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

Association between commuting and mental health among Japanese adolescents

AIM

Mental health issues in adolescence contribute to various disease burdens later in life and are associated with violence, crime, and suicide. Activities such as sleep, diet, exercise, and time spent using electronic devices are related to declining mental health. However, few studies have examined the association between commuting times to school and mental health. This study tested the hypothesis that high school students' long commuting times are associated with poor mental health.

METHOD

A cross-sectional study was conducted between October and December 2022 among 2067 students at two private high schools. Survey items included participant information (sex, grade, school), commuting time, mental health status (Patient Health Questionnaire 9 [PHQ-9]: depressive symptoms, and Generalized Anxiety Disorder 7 [GAD-7]: anxiety symptoms), lifestyle factors, and sleep-related factors.

RESULTS

Data from 1899 high school students were analyzed. The prevalence of depressive and anxiety symptoms was 17.3% and 19.0%, respectively. A commuting time of ≥1 h was significantly associated with depressive symptoms (adjusted odds ratio: 1.60 [95% confidence interval]: 1.14-2.24) and anxiety symptoms (adjusted odds ratio: 1.51 [95% confidence interval]: 1.09-2.10). Sex, grade, use of ≥8 h/day of electronic devices, and chronotype were significantly associated with depressive symptoms, while sex, grade, use of ≥8 h/day of electronic devices, and insomnia were significantly associated with anxiety symptoms.

CONCLUSION

It is suggested that long commuting times are associated with poor mental health in high school students. Parents and schools should consider commuting time when advising students on school selection to maintain their mental health.

Association of Chronotype and Shiftwork With COVID-19 Infection

OBJECTIVE

This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: This study used a cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration, and comorbidities, morning chronotype was associated with a higher (adjusted odds ratio [aOR]: 1.15, 95% CI: 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.

Sleep patterns in Metropolitan and Regional areas in Japan: Before and during COVID-19 social restrictions

Sleep timing is an important output of the circadian system. The COVID-19-mandated social restrictions significantly altered commuting time and sleep duration regionally in Japan. This study aimed to elucidate sleep patterns, especially chronotype and social jetlag (SJL), due to changes in social time pressure through the social restrictions between the Metropolitan and Regional areas in Japan. As part of the Global Chrono Corona Survey 2020 (GCCS), the data were collected during social restrictions (SR), but pre-COVID-19 behaviours were also queried retrospectively. We analyzed a cohort of 729 respondents representing both the Metropolitan and the Regional areas separately for workdays and work-free days. While the areas showed no difference in SJL before SR, the differential decrease was larger in the Metropolitan area during SR, resulting in a significant difference in SJL between the areas. The outdoor light exposure before SR was 30 min longer in the Metropolitan areas than in the Regional; during SR both areas showed similarly low (below 1 h) outdoor light exposures. The variables associated with decreased SJL were the Metropolitan areas, work-from-home, a no-usage alarm clock on workdays, and chronotypes (mid-sleep time on free days corrected for sleep deficit accumulated over the workweek, MSFsc) during SR. The results suggest that relaxed social schedules, as reflected in the increased frequency of work-from-home and reduced alarm clock use, and moving towards earlier MSFsc during SR were linked to decreased SJL and were more prominent in the Metropolitan areas. This study provides insights into sleep patterns and the social time pressure markers, by comparison between residential groups in Japan.

Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak

The COVID-19 pandemic posed an unprecedented challenge to public well-being, necessitating an examination of its health impact. This review discusses the relationship between pandemic-induced stressors and individual sleep patterns and quality. The pandemic stressors include lockdown or physical distancing measures, direct virus exposure, and the dissemination of misinformation and disinformation. The pandemic led to delayed sleep-wake cycles, except for healthcare professionals, and worsened sleep quality. The prevalence of insomnia was higher for women due to pre-existing conditions and susceptibility stressors such as lockdown stress and family responsibilities. Healthcare professionals, who experienced worsened work conditions during the pandemic, reported higher rates of insomnia and sleep difficulties due to infection anxiety and post-traumatic stress from direct virus exposure. For the general population, stress stemmed from social isolation under lockdown and overwhelming false information available online, resulting in sleep problems. Taken together, the findings highlight the importance of promoting social interactions, providing psychological support services, and caution in navigating health information. In summary, this review underscores the need for individual- and group-centered approaches in ongoing research and interventions to address pandemic-related stress and sleep issues during COVID-19.

How COVID-19 Affected Sleep Talking Episodes, Sleep and Dreams?

BACKGROUND

The COVID-19 pandemic increased symptoms of stress and anxiety and induced changes in sleep quality, dream activity, and parasomnia episodes. It has been shown that stressful factors and/or bad sleep habits can affect parasomnia behaviors. However, investigations on how COVID-19 has affected sleep, dreams, and episode frequency in parasomnias are rare. The current study focuses on the impact of the pandemic on a specific parasomnia characterized by speech production (sleep talking, ST).

METHODS

We selected 27 participants with frequent ST episodes (STs) during the pandemic and compared them with 27 participants with frequent STs from a previous study conducted during a pre-pandemic period. All participants performed home monitoring through sleep logs and recorded their nocturnal STs for one week.

RESULTS

We observed a higher frequency of STs in the pandemic group. Moreover, STs were related to the emotional intensity of dreams, independent of the pandemic condition. The pandemic was associated with lower bizarreness of dreams in the pandemic group. There were no differences in sleep variables between the two groups.

CONCLUSION

Overall, these results suggest a stressful effect of COVID-19 on the frequency of STs. Both the pandemic and the frequency of STs affect qualitative characteristics of dreams in this population.

Changes in Sleep Duration and Sleep Timing in the General Population from before to during the First COVID-19 Lockdown: A Systematic Review and Meta-Analysis

BACKGROUND

The COVID-19 lockdown had a profound effect on everyday life, including sleep health. This systematic review and meta-analysis evaluated changes in quantitative sleep parameters during the first lockdown compared with pre-lockdown in the general population.

METHODS

A search in scientific databases was performed to identify eligible observational studies from inception to 8 February 2023. We performed a random effects meta-analysis of those studies reporting (a) means of sleep duration, time in bed (TIB), and sleep timing (bedtime and wake-up time); (b) the percentages of atypical sleep duration before and during the lockdown; (c) the percentages of change in sleep duration and sleep timing.

RESULTS

A total of 154 studies were included. A small increase in sleep duration (0.25 standardized mean difference, 95% CI 0.180-0.315) was found, with 55.0% of the individuals reporting changes, predominantly an increase (35.2%). The pooled relative risk for sleeping more than 8/9 h per night was 3.31 (95% IC 2.60-4.21). There was a moderately significant delay in sleep timing and a surge in napping.

CONCLUSION

An increase in sleep duration and napping, and delayed sleep timing were observed. High-quality studies should evaluate whether these parameters have now become chronic or have returned to pre-lockdown values.

