnia, anosmia, headaches, encephalopathies, encephalitis, cerebrovascular accidents, cognitive and memory impairment, and increased psychiatric disorders. Almost everyone who has been infected has at least one of these neurological symptoms, demonstrating that the virus has a high ability to impact the CNS. As the coronavirus pandemic passes its second year, the manifestations it can cause in the long run, such as its psychological sequels, have not yet been thoroughly studied. Given the high importance of this issue in today's society and due to the lack of reliable knowledge about the COVID-19 landscape on psychiatric disorders, we intend to investigate coronavirus's possible effect on mental illnesses based on available literature. Because the majority of the psychological effects of the coronavirus can continue for a long period after the pandemic ends, our research can give insight into potential psychiatric sequels associated with COVID-19.

Longitudinal changes in mental health following the COVID-19 lockdown: Results from the Survey of Health, Ageing and Retirement in Europe

Background

Methods

Results

Conclusion

Lifestyle predictors of depression and anxiety during COVID-19: a machine learning approach

INTRODUCTION

Recent research has suggested an increase in the global prevalence of psychiatric symptoms during the COVID-19 pandemic. This study aimed to assess whether lifestyle behaviors can predict the presence of depression and anxiety in the Brazilian general population, using a model developed in Spain.

METHODS

A web survey was conducted during April-May 2020, which included the Short Multidimensional Inventory Lifestyle Evaluation (SMILE) scale, assessing lifestyle behaviors during the COVID-19 pandemic. Depression and anxiety were examined using the PHQ-2 and the GAD-7, respectively. Elastic net, random forest, and gradient tree boosting were used to develop predictive models. Each technique used a subset of the Spanish sample to train the models, which were then tested internally (vs. the remainder of the Spanish sample) and externally (vs. the full Brazilian sample), evaluating their effectiveness.

RESULTS

The study sample included 22,562 individuals (19,069 from Brazil, and 3,493 from Spain). The models developed performed similarly and were equally effective in predicting depression and anxiety in both tests, with internal test AUC-ROC values of 0.85 (depression) and 0.86 (anxiety), and external test AUC-ROC values of 0.85 (depression) and 0.84 (anxiety). Meaning of life was the strongest predictor of depression, while sleep quality was the strongest predictor of anxiety during the COVID-19 epidemic.

CONCLUSIONS

Specific lifestyle behaviors during the early COVID-19 epidemic successfully predicted the presence of depression and anxiety in a large Brazilian sample using machine learning models developed on a Spanish sample. Targeted interventions focused on promoting healthier lifestyles are encouraged.

The Positive Effects of Poria cocos Extract on Quality of Sleep in Insomnia Rat Models

Sleep disorders may have various causes and can incur mental and/or physical symptoms, and affect an individual’s quality of life. In this study, we confirm that the Poria cocos extract (PCET) can improve sleep quality and structure by promoting inhibitory neurotransmission via the γ-aminobutyric acid (GABA) type A (GABAA) receptors based on the mechanisms revealed in the experiment with superior cervical ganglion neurons. Pentobarbital-induced sleep tests were conducted in order to determine whether the PCET extract improves the sleep quality and structure in normal ICR mice. Sleep latency and duration were checked with the righting reflex. To simulate the state of awakening as well as a normal sleep state, caffeine was administered orally before the PCET diet. After oral gavage of PCET, sleep latency was decreased, and total sleep duration was increased in normal and caffeine-induced sleep disturbance state. In the ACTH-induced sleep disturbed models, administration of PCET significantly reduced the sleep latency and increased the non-REM sleep duration, which was analyzed in real-time EEG by implanting wireless electrodes in SD rats. PCET was found to improve the sleep quality under a normal sleep state through the GABAA receptor; it also promoted and improved the sleep quality and sleep structure in both the arousal activation state and stress-based sleep disturbance.

