Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

The Influence of Disagreements over COVID-19 Preventive Measures on Stress and Sleep Quality

In this paper we reported the rate of disagreements and their effect on stress levels and sleep quality. Data was collected from 573 South Dakota residents. We estimated two ordinary least squares regressions using stress and sleep quality due to COVID-19 as outcome variables. A high percentage (62.1%) of the participants reported disagreements over COVID-19 with friends and family members. Disagreements over COVID-19 were associated with a higher level of stress (β = 1.001, p = .000) and a lower level of sleep quality (β = -.431, p = .039). The results of this study should serve as a reminder to researchers to consider the impact of interpersonal conflict over public health measures with family and friends on mental health.

Effectiveness of Rehabilitation Interventions in Individuals With Emerging Virtual Respiratory Tract Infectious Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

Assessing rehabilitation effectiveness for persistent symptoms post-infection with emerging viral respiratory diseases.

DATA SOURCES

Systematic review of seven databases (MEDLINE, EMBASE, Cochrane Library, PEDro, MedRxiv, CNKI, Wanfang) until 30 December 2023.

REVIEW METHODS

Evaluated 101 studies (9593 participants) on respiratory function, exercise capacity, and quality of life. Methodological quality was assessed using the Cochrane Collaboration's Risk of Bias tool for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for observational studies and non-RCTs, and the NIH Quality Assessment Tools for before-after studies.

RESULTS

The most common rehabilitation program combined breathing exercises with aerobic exercise or strength training. Rehabilitation interventions significantly enhanced respiratory function, as evidenced by improvements on the Borg Scale (MD, -1.85; 95% CI, -3.00 to -0.70, low certainty), the mMRC Dyspnea Scale (MD, -0.45; 95% CI, -0.72 to -0.18, low certainty), and the Multidimensional Dyspnoea-12 Scale (MD, -4.64; 95% CI, -6.54 to -2.74, moderate certainty). Exercise capacity also improved, demonstrated by results from the Six-Minute Walk Test (MD, 38.18; 95% CI, 25.33-51.03, moderate certainty) and the Sit-to-Stand Test (MD, 3.04; 95% CI, 1.07-5.01, low certainty).

CONCLUSION

Rehabilitation interventions are promising for survivors of viral respiratory diseases, yet gaps in research remain. Future investigations should focus on personalizing rehabilitation efforts, utilizing remote technology-assisted programs, improving research quality, and identifying specific subgroups for customized rehabilitation strategies to achieve the best outcomes for survivors.

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.

Impact of COVID-19 Pandemic Lockdown on Body Mass Index and Physical Fitness in Chinese College Students

PURPOSE

To explore the impact of COVID-19 pandemic lockdown (CoPL) on body mass index (BMI) and physical fitness among college students.

METHODS

Two one-year cohorts, one with no pandemic lockdown (NoPL) exposure and one with CoPL exposure, were included. Baseline measurements were performed in October 2018 (NoPL) and October 2019 (CoPL), and follow-up data were collected one year later. Participants were divided into "deterioration", "no-change", and "improvement" groups based on their quartile distribution of one-year differences (follow-up-baseline) for lower 25%, middle 50%, and upper 25%. Baseline-category logit regression models were used to determine the odds ratios of deterioration and improvement in BMI and physical fitness, with "no-change" used as baseline.

RESULTS

A total of 2,594 and 2,525 students were included in NoPL and CoPL cohorts, respectively. CoPL was associated with higher odds for deterioration in BMI (male), explosive strength, upper-limb muscle strength, abdominal muscle strength, and cardiorespiratory fitness, but lower odds for deterioration in BMI (female) and flexibility. CoPL was associated with lower odds for improvement in BMI (male), explosive strength, lower-limb and upper-limb muscle strength, and cardiorespiratory fitness, but higher odds for improvement in BMI (female) and flexibility.

DISCUSSION

Not all dimensions of health outcomes were negatively impacted by the lockdown, as deterioration in BMI in males, muscle strength, and cardiorespiratory fitness following the CoPL were more than that in the absence of the lockdown, while deterioration in BMI in females and flexibility were less than that in the absence of the lockdown.