Sleep health and associated factors among undergraduates during the COVID-19 in China: A two-wave network analysis

Using network analysis, the current study investigated the pathways that underlie selected components of sleep health and their changes over time. Undergraduates (N = 1423; 80.60% female) completed a two-wave survey, sleep health (i.e. chronotypologies (CTs), sleep procrastination (SP), sleep quality (SQ)), psychological distress (PD), emotion regulation (ER), self-control (SC), problematic smartphone use (PSU) were measured. CTs, SP, and SQ formed a spatially contiguous pattern that remained unchanged in both waves. ER and PD node increased its strength, betweenness, and closeness in the network, while the link between the two was strengthened at T2. PSU was connected to SP, but not to CTs and SQ during both waves. In the context of the network approach, SP had the highest strength, and its associations with other dimensions of individual sleep may represent key factors in understanding the influence of exposure to the COVID-19 outbreak on sleep health.

Associations of Anxiety, Insomnia, and Physical Activity during the COVID-19 Pandemic

PURPOSE

Anxiety, insomnia, and physical activity (PA) are interrelated, but the bi-directional relationships between these three variables are not well understood. Less is known of these relationships in settings of disrupted daily activities and acute stress. This study aimed to characterize and examine relationships between insomnia, anxiety, and PA throughout the first year of the COVID-19 pandemic, when many lifestyle behaviors were disrupted.

METHODS

Participants comprised a convenience sample of 204 adults (55.4% female; 43.85 ± 15.85 years old) who completed the Generalized Anxiety Disorder Questionnaire (GAD-7), Insomnia Severity Index (ISI), and the International Physical Activity Questionnaire (IPAQ) at three time points through the first year of the COVID-19 pandemic. A cross-lagged panel model was used to evaluate these variables' concurrent, autoregressive, and cross-lagged relationships across time. Follow-up dynamic panel modeling using maximum likelihood and structural equation modeling was employed.

RESULTS

Approximately 64% of participants reported their work/occupation as affected by the pandemic. At baseline, associations between anxiety and insomnia were observed (β-coefficient: 15.87; p < 0.001). Insomnia was a positive future predictor of anxiety (ISI time point 2: 7.9 ± 5.6 points; GAD-7 at time point 3: 4.1 ± 4.2 points; β-coefficient: 0.16; p < 0.01). No associations were observed between PA and anxiety or insomnia (all p > 0.05).

CONCLUSIONS

Insomnia and anxiety were interrelated, and effects were cross-lagged. These data can inform future work focused on improving anxiety in settings of acute stress and disruptions to daily life, such as changes in occupational structure and stability. Specifically, targeting sleep parameters may be of interest to elicit downstream positive health behaviors.

Factors and pathways of non-suicidal self-injury in children: insights from computational causal analysis

Background

Non-suicidal self-injury (NSSI) has become a significant public health issue, especially prevalent among adolescents. The complexity and multifactorial nature of NSSI necessitate a comprehensive understanding of its underlying causal factors. This research leverages the causal discovery methodology to explore these causal associations in children.

Methods

An observational dataset was scrutinized using the causal discovery method, particularly employing the constraint-based approach. By integrating machine learning and causal inference techniques, the study aimed to determine direct causal relationships associated with NSSI. The robustness of the causal relationships was evaluated using three methods to construct and validate it: the PC (Peter and Clark) method, Fast Causal Inference (FCI) method, and the GAE (Graphical Autoencoder) method.

Results

Analysis identified nine nodes with direct causal relationships to NSSI, including life satisfaction, depression, family dysfunction, sugary beverage consumption, PYD (positive youth development), internet addiction, COVID-19 related PTSD, academic anxiety, and sleep duration. Four principal causal pathways were identified, highlighting the roles of lockdown-induced lifestyle changes, screen time, positive adolescent development, and family dynamics in influencing NSSI risk.

Conclusions

An in-depth analysis of the factors leading to Non-Suicidal Self-Injury (NSSI), highlighting the intricate connections among individual, family, and pandemic-related influences. The results, derived from computational causal analysis, underscore the critical need for targeted interventions that tackle these diverse causative factors.

Inequalities in emerging adult college students' sleep quality during the COVID-19 pandemic

OBJECTIVE

To examine inequalities in sleep quality during the COVID-19 pandemic by gender, sexual orientation, race/ethnicity, and socioeconomic position (SEP), and test associations between discrimination and sleep quality in a national longitudinal cohort of emerging adult college students.

PARTICIPANTS

Participants were enrolled in college full-time and were aged 18-22 at baseline.

METHODS

Participants completed online surveys in spring 2020 (N = 707) and summer 2021 (n = 313). Measures included the Pittsburgh Sleep Quality Index (PSQI) and the Everyday Discrimination Scale.

RESULTS

Most students reported poor sleep quality (78% in 2020; 82% in 2021) and those from marginalized groups generally experienced worse sleep quality. Discrimination was associated with poorer concurrent sleep quality at both time points.

CONCLUSIONS

Sleep inequalities among college students continued to manifest during the pandemic, even when students were not necessarily on campus. Colleges should take a multi-pronged approach to promote sleep quality through individual, community, and institutional interventions.

Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model

BACKGROUND

This study examined the relationship between loneliness and bedtime procrastination among Chinese university students, the mediating effects of COVID-19 risk perception and self-regulatory fatigue, and connectedness to nature's protective role, post pandemic.

METHODS

We recruited 855 students to complete the Loneliness, Perceived Risk of COVID-19 Pandemic, Self-Regulatory Fatigue, Bedtime Procrastination, and Connectedness to Nature Scales. Data for descriptive statistics, correlation analysis, and moderated chain mediation effects were analyzed using SPSS 24.0 and process 3.5 macros.

RESULTS

Loneliness positively correlated with bedtime procrastination, COVID-19 risk perception mediated the impact of loneliness on bedtime procrastination, self-regulatory fatigue mediated the effect of loneliness on bedtime procrastination, and COVID-19 risk perception and self-regulatory fatigue mediated the effect between loneliness and bedtime procrastination. Furthermore, connectedness to nature mediated the impact of COVID-19 risk perception on self-regulatory fatigue.

CONCLUSIONS

The results indicate the effects and potential mechanisms of loneliness on bedtime procrastination after the relaxation of the pandemic prevention and control policy in China from the perspective of self-regulatory resources and provide insights into improving university students' sleep routine and mental health post pandemic.

The quality of sleep: evaluation among university students

Introduction

This study explored the quality of sleep among university students in the South of Italy during the Covid-19 pandemic.

Methods

A cross-sectional study was conducted between March 2022 and January 2023 and involved students over the age of 18, who were invited to complete a self-administered questionnaire using an online application.