The impact of COVID-19 pandemic on sleep quality in healthcare workers in Turkey

Background

The COVID-19 pandemic has caused serious concerns and psychological distress globally. Healthcare workers remain one of the most affected groups due to life threatening risks in addition to increased working hours and labor intensity. All these factors may affect sleep quality of this population. The aim of this study is to evaluate the sleep behaviors of healthcare professionals working in secondary and tertiary hospitals in a large population in Turkey and to show how sleep quality is affected during the pandemic process using the easily applicable Jenkins Sleep Scale (JSS). The population of this cross-sectional descriptive study consists of two pandemic hospitals determined in Kahramanmaraş province. In our questionnaire, we asked subjective sleep quality, sleep time, time to fall asleep, total sleep time, and medication use. We also used JSS Turkish version (JSS-TR) to assess sleep quality and the Epworth Sleepiness Scale (ESS) for increased daytime sleepiness.

Results

Healthcare workers who participated in our survey reported that they started to go to bed later, fell asleep later (mean: 41.75 ± 35.35 min), their total sleep time (mean: 6.67 ± 1.88 h) was shortened, and they needed medication to sleep more (5.7%) after the COVID-19 pandemic. During the COVID-19 pandemic, bedtime behavior after 24:00 decreased from 80.1 to 43.9% of those who previously went to bed before 24:00. For those who went to bed after 24:00 before, it increased from 19.9 to 56.1%. In addition, sleep quality as assessed by subjective and JSS significantly deteriorated after the COVID-19 pandemic. Excessive daytime sleepiness increased. Those with ESS > 10 before and after COVID-19 were 3.9% and 14.1%, respectively (p < 0.001).

Conclusions

The COVID-19 pandemic has significantly adversely affected the sleep behavior and sleep quality of healthcare professionals. The JSS is an easily applicable scale for assessing sleep quality in large population studies.

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.

The bidirectional effects of obsessive-compulsive symptoms and difficulties in emotion regulation in Chinese adults during the COVID-19 pandemic-a dynamic structural equation model

Background

With the accumulation of negative emotions brought by COVID-19-related dysfunctional beliefs, individuals adopted obsessive–compulsive (OC) symptoms (e.g., over-checking the wearing of masks) and formed difficulties in emotion regulation (DER). This study focused on the temporal dynamics of the bidirectional relation between OC symptoms and DER, which had a devastating effect on the individual's mental health. As an extension, we further explored whether OC and DER and their relationship affect sleep problems.

Methods

In February 2020, a 14-day (twice a day, of 28 measurement intervals) online questionnaire survey was conducted on 122 Chinese adults (aged 18–55 years; 63 females). Subsequently, this research applied a dynamic structural equation model with a cross-lagged relationship and a time series. Health anxiety, anxiety, and depression were controlled as covariates.

Results

Both OC symptoms and DER had a significant autoregressive and cross-lagged effect. Comparatively speaking, DER was a stronger predictor of OC symptoms than OC’s prediction of DER. Moreover, both higher levels of OC symptoms and DER were related to the severity of sleep problems.

Conclusions

More guidance on intervening in OC symptoms and identifying emotion regulation should be added to reduce the negative impact of the COVID-19 pandemic on public mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00841-5.

[Cognitive disorders and sleep disturbances in long COVID]

Hintergrund

In den letzten 2 Jahren der COVID-19(„coronavirus disease 2019“)-Pandemie ist das Wissen um Langzeitfolgen der Erkrankung, das sog. „Long-COVID“, rapide gewachsen. Es bleiben jedoch noch viele Fragen offen, v. a. was die Ursachen überdauernder Beschwerden und ihre Prognose betrifft. Kognitive Störungen und Schlafstörungen gehören zu den häufig beklagten Beschwerden. Beide gehen mit starkem Leidensdruck und deutlicher Alltagsbeeinträchtigung einher.

Ziel der Arbeit

Wie ist die Datenlage zum Auftreten kognitiver Störungen und Schlafstörungen bei Long-COVID? Welches sind Einflussfaktoren und was ist bekannt zum Verlauf und zu möglichen zugrunde liegenden Mechanismen? Welche Therapieoptionen gibt es?