Poor sleep hygiene practices are associated with a higher increase in sleep problems during the COVID-19 pandemic: A latent change score model

The Coronavirus 2019 (COVID-19) pandemic significantly influenced physical and mental health worldwide. The present study aimed to investigate changes in sleep problems across three waves of the COVID-19 pandemic, and to identify potential predictors of the inter-individual variability around these changes, with a particular focus on the role of detrimental sleep hygiene practices. A total of 352 participants completed an online survey of self-report questionnaires at three different waves of the COVID-19 pandemic: T1 (Spring 2020); T2 (Autumn-Winter 2020); and T3 (Spring 2021). The questionnaires collected information on socio-demographic and COVID-19-related variables, psychological distress (i.e. the Depression Anxiety Stress Scale-21), sleep hygiene (i.e. the Sleep Hygiene Index) and sleep problems (i.e. the Medical Outcomes Study-Sleep Scale). Latent change score modelling revealed an average increase in sleep problems between T1 and T2 with significant inter-individual variability. No substantial changes were observed on average between T2 and T3. Notably, poorer sleep hygiene practices were associated with a more pronounced increase in sleep problems between T1 and T2 (β = 0.191, p = 0.013), even after controlling for relevant confounders such as demographic factors, COVID-19-related information and psychological distress. These findings expand on previous research regarding the detrimental effects of the pandemic on mental health, suggesting that interventions targeting sleep hygiene practices may be beneficial for mitigating its negative impact on sleep disruptions.

Effects of (non)deceptive placebos on reported sleep quality and food cue reactivity

A lack of sleep can increase appetite, particularly for high-calorie food. The current study tested the effects of an open-label placebo for improving sleep quality and reducing food cue reactivity. In open-label placebo interventions, placebo recipients are informed that they are receiving a placebo without a pharmacologically active substance. Participants (n = 150) were randomly allocated to one of three groups that received either an open-label placebo to improve sleep quality, a deceptive placebo ("melatonin"), or no placebo. The placebo was administered daily before bedtime for 1 week. Sleep quality and reactivity to high-calorie food cues (appetite, visual attention to food images) were assessed. The deceptive placebo (but not the open-label placebo) reduced reported sleep-onset latency. The open-label placebo decreased perceived sleep efficiency. The placebo interventions did not change food cue reactivity. This study demonstrated that open-label placebos do not present an alternative to deceptive placebos for improving sleep quality. The undesirable open-label placebo effects found warrant further exploration.

Estimation bias and agreement limits between two common self-report methods of habitual sleep duration in epidemiological surveys

Accurate measurement of habitual sleep duration (HSD) is crucial for understanding the relationship between sleep and health. This study aimed to assess the bias and agreement limits between two commonly used short HSD self-report methods, considering sleep quality (SQ) and social jetlag (SJL) as potential predictors of bias. Data from 10,268 participants in the International COVID Sleep Study-II (ICOSS-II) were used. Method-Self and Method-MCTQ were compared. Method-Self involved a single question about average nightly sleep duration (HSDself), while Method-MCTQ estimated HSD from reported sleep times on workdays (HSDMCTQwork) and free days (HSDMCTQfree). Sleep quality was evaluated using a Likert scale and the Insomnia Severity Index (ISI) to explore its influence on estimation bias. HSDself was on average 42.41 ± 67.42 min lower than HSDMCTQweek, with an agreement range within ± 133 min. The bias and agreement range between methods increased with poorer SQ. HSDMCTQwork showed less bias and better agreement with HSDself compared to HSDMCTQfree. Sleep duration irregularity was - 43.35 ± 78.26 min on average. Subjective sleep quality predicted a significant proportion of variance in HSDself and estimation bias. The two methods showed very poor agreement and a significant systematic bias, both worsening with poorer SQ. Method-MCTQ considered sleep intervals without adjusting for SQ issues such as wakefulness after sleep onset but accounted for sleep irregularity and sleeping in on free days, while Method-Self reflected respondents' interpretation of their sleep, focusing on their sleep on workdays. Including an SQ-related question in surveys may help bidirectionally adjust the possible bias and enhance the accuracy of sleep-health studies.