Results

Overall, 88% of men and 94.5% of women had Pittsburgh Sleep Quality Index (PSQI) scores of ≥5 and a mean PSQI score of 9.2 ± 3. Students with severe or extremely depression score, with sever or extremely stress score, male and who did not had Covid-19 infection were more likely to have a PSQI global score. Moreover, 62.6% of the students declared a reduction in social relations and 72.3% an increase in the use of social media during the pandemic period. The majority of respondents reported an extremely severe level of depression (68.1%), anxiety (84.4%) and stress (71.9%).

Conclusion

This finding indicate that a relevant percentage of students are poor sleepers with a higher overall PSQI score with depression and stress and underline the role the implementation of public health interventions to promote healthy life styles and in particular focus on the duration of long night sleep.

Undergraduate Student Stress, Sleep, and Health Before and during the COVID-19 Pandemic

Before the COVID-19 pandemic, undergraduate students experienced sleep problems and mental health issues that were negatively associated with academic achievement. Studies comparing undergraduate sleep and health pre- to mid-pandemic have yielded mixed results, necessitating additional research on other cohorts and examination of potential moderators. The present study was conducted to examine whether American undergraduate students tested mid-pandemic experienced poorer sleep, health, and academic achievement relative to students tested pre-pandemic, as well as to examine whether poor sleep during the pandemic was preferentially associated with poorer health in women. The current cross-sectional study included 217 participants tested pre-pandemic (February-December 2019) and a separate sample of 313 participants tested mid-pandemic (November-December 2020). Participants in both samples provided demographic information and completed questionnaires inquiring about participant sleep quality, insomnia, and cumulative grade point average (GPA); participants in the mid-pandemic sample also reported on measures of general, physical, and mental health. Participants tested mid-pandemic reported poorer global sleep quality, greater insomnia severity, greater stress, and higher cumulative GPAs relative to participants tested pre-pandemic. For the mid-pandemic sample only, poorer sleep quality was associated with reduced physical health; interactions indicated that women with poor sleep quality reported poorer mental health relative to both women with good sleep quality and men with poor quality sleep. Perceived stress mediated the association between sleep problems and GPA. These findings indicate that the pandemic negatively impacted the functioning of undergraduate students and highlights the need for future studies examining additional moderators of the reported effects.

Psychological impact of COVID-19 and determinants among Spanish university students

Background

University students are a vulnerable population and faced a significant psychological impact from the COVID-19 pandemic. Therefore, this study aimed to determine the level of fear of COVID-19 among university students and to evaluate the possible relationship between fear of COVID-19 and socio-demographic, health-related determinants, variables related to the COVID-19 and variables related to the psychological impact of the COVID-19 pandemic.

Methods

We conducted a cross-sectional study between December 2020 and December 2021 on a sample of 950 university students from two universities in southern Spain. Participants completed a form that collected socio-demographic, health-related and COVID-related variables, a validated questionnaire related to the psychological impact of the COVID-19 pandemic and the fear of COVID Scale (FCV-19S). Descriptive, inferential, and multivariable linear regression analyzes were conducted.

Results

The mean FCV-19S score was 14.86 ± 5.16 points. The factors identified as predictors of FCV-19S were being female (p < 0.001), holding religious beliefs (p = 0.04), living in towns with over 10,000 inhabitants (p < 0.01), living with someone vulnerable to COVID-19 (p = 0.02), watching TV to keep informed about COVID-19 (p < 0.01), believing in a low probability of surviving if infected with COVID-19 (p < 0.001), having a higher level of death anxiety (p < 0.001) and suffering from insomnia (p < 0.001).

Conclusion

An average fear of COVID-19 score of 14.86 ± 5.16 points has been found among university students in Spain. These findings can aid in identifying specific factors contributing to fear of COVID-19 and in developing coping strategies to alleviate the stress of the pandemic.

Sleep and Well-Being during the COVID-19 Remote and In-Person Periods: Experiences of College Faculty and Staff with and without Disabilities

We explored the impacts of the remote and return-to-in-person work periods on sleep and well-being as reported by faculty (n = 22) and non-teaching staff (n = 21) with and without disabilities. Participants were recruited through college platforms and personal contacts. Our results show that contrary to expectations, the COVID-19 remote teaching/working period resulted in better sleep, as well as greater well-being, than the return-to-in-person work period. With respect to sleep, faculty members had slightly more negative outcomes than staff, most evident in heightened anxiety and work aspects. Faculty with disabilities had somewhat worse sleep and well-being during the remote period than faculty without disabilities. During the return to in-person work, both faculty and non-teaching staff reported more negative than positive sleep and well-being outcomes. In particular, during the in-person period, faculty members experienced slightly more negative sleep outcomes related to anxiety and work, while staff members experienced slightly more negative sleep outcomes related to the need to commute and lifestyle. Our findings show that there were benefits and disadvantages to both remote and in-person work periods, suggesting a hybrid work schedule should be considered in more detail, particularly as an optional reasonable accommodation for faculty and staff with disabilities. Our study highlights that training to keep faculty abreast of the latest technological innovations, ways to promote work-life balance, and steps to remedy classroom size and building ventilation to prevent the spread of disease all need urgent attention.

Better alignment between circadian preference and sleep and work timings during COVID-19 did not benefit work engagement at home

Modern society is structured around early routines which cause evening types to suffer from health and performance detriments associated with sleep times being misaligned with biological needs (circadian preference). Given that COVID-19 lockdowns were less constrained by social schedules, the current study explores whether temporal behaviours became better aligned with biological needs, and whether these changes benefited work engagement. 406 UK participants reported circadian preference and pre-lockdown and lockdown sleep times, work times, and work engagement. Results found that sleep health improved under lockdown measures in terms of increased sleep duration and reduced social jetlag, and sleep and work times became better aligned with circadian preferences. The most circadian-misaligned participants - students and young adults - exhibited the largest changes to sleep and work habits. However, work engagement decreased more in participants with improved social jetlag and delayed work habits, which is surprising given that these temporal changes reflect improved circadian alignment. We discuss potential moderators including poor sleep quality, non-engaging work-from-home environments, and mental health. These findings have implications for encouraging flexible educational and employment schedules post-COVID-19 to satisfy the common drive to improve circadian alignment, but future work must determine the moderating factors that impair work engagement during remote work.