Material und Methode

In einem narrativen Review werden die wichtigsten Befunde zu kognitiven Störungen und Schlafstörungen bei Long-COVID dargestellt. Es wird ein Überblick gegeben über die Kohortenstudien mit Daten zu Prävalenz und Einflussfaktoren beider Symptomkomplexe. Es werden derzeitige Kenntnisse und Hypothesen zu pathophysiologischen Mechanismen dargestellt und ein Ausblick auf Behandlungsansätze gegeben.

Ergebnisse

Etwa ein Fünftel der Betroffenen berichtet mehr als 3 Monate nach einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion über kognitive Einschränkungen, etwa ein Drittel über Schlafstörungen, wobei es neben insomnischen auch zu hypersomnische Beschwerden kommt. Kognitive Störungen und Schlafstörungen treten bei Betroffenen aller Schweregrade auf. Es gibt Hinweise auf eine Besserung kognitiver Defizite im Verlauf, allerdings sind weitere Längsschnittstudien notwendig.

Diskussion

Neben der Prognose sind die zugrunde liegenden Krankheitsmechanismen noch unzureichend verstanden. Zudem besteht großer Forschungsbedarf zur Wirksamkeit und zu spezifischen Wirkfaktoren therapeutischer Interventionen.

Treating Anti-Vax Patients, a New Occupational Stressor-Data from the 4th Wave of the Prospective Study of Intensivists and COVID-19 (PSIC)

The Prospective Study of Intensivists and COVID-19 (PSIC) is a longitudinal study that besides investigating a cohort of intensivists from one of the two COVID-19 hub hospitals in Central Italy since the beginning of the pandemic (first wave, April 2020), has conducted a new survey at each successive wave. In addition to the variables investigated in previous surveys (job changes due to the pandemic, justice of safety procedures, job stress, sleep quality, satisfaction, happiness, anxiety, depression, burnout, and intention to quit), the latest fourth wave (December 2021) study has evaluated discomfort in caring for anti-vax patients. A multivariate logistic regression model confirmed that high levels of occupational stress (distressed 75.8%) were associated with isolation, monotony, lack of time for meditation, and poor relationships with anti-vaccination patients. Compared to the first phase, there was a reduction in levels of insomnia and anxiety, but the percentage of intensivists manifesting symptoms of depression remained high (58.9%). The study underlined the efficacy of organizational interventions and psychological support.

Sleep quality and mental health during the COVID-19 pandemic in patients with severe obstructive sleep apnea

Background

The first wave of the COVID-19 pandemic has produced remarkable effects on the sleep quality and mental status of the general population and more dramatic effects on patients with chronic illness. Patients with obstructive sleep apnea (OSA), already suffering from disordered sleep, might be more susceptible to the effect of the pandemic on their sleep quality and mental health. We therefore performed a case–control study to compare sleep quality, depression and anxiety symptoms reported by patients with severe OSA and age-matched healthy subjects during the first wave of the COVID-19. In June–July 2020 we enrolled a total of 222 patients with severe OSA, all treated with continuous positive airway pressure, and 164 healthy controls. Self-reported sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). Symptoms of depression were assessed using the Patient Health Questionnaire module 9 (PHQ-9), while the specific “Coronavirus Anxiety Scale” (CAS) evaluated the level of anxiety.

Results

Patients with OSA (61% males, 65 ± 9.6 years old, BMI 30.5 ± 3.6) and healthy controls had similar characteristics except for BMI slightly lower in controls. The perceived quality of sleep, referred to the pre-pandemic period, was significantly worse in patients with OSA than in controls. During the pandemic the rate of reported sleep disturbance increased from 54 to 66% in patients with OSA and from 29 to 40% in controls. A high percentage of patients and controls reported symptoms of depression (61% OSA and 65% controls), whereas lower levels of anxiety, similar in the two groups, were observed. In patients with OSA the PSQI score significantly positively correlated with the PHQ-9 score (r² = 0.81) and the CAS score (r² = 0.65).

Conclusion

The rate of reported sleep disturbance in patients with OSA during the first wave of the COVID-19 pandemic is one of the highest evidenced in literature so far. As for the general population, in these patients there is a strict link between the perceived sleep quality and the psychological distress caused by the pandemic. A further deterioration of sleep quality is a fearsome event in the life of these patients who face life-long sleep problems.