Prevalence of poor sleep quality in COVID-19 patients: a systematic review and meta-analysis

Objective

The coronavirus disease (COVID-19) and the public health responses were associated with a huge health burden, which could influence sleep quality. This meta-analysis and systematic review examined the prevalence of poor sleep quality in COVID-19 patients.

Methods

PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 27, 2022. Prevalence rates of poor sleep were analyzed using a random effects model.

Results

Totally, 24 epidemiological and 12 comparative studies with 8,146 COVID-19 patients and 5,787 healthy controls were included. The pooled prevalence of poor sleep quality based on the included studies was 65.0% (95%CI: 59.56-70.44%, I2 = 97.6%). COVID-19 patients had a higher risk of poor sleep quality compared to healthy controls (OR = 1.73, 95% CI: 1.30-2.30, p < 0.01, I2 = 78.1%) based on the 12 comparative studies. Subgroup analysis revealed that COVID-19 patients in low-income countries (p = 0.011) and in studies using a lower Pittsburgh Sleep Quality Index score cut-off (p < 0.001) were more likely to have poor sleep quality. Meta-regression analyses revealed that being female (p = 0.044), older (p < 0.001) and married (p = 0.009) were significantly correlated with a higher risk of poor sleep quality while quality score (p = 0.014) were negatively correlated with the prevalence of poor sleep quality in COVID-19 patients.

Conclusion

Poor sleep quality was found to be very common in COVID-19 patients. Considering the negative effects of poor sleep quality on daily life, sleep quality should be routinely assessed and appropriately addressed in COVID-19 patients.

Problematic Gaming during COVID-19 Pandemic: A Systematic Review, Meta-Analysis, and Meta-Regression

The COVID-19 pandemic led to government measures enforcing isolation in order to mitigate the spread of the virus. Consequently, online activities, including gaming, increased during this challenging period. Thus, it was possible that problematic gaming (PG) patterns also increased. In this systematic review and meta-analysis, we estimated the prevalence of PG during the COVID-19 pandemic and examined differences among subpopulations. The evaluation of 38 studies revealed that the overall prevalence of PG during the COVID-19 pandemic was 3.6%. Furthermore, higher PG scores were found in undergraduate and gamer subpopulations, as well as in studies using the Gaming Addiction Scale. Finally, meta-regression analyses suggest that stricter government measures, as identified by the Government Stringency Index, may have contributed to a lower prevalence of PG behaviors. A potential explanation of this finding is that containment measures had a protective function with respect to emotional distress, and thus towards PG; alternatively, it could be that current measures for PG become less precise if an individual's functioning is already impaired due to other reasons, such as COVID-19 restrictions. Further theoretical, methodological, and practical implications of the findings are discussed.

Fatigue, sleepiness and sleep quality are SARS-CoV-2 variant independent in patients with long COVID symptoms

Acute infections with SARS-CoV-2 variants of concerns (VOCs) differ in clinical presentation. Discrepancies in their long-term sequelae, commonly referred to as long COVID, however, remain to be explored. We retrospectively analyzed data of 287 patients presented at the post-COVID care of the Pulmonology Department, Semmelweis University, Budapest, Hungary, and infected with SARS-CoV-2 during a period of 3 major epidemic waves in Hungary (February-July 2021, VOC: B.1.1.7, Alpha, N = 135; August-December 2021, VOC: B.1.617.2, Delta, N = 89; and January-June 2022, VOC: B.1.1.529, Omicron; N = 63), > 4 weeks after acute COVID-19. Overall, the ratio of long COVID symptomatic (LC) and asymptomatic (NS) patients was 2:1. Self-reported questionnaires on fatigue (Fatigue Severity Scale, FSS), sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) showed higher scores for LC (4.79 ± 0.12, 7.45 ± 0.33 and 7.46 ± 0.27, respectively) than NS patients (2.85 ± 0.16, 5.23 ± 0.32 and 4.26 ± 0.29, respectively; p < 0.05 for all vs. LC). By comparing data of the three waves, mean FSS and PSQI scores of LC patients, but not ESS scores, exceeded the normal range in all, with no significant inter-wave differences. Considering FSS ≥ 4 and PSQI > 5 cutoff values, LC patients commonly exhibited problematic fatigue (≥ 70%) and poor sleep quality (> 60%) in all three waves. Comparative analysis of PSQI component scores of LC patients identified no significant differences between the three waves. Our findings highlight the importance of concerted efforts to manage both fatigue and sleep disturbances in long COVID patient care. This multifaceted approach should be followed in all cases infected with either VOCs of SARS-CoV-2.