Physical activity, sleep, and mental health during the COVID-19 pandemic: A one-year longitudinal study of Spanish university students

The objective of this longitudinal study was to analyze changes in physical activity, sedentary time, sleep, anxiety, mood, and perceived health as a result of COVID-19 pandemic in a cohort of Spanish university students, both during the home confinement and one year after. Additionally, we analyzed the associations between physical activity, sedentary time, and other measured parameters. Data were collected through two online questionnaires that included the International Physical Activity Questionnaire-Short Form, the Pittsburgh Sleep Quality Index, and self-reported anxiety, mood, and perceived health levels before, during and one year after home confinement. Participants reported decreased physical activity, increased sedentary time, and deterioration in sleep quality and perceived health during confinement. Most parameters had improved one year later; however, the participants still reported less physical activity, more sedentary time, and deterioration in sleep quality and perceived health compared to before confinement. Men reported greater reduction of physical activity during home confinement than women. In contrast, women reported reduced physical activity one year after confinement, whereas men reported increased activity. Participants reported higher anxiety and worse mood both during and one year post-confinement compared to pre-confinement, with women reporting higher levels of anxiety than men. Sports science students were closer to regaining pre-pandemic levels of physical activity one year post-confinement than students in other disciplines. Sleep, anxiety, and mood were worse among students with obesity compared to students in other BMI categories. Overall, increased physical activity and decreased sedentary time were associated with less anxiety and better sleep, mood, and perceived health during and one year post-confinement. In conclusion, our results demonstrate that physical activity, sedentary behavior, sleep, anxiety, mood, and perceived health were disrupted one year after home confinement. Higher levels of physical activity and lower sedentary time were associated with preserved sleep and mental health during the pandemic.

The impact of the COVID-19 pandemic on adolescent sleep behavior

Restorative sleep is a fundamental component of adolescent wellbeing, and the COVID-19 pandemic presented both challenges and opportunities for adolescents' sleep. In this review, we synthesize emergent themes from the growing scientific evidence for the impact of the pandemic on adolescent sleep behavior across different stages of the pandemic and in different locations around the world. We also highlight the ways in which COVID-19 shaped sleep patterns among college students-a subgroup of adolescents transitioning to emerging adulthood that were particularly impacted by the shift to remote learning. Finally, we discuss variations in the impact according to several potential moderating factors in adolescents' lives and point to areas that require additional longitudinal research.

COVID-19 stay-at-home restrictions increase the alignment in sleep and light exposure between school days and weekends in university students

Younger adults have a biological disposition to sleep and wake at later times that conflict with early morning obligations like work and school; this conflict leads to inadequate sleep duration and a difference in sleep timing between school days and weekends. The COVID-19 pandemic forced universities and workplaces to shut down in person attendance and implement remote learning and meetings that decreased/removed commute times and gave students more flexibility with their sleep timing. To determine the impact of remote learning on the daily sleep-wake cycle we conducted a natural experiment using wrist actimetry monitors to compare activity patterns and light exposure in three cohorts of students: pre-shutdown in-person learning (2019), during-shutdown remote learning (2020), and post-shutdown in-person learning (2021). Our results show that during-shutdown the difference between school day and weekend sleep onset, duration, and midsleep timing was diminished. For instance, midsleep during school days pre-shutdown occurred 50 min later on weekends (5:14 ± 12 min) than school days (4:24 ± 14 min) but it did not differ under COVID restrictions. Additionally, we found that while the interindividual variance in sleep parameters increased under COVID restrictions the intraindividual variance did not change, indicating that the schedule flexibility did not cause more irregular sleep patterns. In line with our sleep timing results, school day vs. weekend differences in the timing of light exposure present pre- and post-shutdown were absent under COVID restrictions. Our results provide further evidence that increased freedom in class scheduling allows university students to better and consistently align sleep behavior between school days and weekends.

Association of Chronotype and Shiftwork with COVID-19 Infection

Objective

This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work.

Methods

Cross-sectional survey of 19,821 U.S. adults.

Results

COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74).

Conclusion

Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.

Stress, anxiety, and sleep among college and university students during the COVID-19 pandemic

OBJECTIVE

We categorized levels of self-reported stress, anxiety, worry, and sleep among US college and university students during the COVID-19 pandemic.

METHODS

We conducted an anonymous online survey between May 7 and June 21, 2020.

RESULTS

Nearly all participants reported worry about the pandemic. Nearly half (95% CI: 43.3-51.3) reported moderate-to-severe anxiety, and 42.0% (95% CI: 38.0-45.9) reported experiencing poor sleep quality. Those with moderate-to-severe anxiety were more likely (OR: 3.3; 95% CI: 2.4-4.7) to report poor sleep quality than those with less anxiety. Moderate or extreme worry about the pandemic was associated with poor sleep quality (OR: 1.5; 95% CI: 1.1-2.1).

CONCLUSIONS

Our survey found high levels of stress, worry, anxiety, and poor sleep among US college and university students during the early months of the pandemic. Universities should prioritize access to resources for healthy coping to help students manage anxiety and improve sleep quality as the pandemic continues.

Anxiety as a mediator in the relationship between the socioeconomic impact of COVID-19 and quality of life: a cross-sectional study in Vietnam

Previous studies have investigated the effects of the pandemic on quality of life; both economical and psychosocial effects were explored. Some studies also mentioned mediating factors as mechanisms in this relationship; however, the mediating role of anxiety has not been examined. The present study examined the mediating effects of anxiety on the relationship between socioeconomic impact of COVID-19 and quality of life. An online survey of 280 Vietnamese residents was conducted in the context of the pandemic outbreak. Anxiety was found to be a completely mediating variable in the association between the socioeconomic impact of the pandemic and quality of life during the lockdown period. This finding contributes to a better understanding of how the pandemic affects people's quality of life and serves as the foundation for lessening the negative effects of the epidemic on people's lives.

Effects of COVID-19 Stress on Healing Behavior in Residential Spaces

This study aims to analyze the effects of COVID-19 stress on healing behavior in residential spaces. Based on the results, the study further examines the residential space as a healing environment according to space use behavior in the post-COVID era. A survey including 2101 Korean people was conducted. The COVID Stress Scale for Korean People (CSSK) was used to identify COVID-19 stress. In addition, using a literature review on healing environment factors and behavioral changes after the pandemic, survey questions were developed to assess changes in healing behavior. A frequency analysis was conducted for sociodemographic factors, and the relationship between COVID stress factors and healing behavior factors in residential spaces was examined using factor and correlation analyses. Multiple regression analysis was conducted to verify the effects of COVID stress factors on changes in healing behavior. The results revealed that COVID stress affected healing behavior in residential spaces; however, there were differences in healing behavior depending on the COVID stress factors. Fear of being infected positively affected infection prevention behavior in homes. Anger towards others negatively affected the establishment of elements that support various activities in the residential spaces and furniture arrangement. Stress from social distancing difficulties affected healing behavior in residential spaces but was not related to infection prevention behavior. Residential spaces can serve as healing spaces when people are provided with various spatial factors that support diverse types of behavior during a pandemic crisis.

Desynchronized daily activity rhythms and gender related psychological well-being of Moroccan university students during the quarantine-isolation

BACKGROUND

The disturbance of students' biological and academic rhythms induced by the Coronavirus generated considerable challenges that had an influence on their psychological well-being. This study aims to highlight the daily rhythm desynchronization and examine the mental health of Moroccan students who were impacted, notably females, in the context of the COVID-19 pandemic.