The COVID-19 infodemic at your fingertips. Reciprocal relationships between COVID-19 information FOMO, bedtime smartphone news engagement, and daytime tiredness over time

Considering that insufficient sleep has long been regarded as a significant public health challenge, the COVID-19 pandemic and its co-evolving infodemic have further aggravated many people's sleep health. People's engagement with pandemic-related news, particularly given that many people are now permanently online via smartphones, has been identified as a critical factor for sleep health, such that public health authorities have recommended limited news exposure. This two-wave panel survey, conducted with a representative sample in Austria during its first COVID-19 lockdown, examines (a) how fear of missing out on pandemic-related news (i.e., COVID-19 information FOMO) is reciprocally related to smartphone-based bedtime news engagement, as well as (b) how both bedtime news engagement and COVID-19 information FOMO predict daytime tiredness. Partial metric measurement invariant structural equation modeling revealed that COVID-19 information FOMO and bedtime news engagement are reciprocally associated over time, indicating a potentially harmful reinforcing loop. However, results further suggested that COVID-19 information FOMO may be the primary driver of daytime tiredness, not smartphone-based bedtime news engagement. These findings suggest that a perceived loss of (informational) control over the pandemic outbreak more strongly than poor sleep habits accounts for depleted energy resources during lockdown. However, given the initial evidence for a reinforcing loop, this effect pattern may change in the long term.

"Feeling Anxious about Catching COVID": Facilitators and Barriers of Sleep Health among Young Adults with Type 1 Diabetes

BACKGROUND

The COVID-19 pandemic has imposed pervasive stress and significant disruptions in sleep health in young adults. The purpose of this study was to describe the perceived facilitators and barriers of sleep health among young adults with type 1 diabetes during the COVID-19 pandemic.

PARTICIPANTS

Thirty-two young adults with T1D (87.5% female; mean age = 21.5, SD = 2.0) participated in an online survey between January and July 2021. Young adults between the ages of 18-25 years with T1D for at least 6 months were eligible to participate, while those who had a previous OSA diagnosis, were currently pregnant, or worked the night shift were not eligible to participate.

METHODS

A qualitative descriptive approach was used to explore the perceived facilitators and barriers to sleep among a convenience sample. Qualitative content was analyzed and coded for themes using qualitative content analysis. Responses were coded using an in vivo approach.

RESULTS

Young adults with T1D identified changes in facilitators and barriers of sufficient sleep from before the COVID-19 pandemic to during the pandemic. Three overarching barriers and facilitators were identified: (1) general, (2) diabetes-specific, and (3) COVID-19 specific.

CONCLUSIONS

Our findings can inform future educational and cognitive-behavioral interventions to promote sleep health in young adults with T1D and other complex chronic conditions. When designing sleep-promoting interventions for young adults with T1D in the COVID-19 pandemic and post-pandemic, researchers should consider T1D as well as COVID-specific barriers and facilitators.

Alcohol use, sleep, and depression among family caregivers in the time of COVID-19

The COVID-19 pandemic has substantially altered daily life around the world, resulting in significant impacts on health behaviors. The additional burdens imposed by family caregiving (i.e., providing unpaid care for children and/or adults) may further exacerbate negative effects of the pandemic on health and health behaviors, including increased alcohol consumption, poor sleep, and increased depressive symptoms. The current study examined this possibility. Participants (N = 320, mean age = 35.11 years) completed an online questionnaire assessing alcohol use, sleep, and depression during the COVID-19 pandemic (June–August 2020) and retrospectively assessed the same health behaviors in the months prior to the pandemic. Insomnia severity increased, sleep quality decreased, and depressive symptoms increased for both caregivers and non-caregivers during the pandemic (p < 0.001). By contrast, alcohol consumption increased among caregivers only (p < 0.05). Further, increased alcohol use was associated with decreased sleep quality and increased insomnia symptoms among caregivers, but not non-caregivers. While additional longitudinal research is warranted in this population, our findings offer important insight on self-reported changes in alcohol consumption, sleep patterns, and mood among family caregivers during the COVID-19 pandemic.