The mediating role of sleep quality in the relationship between orthorexia nervosa and fear of COVID-19

The COVID-19 (SARS-CoV-2) pandemic has jeopardized humanity worldwide and has considerably altered the healthy lifestyle behaviors of societies. This study examined the possible mediating role of sleep quality in the relationship between orthorexia nervosa and fear of COVID-19 among Turkish adults. This study used an observational and descriptive design. It was carried out online with 1,130 participants across Turkey between April and August 2021. The data were collected using a questionnaire, the Fear of COVID-19 Scale (FC-19S), the Pittsburgh Sleep Quality Index (PSQI), and Orthorexia Nervosa-R (ON-R). The participants had an ON-R mean score of 3.08 ± 0.90 and a mean PSQI score of 8.03 ± 2.80. Likewise, their mean FC-19S score was 18.24 ± 6.55. There was a significant positive correlation between the FC-19S and the PSQI (r = 0.208; p = 0.000) as well as a significant negative correlation between the ON-R and the PSQI (r = - 0.145; p = 0.000). In addition, the results of the process model analysis supported our hypotheses that the PSQI was a predictor of ON-R and that its direct and indirect effects were moderated by FC19S and the PSQI. A one-unit increase in FC-19S scores causes an average 1% increase on the ON-R scale, while it generates an 8% increase on the PSQI. It was determined that the PSQI total score caused an average of 6% increase in the ON-R scale score. The findings of this study showed that sleep quality has a mediating role in the relationship between orthorexia nervosa and fear of COVID-19 experienced by Turkish adults during the pandemic. For this reason, governments need to take the necessary precautions concerning this subject when creating action plans for possible global crisis situations that may adversely affect public health in the future.

Anxiety, depression, and insomnia among nurses during the full liberalization of COVID-19: a multicenter cross-sectional analysis of the high-income region in China

Introduction

Frontline nurses fighting against the epidemic were under great psychological stress. However, there is a lack of studies assessing the prevalence rates of anxiety, depression, and insomnia among frontline nurses after the full liberalization of COVID-19 in China. This study demonstrates the impact of the full liberalization of COVID-19 on the psychological issues and the prevalence rate and associated factors of depressive symptoms, anxiety, and insomnia among frontline nurses.

Methods

A total of 1766 frontline nurses completed a self-reported online questionnaire by convenience sampling. The survey included six main sections: the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7), the 7-item Insomnia Severity Index (ISI), the 10-item Perceived Stress Scale (PSS-10), sociodemographic information, and work information. Multiple logistic regression analyses were applied to identify the potential significantly associated factors for psychological issues. The study methods were compliant with the STROBE checklist.

Results

90.83% of frontline nurses were infected with COVID-19, and 33.64% had to work while infected COVID-19. The overall prevalence of depressive symptoms, anxiety and insomnia among frontline nurses was 69.20%, 62.51%, and 76.78%, respectively. Multiple logistic analyses revealed that job satisfaction, attitude toward the current pandemic management, and perceived stress were associated with depressive symptoms, anxiety, and insomnia.