METHODS AND MATERIAL

A cross-sectional online survey was conducted in May 2020 at ten Moroccan faculties including 312 students with an average age of 22 ± 1.70 years old, processed according to a random sampling. A Daily Activities Biorhythm Questionnaire was used to assess the students' daily activities time use and duration, while the PTSD Symptom Scale, Hamilton Scale, Worry Domains Questionnaire, and Visual Analog Mood State Scale were used to assess their mental health. A statistical analysis used both Chi-square and t test to evaluate the relationship between females and males as two independent groups to the studied variables.

RESULTS

Based on individual gender differences, a significant disruption emerged in the daily time use and duration of activities during home confinement. Besides, females were more likely to experience psychological issues notably anxiety (2.04 ± 0.49), physical tiredness (2.11 ± 0.39), sadness (p <.05), and posttraumatic stress disorder (p <.01). In contrast, there is a strong correlation between males' concern of declining employment (p <.05) and their worry of declining family budgets (2.10 ± 1.39).

CONCLUSIONS

As an emerging behavior for a new risk factor, the daily activities rhythm of Moroccan university students have been altered and mental health difficulties have appeared due to the quarantine isolation. This might influence their overall academic performance and psychological balance. In this instance, psychological assistance is highly recommended.

Association between COVID-19 lockdown and sleep behaviors in Korean adolescents

To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10-1.19), 6 hours, OR 1.07; 95% CI 1.03-1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06-1.11) and late chronotype (OR, 1.43; 95% CI, 1.38-1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.

Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation

Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.

Sleep and Lifestyle Habits of Medical and Non-Medical Students during the COVID-19 Lockdown

It has been shown that the measures of social distancing and lockdown might have had negative effects on the physical and mental health of the population. We aim to investigate the sleep and lifestyle habits as well as the mood of Croatian medical (MS) and non-medical students (NMS) during the COVID-19 lockdown. The cross-sectional study included 1163 students (21.6% male), whose lifestyle and sleep habits and mood before and during the lockdown were assessed with an online questionnaire. The shift towards later bedtimes was more pronounced among NMS (~65 min) compared to MS (~38 min), while the shift toward later wake-up times was similar in both MS (~111 min) and NMS (~112 min). All students reported more frequent difficulty in falling asleep, night-time awakenings and insomnia (p < 0.001) during lockdown. A higher proportion of MS reported being less tired and less anxious during lockdown compared to pre-lockdown (p < 0.001). Both student groups experienced unpleasant moods and were less content during lockdown compared to the pre-lockdown period (p < 0.001). Our results emphasize the need for the promotion of healthy habits in the youth population. However, the co-appearance of prolonged and delayed sleep times along with decreased tiredness and anxiety among MS during lockdown reveals their significant workload during pre-lockdown and that even subtle changes in their day schedule might contribute to the well-being of MS.

The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students

OBJECTIVE

To investigate COVID-19's impact on college student health behaviors.

PARTICIPANTS

189 college students.

METHODS

Participants completed an online survey on behaviors relating to sleep, sedentary activities, and physical activity before and during the COVID-19 pandemic. Comparisons utilized Students' dependent t-test or Wilcoxon signed-rank tests.

RESULTS

There was an increase in time to fall asleep (before: 23.4 ± 18.0 vs. during: 42.8 ± 44.3 min·day^-1, p < 0.001), time spent in bed (before: 7.8 ± 1.5 vs. during: 8.5 ± 1.5 hr·day^-1, p < 0.001), as well as shifts in later bed and awake time (p < 0.001). Total sedentary time increased during the pandemic (before: 9.0 ± 3.8 vs. during: 9.9 ± 4.1 hr·day^-1, p = 0.016); and time spent using a TV, computer, or phone (before: 3.1 ± 1.9 vs. during: 4.2 ± 2.3 hr·day^-1, p < 0.001). There was a significant decrease in moderate-vigorous activity (before: 123.8 ± 96.0 vs. during: 108.9 ± 75.5 min·week^-1, p = 0.028) and resistance training days (before: 2.4 ± 2.1 vs. during: 1.7 ± 2.1 days·week^-1, p < 0.001).

CONCLUSIONS

COVID-19 negatively influenced health behaviors in college students.

Changes in the sleeping habits of Japanese university students during the COVID-19 pandemic: a 3-year follow-up study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has greatly changed our daily life. Owing to the imposed restrictions, many educational facilities have introduced remote teaching. This study aims to clarify the association between remote teaching and Japanese university students' sleeping habits.

METHODS

The participants were medical students at Aichi Medical University. We used data from an ongoing longitudinal sleeping habits survey. For the participants who enrolled in the university during 2018-2020, multilevel analyses of sleep duration during weekdays and weekends across 3 years were conducted, adjusting for sex, grade, place of stay, sleep problems and lifestyle habits.

RESULTS

Among the students enrolled in the university, the data of 677 in 2018, 657 in 2019, and 398 in 2020 was available for analysis. The mean sleep duration during weekdays (in minutes) was 407.6 ± 60.3 in 2018, 406.9 ± 63.0 in 2019, and 417.3 ± 80.9 in 2020. The mean sleep duration during weekends (in minutes) was 494.5 ± 82.5 in 2018, 488.3 ± 87.9 in 2019, and 462.3 ± 96.4 in 2020. Multilevel analysis conducted for the 684 participants who enrolled during 2018-2020 showed that sleep duration during weekdays was associated with the place of stay and survey year. Moreover, students reported significantly longer sleep duration during weekdays in 2020 than in 2019, but no significant difference in sleep duration was found between 2018 and 2019. The other multilevel analysis found sleep duration during weekends to be associated with the survey year, sex and always doing something before going to bed. Sleep duration during weekends was shorter in 2020 than in 2019 and longer for male students and students who always do something before going to bed. Ten students were reported to have a delayed sleep phase in 2020.

CONCLUSIONS

Students' sleep duration increased during weekdays and decreased during weekends in 2020. This difference could be explained by the COVID-19 pandemic and the introduction of remote teaching.