Management of patients with SARS-CoV-2 infections with focus on patients with chronic lung diseases (as of 10 January 2022) : Updated statement of the Austrian Society of Pneumology (ASP)

The Austrian Society of Pneumology (ASP) launched a first statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, at a time when in Austria 285 people had died from this disease and vaccinations were not available. Lockdown and social distancing were the only available measures to prevent more infections and the breakdown of the health system. Meanwhile, in Austria over 13,000 patients have died in association with a SARS-CoV‑2 infection and coronavirus disease 2019 (COVID-19) was among the most common causes of death; however, SARS-CoV‑2 has been mutating all the time and currently, most patients have been affected by the delta variant where the vaccination is very effective but the omicron variant is rapidly rising and becoming predominant. Particularly in children and young adults, where the vaccination rate is low, the omicron variant is expected to spread very fast. This poses a particular threat to unvaccinated people who are at elevated risk of severe COVID-19 disease but also to people with an active vaccination. There are few publications that comprehensively addressed the special issues with SARS-CoV‑2 infection in patients with chronic lung diseases. These were the reasons for this updated statement. Pulmonologists care for many patients with an elevated risk of death in case of COVID-19 but also for patients that might be at an elevated risk of vaccination reactions or vaccination failure. In addition, lung function tests, bronchoscopy, respiratory physiotherapy and training therapy may put both patients and health professionals at an increased risk of infection. The working circles of the ASP have provided statements concerning these risks and how to avoid risks for the patients.

Effectiveness of emotional freedom techniques (EFT) vs sleep hygiene education group therapy (SHE) in management of sleep disorders among elderly

Sleep disorders are common among elderly persons, with deleterious effects on their physical and mental health. Many approaches are used to manage such disorders. To compare the Emotional Freedom Techniques–Insomnia (EFT-I) and Sleep Hygiene Education (SHE) group therapy as two treatments for insomnia in a geriatric population when delivered, and their effects on sleep quality, depression, and life satisfaction. This open-label randomized controlled trial study was conducted at El-Abbasia Mental Hospital and Osana family wellness elderly nursing home at Maadi, Cairo. It included 60 elderly patients suffering insomnia sleep problems randomized into two equal groups: one group received a Sleep Hygiene Education (SHE) intervention, the other had a form of Emotional Freedom Techniques (EFT) adapted for use with insomnia (EFT-I). A self-administered questionnaire with tools for sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression, and life satisfaction was used to collect data. The fieldwork was from January to March 2021. The two groups had equal median age (70 years), and almost similar gender and place of residence distribution. After the intervention, 73.3% of the EFT group had good sleep quality, compared to 100.0% in the SHE group (P = 0.005); the median score of depression (3.00) was higher in the EFT group compared with 0.00 in the SHE group (P < 0.001); as for life satisfaction, the difference was not statistically significant. The multivariate analyses identified the study intervention as the main statistically significant negative predictor of PSQI and depression scores, and a positive predictor of life satisfaction. Being in the SHE group was a negative predictor of PSQI and depression scores. Both SHE and EFT approaches are beneficial for elderly patients’ sleep quality, with SHE being more effective in ameliorating sleep. Further replication of this study is needed on a large probability sample from different geographical areas to help for the generalization of the results.

Changes in objectively measured lifestyle factors during the COVID-19 pandemic in community-dwelling older adults

Background

In this manuscript, we investigate whether objectively measured lifestyle factors, including walking steps, sedentary time, amount of unforced physical activity, level of slight and energetic physical activity, conversation time, and sleep parameters, were altered before and during the COVID-19 pandemic among community-dwelling older adults.

Methods

Data were obtained from a prospective cohort study conducted from 2015 to 2019 and a subsequent dementia prevention study undertaken in September 2020. Community-dwelling adults aged ≥ 65 years wore wearable sensors before and during the pandemic.

Results

A total of 56 adults were enrolled in this study. The mean age was 74.2 ± 3.9 years, and 58.9% (n = 33) of the participants were female. Moderate and vigorous physical activity time significantly decreased, and sedentary time significantly increased during the pandemic.