Poor sleep quality during COVID-19 pandemic restrictions associated with reduced psychological wellbeing in healthcare students

Sleep is inexorably linked to both physiological and psychological wellbeing. Restrictions imposed to control the COVID-19 pandemic likely impacted upon daily and weekly routines, which can have a negative impact on a range of factors including sleep quality, and/or quantity and general wellbeing. The aim of this study was to investigate the effect of COVID-19 related restrictions on sleep patterns and psychological wellbeing of healthcare students. A survey was delivered to healthcare students across three faculties at a single institution. Participants completed questionnaires on the effect of COVID-19 restrictions on course delivery and clinical placements, its effect on sleep-wake times, sleep quality, sleep hygiene, psychological wellbeing, their current sleep knowledge and sleep education in their current course. Using the Pittsburgh Sleep Quality Index (PSQI), over 75% of participants were found to have poor sleep quality. Changes in sleep habits and sleep behaviours during COVID-19 restrictions were associated with poorer sleep quality, and this poor sleep quality was associated with poor psychological wellbeing, particularly, motivation, stress and fatigue. Increases in negative sleep hygiene behaviours were associated with a statistically significant increase in PSQI global score. Positive emotions were positively correlated with PSQI (r = 0.22-0.24, p < .001), negative emotions were negatively correlated with PSQI (r = -0.22 - -0.31, p < .001). Also, a self-perceived lack of sleep education was identified. This study illustrates the negative association between self-reported poor sleep behaviour and poor sleep quality during COVID-19 restrictions on university student mental health and wellbeing. Additionally, there is a self-perceived lack of sleep education with little to no time spent educating students in their current degree. Hence, appropriate sleep education may improve sleep behaviours and subsequent sleep quality, which may prove to be a protective factor against poor mental health in the face of unexpected changes to routines.

Delayed sleep-wake rhythm due to staying at home during the COVID-19 pandemic and sleep debt after returning to campus among Japanese nursing university students: A longitudinal study

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24-8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis

BACKGROUND

Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic.

PARTICIPANTS/METHODS

A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 731 good sleepers), adjusted for demographic differences.

RESULTS

Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81).

CONCLUSION

Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.

Parental survey of the sleep patterns and screen time in US school children during the first 6 months of the COVID-19 pandemic

BACKGROUND

This study compared sleep duration, screen exposure and sleep quality in school-aged children before COVID-19 to that during school closures and again when schools re-opened in fall 2020.

METHODS

Cross-sectional anonymous, online survey of parents of children 5-13 years old. Questions elicited information about sleep timing and quality, screen time, and schooling at three distinct periods: before the pandemic, when schools first closed and then re-opened in the fall.

RESULTS

Respondents described 101 children who were an average of 8.5 years old and 51% male. In lockdown, children slept 25 min more (95%CI 00:13-00:38) due to later wake times (75 min, 95% CI 0:57-1:34) with later bedtimes (29 min, 95%CI 0:00-0:58). When schools re-opened, sleep duration returned to pre-pandemic levels, but sleep onset and offset times remained later. Despite more sleep, sleep quality and habits (e.g. bedtime refusal) worsened during lockdown and did not normalize in fall 2020. During lockdown, screen time increased in 65% of all children, and 96% of those in private schools. When schools reopened, 78% of children in hybrid/virtual learning had more than 4 h of screen exposure daily. Less screen time was associated with twofold higher odds of better sleep (OR 2.66, 95%CI 1.15-6.14).

CONCLUSIONS

Although school-aged children had more total sleep when schools were closed, sleep quality and habits worsened. Upon return to school, sleep times and quality did not normalize and were linked to screen time.

Risk of insomnia during COVID-19: effects of depression and brain functional connectivity

Normal sleepers may be at risk for insomnia during COVID-19. Identifying psychological factors and neural markers that predict their insomnia risk, as well as investigating possible courses of insomnia development, could lead to more precise targeted interventions for insomnia during similar public health emergencies. Insomnia severity index of 306 participants before and during COVID-19 were employed to determine the development of insomnia, while pre-COVID-19 psychometric and resting-state fMRI data were used to explore corresponding psychological and neural markers of insomnia development. Normal sleepers as a group reported a significant increase in insomnia symptoms after COVID-19 outbreak (F = 4.618, P = 0.0102, df = 2, 609.9). Depression was found to significantly contribute to worse insomnia (β = 0.066, P = 0.024). Subsequent analysis found that functional connectivity between the precentral gyrus and middle/inferior temporal gyrus mediated the association between pre-COVID-19 depression and insomnia symptoms during COVID-19. Cluster analysis identified that postoutbreak insomnia symptoms followed 3 courses (lessened, slightly worsened, and developed into mild insomnia), and pre-COVID-19 depression symptoms and functional connectivities predicted these courses. Timely identification and treatment of at-risk individuals may help avoid the development of insomnia in the face of future health-care emergencies, such as those arising from COVID-19 variants.

Sleep During the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected childhood sleep. Decreased sleep quality and duration, more bedtime resistance, difficulty initiating and maintaining sleep, and higher rates of parasomnias have all been noted. The mental health crisis with doubling rates of anxiety and depression has also had a profound influence on youth sleep. The pediatric sleep medicine field has responded to the COVID-19 pandemic by adapting existing practices for safety and greatly expanding telemedicine services. Research and training considerations are further discussed.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review

The 2019 coronavirus pandemic forced the shift to distance education aggravating mental and physical vulnerabilities of undergraduate students, including sleep. This review aims to describe sleep problem rates and prevalence, sleep pattern disruption, sleep duration, sleep quality, insomnia symptoms, psychological and socio-economic factors affecting sleep of undergraduates in 22 countries. A systematic search for articles published from 2020 to 2021 using 'COVID-19,' 'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection criteria were: English full-text available articles, undergraduates and not postgraduates, reported sleep outcomes, and participants not from allied health courses. Risk of bias was assessed using various Joanna Briggs Institute checklists and outcomes were descriptively synthesized. Prevalence of sleep problems was notable, while longitudinal studies showed increased rates. There was significantly increased sleep duration, and sleep pattern disruption during lockdowns. Several psychological, behavioural, environmental, demographic, and socio-economic factors were found to be associated with sleep changes. These highlight the pandemic's impact on sleep of undergraduate students and reveal opportunities for institutions to intervene with policies and programs to promote the well-being of undergraduates. Limitations include recall bias and underrepresentation of other countries. This study is self-funded with registration number RGAO-2021-0071.

Examining bedtime procrastination, study engagement, and studyholism in undergraduate students, and their association with insomnia

Introduction

Compulsive overstudying, known as studyholism, is an emerging behavioral addiction. In this study, we examine the prevalence of, and the relationships between, insomnia, study engagement, studyholism, bedtime procrastination among undergraduate students.

Methods

The Studyholism (SI-10), Athens Insomnia (AIS), and bedtime procrastination scales were administered to a convenience sample of 495 university students.

Results

Our findings indicate that the prevalence of insomnia was 75.31%, high studyholism was found in 15.31% of the sample, and increased study engagement was detected in 16.94%. Gender differences analysis revealed that females reported higher studyholism and bedtime procrastination than males. Fifth-year students had higher levels of studyholism than internship (p < 0.001), first-year (p < 0.01), and sixth-year students (p < 0.05). Insomnia was positively related to studyholism and bedtime procrastination. Furthermore, insomnia can be positively predicted by studyholism and bedtime procrastination. Participants with a medium level of studyholism were twice as likely to experience insomnia as those with a low level. Studyholics were six times more susceptible to insomnia than students with low studyholism levels. Compared to individuals with low bedtime procrastination levels, those with medium and high bedtime procrastination were twice as likely to report insomnia.

Conclusion

Our study highlights the interplay between insomnia, studyholism, and bedtime procrastination. Further, the findings indicate the need to increase awareness of insomnia.

Predictors and prevalence of stress, anxiety, depression, and PTSD among university students during the second wave of the COVID-19 pandemic in Turkey

This study aimed to find the prevalence of stress, anxiety, depression, and PTSD; differences according to demographic variables; and predictors of mental health problems during the second wave of the coronavirus disease (COVID-19) pandemic in Turkey. Differences in exposure to COVID-19 during the first and second waves of the pandemic among students were compared. A total of 754 students from seven universities in different parts of Turkey participated in the survey between November and December 2020. Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Checklist-Civilian Version (PCL-C) scale measuring posttraumatic stress disorder (PTSD), and Satisfaction with Life Scale (SWLS) were used to measure the mental well-being of students. Descriptive statistics, one-way ANOVA, correlations, and multinomial logistic regression methods were used to analyze the data. The prevalence of high stress, high generalized anxiety (GAD-7 ≥ 10), high depression symptoms (PHQ-9 ≥ 10), and high PTSD in the total sample were 84.2, 36.2, 55.0, and 61.2%, respectively. High perceived stress, moderate generalized anxiety disorder, mild depression symptoms, high severity PTSD, and moderate satisfaction were found among students in Turkey. Religiosity and spirituality have significant negative correlations with anxiety, depression, and PTSD. Religiosity level, gender, relationship status, year of study, physical activity, symptoms of coronavirus, death of a close relative, job loss, and economic status are significant parameters for predicting psychological problems of students in Turkey.

Fear Related to COVID-19, Mental Health Issues, and Predictors of Insomnia among Female Nursing College Students during the Pandemic

Fear of infection has been sparked by the advent of the novel coronavirus disease (COVID-19). Insomnia in college students, especially its correlations and predictions with mental diseases, remains a research concern. Aim: To estimate the prevalence of fear related to COVID-19, depression, anxiety, and insomnia among female nursing college students throughout the pandemic and to determine the predictors of insomnia. Methods: A web-based cross-sectional descriptive study used 145 female nursing college students. Results: Students reported fear related to COVID-19, depression, and anxiety at rates of 79.3%, 30.2%, and 35.2%, respectively. Insomnia disturbed 24.7% of students. Anxiety predicted worsening insomnia in the student (AOR = 1.08, 95% CI: 0.92−0.97, p < 0.001). Fear related to COVID-19 was also a predictor (AOR = 0.96, 95% CI: 1.07−1.21, p < 0.05). Additionally, when depression severity declined, the chance of insomnia improved (AOR = 0.87, 95% CI: 0.85−0.91, p < 0.001). Insomnia was more common in chronically unwell students (AOR = 1.50, 95% CI = 1.01−2.24, p < 0.05). Conclusion: During the COVID-19 pandemic, university students’ mental health should be monitored, and all essential safeguards should be taken, including resource allocation, awareness raising efforts, and the building of a mental health counseling facility.

Impact of COVID-19 on the sleep-wake patterns of preschool children

OBJECTIVE

To explore the impact of the COVID-19 pandemic on the sleep-wake patterns of preschool children.

METHODS

A cohort of preschoolers established before the COVID-19 pandemic was invited to participate in this study. Data including children's demographics, their own and parental sleep-wake patterns, physical activities, and screen time were collected through an online questionnaire from August to September 2020. A comparison was made on the collected data from the same cohort of children before and during the pandemic.

RESULTS

The cohort which was established before the pandemic consisted of 3720 preschoolers. For this current study, 642 (17%) participated, and 497 (13%) children who fulfilled the eligibility criteria were included in the final analysis. They showed a delay in their bedtime and wake time on both weekdays and weekends with a 15-30 min increase in nocturnal sleep duration. However, with a reduction in nap time, the average daily sleep duration was shortened by 16.3 ± 64.3 min (p < 0.001) and 27.5 ± 72.9 min (p < 0.001) during weekdays and weekends, respectively. Screen time was increased while outdoor activity duration was decreased. Parental sleep/wake times were also delayed with an increase in sleep duration. Children's sleep habits were associated with screen time and parental sleep/wake patterns.

CONCLUSION

Despite school suspension during the COVID-19 pandemic, preschoolers were not sleeping longer. Screen time and parental sleep/wake patterns were the major factors driving the preschoolers' sleep habits. Health education is required to control screen time in children and to promote sleep hygiene among all family members.

Working-from-home persistently influences sleep and physical activity 2 years after the Covid-19 pandemic onset: a longitudinal sleep tracker and electronic diary-based study

Objective

Working from home (WFH) has become common place since the Covid-19 pandemic. Early studies observed population-level shifts in sleep patterns (later and longer sleep) and physical activity (reduced PA), during home confinement. Other studies found these changes to depend on the proportion of days that individuals WFH (vs. work from office; WFO). Here, we examined the effects of WFH on sleep and activity patterns in the transition to normality during the later stages of the Covid-19 pandemic (Aug 2021-Jan 2022).

Methods

Two-hundred and twenty-five working adults enrolled in a public health study were followed for 22  weeks. Sleep and activity data were collected with a consumer fitness tracker (Fitbit Versa 2). Over three 2-week periods (Phase 1/week 1-2: August 16-29, 2021; Phase 2/week 11-12: October 25-November 7, 2021; Phase 3/week 21-22: January 3-16, 2022), participants provided daily Fitbit sleep and activity records. Additionally, they completed daily phone-based ecological momentary assessment (EMA), providing ratings of sleep quality, wellbeing (mood, stress, motivation), and information on daily work arrangements (WFH, WFO, no work). Work arrangement data were used to examine the effects of WFH vs. WFO on sleep, activity, and wellbeing.

Results

The proportion of WFH vs. WFO days fluctuated over the three measurement periods, mirroring evolving Covid restrictions. Across all three measurement periods WFH days were robustly associated with later bedtimes (+14.7 min), later wake times (+42.3 min), and longer Total Sleep Time (+20.2 min), compared to WFO days. Sleep efficiency was not affected. WFH was further associated with lower daily step count than WFO (-2,471 steps/day). WFH was associated with higher wellbeing ratings compared to WFO for those participants who had no children. However, for participants with children, these differences were not present.

Conclusion

Pandemic-initiated changes in sleep and physical activity were sustained during the later stage of the pandemic. These changes could have longer term effects, and conscious effort is encouraged to harness the benefits (i.e., longer sleep), and mitigate the pitfalls (i.e., less physical activity). These findings are relevant for public health as hybrid WHF is likely to persist in a post-pandemic world.