Conclusions

This is the first study to demonstrate differences in objectively assessed lifestyle factors before and during the COVID-19 pandemic among community-dwelling older adults. The findings show that the pandemic has adversely affected physical activity among older adults living on their own in Japan.

Estimation of sleep problems among pregnant women during COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVE

To estimate the sleep problems among pregnant women during the COVID-19 pandemic.

ELIGIBILITY CRITERIA

English, peer-reviewed, observational studies published between December 2019 and July 2021 which assessed and reported sleep problem prevalence using a valid and reliable measure were included.

INFORMATION SOURCES

Scopus, Medline/PubMed Central, ProQuest, ISI Web of Knowledge and Embase.

RISK OF BIAS ASSESSMENT TOOL

The Newcastle-Ottawa Scale checklist.

SYNTHESIS OF RESULTS

Prevalence of sleep problems was synthesised using STATA software V.14 using a random effects model. To assess moderator analysis, meta-regression was carried out. Funnel plot and Egger's test were used to assess publication bias. Meta-trim was used to correct probable publication bias. The jackknife method was used for sensitivity analysis.

INCLUDED STUDIES

A total of seven cross-sectional studies with 2808 participants from four countries were included.

SYNTHESIS OF RESULTS

The pooled estimated prevalence of sleep problems was 56% (95% CI 23% to 88%, I²=99.81%, Tau²=0.19). Due to the probability of publication bias, the fill-and-trim method was used to correct the estimated pooled measure, which imputed four studies. The corrected results based on this method showed that pooled prevalence of sleep problems was 13% (95% CI 0% to 45%; p<0.001). Based on meta-regression, age was the only significant predictor of prevalence of sleep problems among pregnant women.

LIMITATIONS OF EVIDENCE

All studies were cross-sectional absence of assessment of sleep problems prior to COVID-19, and the outcomes of the pregnancies among those with and without sleep problems in a consistent manner are among the limitation of the current review.

INTERPRETATION

Pregnant women have experienced significant declines in sleep quality when faced with the COVID-19 pandemic. The short-term and long-term implications of such alterations in sleep on gestational and offspring outcomes are unclear and warrant further studies.

PROSPERO REGISTRATION NUMBER

CRD42020181644.

What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

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

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

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.

Young people and adolescents have more irregular meals during the COVID-19 pandemic: A nested case-control study on chrono-nutrition before and during the COVID-19 pandemic

Chrono-nutrition is an emerging field of research that includes three aspects of time: (1) regularity, (2) frequency, and (3) clock time. Due to the COVID-19 pandemic and the implemented lockdown, daily routines were disrupted, which presented a unique opportunity to investigate chrono-nutrition, in particular in adolescents. A nested case-control study was conducted and information on chrono-nutrition was collected via an anonymous online questionnaire including 99 participants aged 13 to 20 years (N = 43 before the COVID-19 pandemic and N = 56 during the COVID-19 pandemic). Differences in chrono-nutrition were tested with chi-square and Mann-Whitney U. During the COVID-19 pandemic, participants consumed their breakfast less regularly (34%) compared with participants before the COVID-19 pandemic (65%) (P = .003). Additionally, during the COVID-19 pandemic, participants consumed snacks in the morning (26% vs. 60%, P = .001), afternoon (19% vs. 81%, P < .000), and evening (22% vs. 84%, P < .001) less regularly. However, the frequency in afternoon (4.9 ± 2.2 times per week vs. 3.8 ± 1.9 times per week, P = .002) and evening snacks (4.4 ± 2.4 times per week vs. 3.4 ± 2.0 times per week, P = .02) was higher for participants during the COVID-19 pandemic. We also observed that participants reported more sleeping problems during the COVID-19 pandemic (34% vs. 14%; P = .07). This study in 99 young people and adolescents suggests that meal regularity declined during the COVID-19 pandemic, while meal frequency, especially snack consumption, increased. This highlights the importance of maintaining a regular daily structure to avoid excessive energy intake via snacks.