Prevalence of Insomnia and Sleep Habits during the First and Second Wave of COVID-19 in Belgium

Belgium has one of the highest numbers of COVID-19 cases per 1 million inhabitants. The pandemic has led to significant societal changes with repercussions on sleep and on mental health. We aimed to investigate the effect of the first and the second wave of COVID-19 on the sleep of the Belgian populationWe launched two online questionnaires, one during the first lockdown (7240 respondents) and one during the second (3240 respondents), to test differences in self-reported clinical insomnia (as measured by the Insomnia Severity Index) and sleep habits during the two lockdowns in comparison with the pre-COVID period. The number of persons with clinical insomnia rose during the first lockdown (19.22%) and further during the second (28.91%) in comparison with pre-lockdown (7.04-7.66%). Bed and rise times were delayed and there was an increased time in bed and sleep onset latency. There was further a decrease in total sleep time and in sleep efficiency during both confinements. The prevalence of clinical insomnia quadrupled during the second wave in comparison with the pre-lockdown situation. Sleep habits were most altered in the younger population, indicating a greater risk for this group to develop a sleep-wake rhythm disorder.

Sleep as a protective factor of children's executive functions: A study during COVID-19 confinement

Confinements due to the COVID-19 outbreak affected sleep and mental health of adults, adolescents and children. Already preschool children experienced acutely worsened sleep, yet the possible resulting effects on executive functions remain unexplored. Longitudinally, sleep quality predicts later behavioral-cognitive outcomes. Accordingly, we propose children's sleep behavior as essential for healthy cognitive development. By using the COVID-19 confinement as an observational-experimental intervention, we tested whether worsened children's sleep affects executive functions outcomes 6 months downstream. We hypothesized that acutely increased night awakenings and sleep latency relate to reduced later executive functions. With an online survey during the acute confinement phase we analyzed sleep behavior in 45 children (36-72 months). A first survey referred to the (retrospective) time before and (acute) situation during confinement, and a follow-up survey assessed executive functions 6 months later (6 months retrospectively). Indeed, acutely increased nighttime awakenings related to reduced inhibition at FOLLOW-UP. Associations were specific to the confinement-induced sleep-change and not the sleep behavior before confinement. These findings highlight that specifically acute changes of children's nighttime sleep during sensitive periods are associated with behavioral outcome consequences. This aligns with observations in animals that inducing poor sleep during developmental periods affects later brain function.

Changes in Sleep Regularity and Perceived Life Stress across the COVID-19 Pandemic: A Longitudinal Analysis of a Predominately Female United States Convenience Sample

The Coronavirus Disease 2019 (COVID-19) pandemic had a profound impact on sleep and psychological well-being for individuals worldwide. This pre-registered investigation extends our prior study by tracking self-reported social jetlag (SJL), social sleep restriction (SSR), and perceived life stress from May 2020 through October 2021. Using web-based surveys, we collected self-reported sleep information with the Ultrashort Munich Chronotype Questionnaire at three additional timepoints (September 2020, February 2021 and October 2021). Further, we measured perceived life stress with the Perceived Stress Scale at two additional timepoints (February 2021 and October 2021). In a subsample of 181, predominantly female (87%), United States adults aged 19-89 years, we expanded our prior findings by showing that the precipitous drop in SJL during the pandemic first wave (May 2020), compared to pre-pandemic (February, 2020), rapidly rose with loosening social restrictions (September 2020), though never returned to pre-pandemic levels. This effect was greatest in young adults, but not associated with self-reported chronotype. Further, perceived life stress decreased across the pandemic, but was unrelated to SJL or SSR. These findings suggest that sleep schedules were sensitive to pandemic-related changes in social restrictions, especially in younger participants. We posit several possible mechanisms supporting these findings.

Age-Based Differences in Sleep Quality, Pre-Sleep Arousal, and Psychosocial Factors during the Second Wave Lockdown of the COVID-19 Pandemic in Georgia-A Higher Vulnerability of Younger People

The COVID-19 pandemic has deeply disrupted sleep and mental health of people around the world. We aimed to investigate age-based differences in the prevalence of and relationship between sleep quality, pre-sleep arousal, and psychosocial factors during the second wave lockdown of the COVID-19 pandemic in Georgia. Data were collected through an online survey (n = 1117). Participants were categorized into four age groups: 18-29, 30-41, 42-53, and 54-70 years. The youngest participants reported the most prevalent disruption of sleep behavior. Overall, 58.3% of respondents were poor sleepers. The Pittsburgh Sleep Quality Index (PSQI) global score was highest in the youngest age group but the difference was not significant. There was a significant difference in the PSQI component scores for subjective sleep quality, sleep latency, and daytime dysfunction, all being worse in young respondents. We also observed a significantly higher prevalence rate of worse sleep quality in the youngest age group, relative to the pre-pandemic period. On the other hand, the oldest respondents showed significantly greater use of sleeping medications. Significantly higher levels of somatic and cognitive pre-sleep arousal, perceived stress, feeling depressed, anxious, and socially isolated were reported by the youngest age group. Study findings indicate a higher vulnerability of younger people to the impact of the COVID-19 pandemic. Assessment of pre-sleep arousal and implementation of specific, age-based interventions may prove beneficial to improve possible consequences of the pandemic on sleep and mental health.

The Effect of Chronotype on Risk-Taking Behavior: The Chain Mediation Role of Self-Control and Emotional Stability

BACKGROUND

Although previous studies indicate that chronotype might be associated with risk-taking behavior, the specific mechanism has not been thoroughly discussed. This study aimed to fill this gap by exploring the mediating role of self-control and the chain mediating role of self-control and emotional stability between chronotype and risk-taking behavior.

METHODS

A total of 547 Chinese college students between 18 and 24 years old were selected to complete the Morningness-Eveningness Questionnaire (MEQ), Self-Control Scale (SCS), Eysenck's Personality Questionnaire-neuroticism (EPQ-N), and Adolescent Risk-Taking Questionnaire: Risk Behavior Scale (ARQ-RB) to assess chronotype, risk-taking behavior, self-control, and emotional stability, respectively. Hayes' PROCESS macro for SPSS was used to test the relationships among these variables.

RESULTS

Our result showed significant positive correlations among chronotype, self-control, emotional stability, and significant negative correlations between self-control, emotional stability, and risk-taking behavior. We also found that chronotype had a significant predictive effect on risk-taking behavior in the chain mediation model. Specifically, chronotype affected risk-taking behavior through two pathways: the separate mediating role of self-control and the serial mediation pathway of self-control → emotional stability.

CONCLUSIONS

Our study provides direct evidence that chronotype is associated with risk-taking behavior. The results showed that the predictive function of chronotype was mediated by self-control and emotional stability. This study provides a new perspective on preventing and reducing risk-taking behavior.

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

Background

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

Methods

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

Results

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

Conclusion

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

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

OBJECTIVES

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

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND & AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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