Conclusions

This study highlighted that frontline nurses were suffering from varying degrees of depressive symptoms, anxiety, and insomnia during full liberalization of COVID-19. Early detection of mental health issues and preventive and promotive interventions should be implemented according to the associated factors to prevent a more serious psychological impact on frontline nurses.

Longitudinal Findings on the Oneiric Activity Changes Across the Pandemic

Purpose

COVID-19 pandemic waves have strongly influenced individuals' behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress.

Materials and Methods

Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as "Improved" (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as "Not Improved" (N=398).

Results

Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects.

Conclusion

Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.

COVID-19 and Sleep Disturbances: A Literature Review of Clinical Evidence

The need for adequate good quality sleep to optimally function is well known. Over years, various physical, psychological, biological, and social factors have been investigated to understand their impact on sleep. However, understanding the etiological processes that are involved in causing sleep disturbances (SD) as impacted by stressful phases such as pandemics has not been well studied. Many such etiological and management strategies have surfaced during the latest "coronavirus disease of 2019 (COVID-19) pandemic. The occurrence of these SD in the infected and uninfected individuals poses a need to investigate factors linked to such occurrence during this phase. Some of such factors include stressful practices such as social distancing, masking, vaccines, and medications availability, changes in routines, and lifestyles. As the status of infection improved, a collective term for all the prolonged effects of COVID-19 after the resolution of the primary infection called the post-COVID-19 syndrome (PCS) surfaced. Apart from impacting sleep during the infectious phase, the aftereffects of this virus left an even greater impact during the PCS. Various mechanisms have been hypothesized to be linked to such SD during the PCS, but the available data are inconclusive. Further, the varied patterns of incidence of these SDs differed by many factors, such as age, gender, and geographical location, making clinical management even more challenging. This review elucidates the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease on sleep health during the various phases of the COVID-19 pandemic. We also investigate different causal relationships, management strategies, and knowledge gaps related to SD during the COVID-19 pandemic.

Sleep Quality between Nurses and the General Population during the COVID-19 Pandemic in Portugal: What Are the Differences?

Although several studies have described the impact of the COVID-19 pandemic, particularly on sleep quality, there are few studies that, in the same time period and using the same assessment tools, compare sleep quality and mental health status between nurses and the general population. Thus, the aim of this study was to (a) examine whether there were differences between nurses and the general population regarding sleep quality and mental health status during the COVID-19 pandemic and (b) identify which factors may explain sleep quality during the COVID-19 pandemic. To do that, we carried out a cross-sectional study in Portugal. Data were collected using an online survey platform during the first COVID-19 wave, from April to August 2020. Nurses presented poorer sleep quality than the general population, as well as higher anxiety levels. Irritability and worries about the future were two of the factors that might explain those differences. Thus, we can conclude that irritability and worries about the future are dimensions of anxiety that were associated with poor sleep quality during the COVID-19 pandemic. Thus, it would be important to adopt regular anxiety and sleep assessments, particularly for nurses, and to implement strategies to reduce this problem.

Contemporary Concise Review 2022: Sleep

COVID-19 AND SLEEP: The COVID-19 pandemic is associated with an increase in insomnia and impaired sleep quality Health care workers are particularly susceptible and improved with cognitive behavioural therapy for insomnia (CBT-I) Long COVID has significant effects on sleep OSA impacts on the severity of acute COVID-19 illness OBSTRUCTIVE SLEEP APNOEA: Large trials of clinically representative patients confirm the cardiovascular benefits of CPAP treatment in OSA CPAP may improve long-term cognitive outcomes in OSA, but further research is needed Racial disparities in OSA prevalence and mortality risk are becoming evident Periodic evaluation of OSA risk in pregnancy is important as timing may be key for intervention to prevent or treat cardiovascular risk factors INSOMNIA: Comorbid insomnia and obstructive sleep apnoea (COMISA) can frequently co-exist and the combined negative effects of both may be deleterious, particularly to cardiovascular health There is evidence for effectiveness with novel orexin receptor antagonists.

Proceedings of a roundtable event 'Workplace Diet and Health - priorities for researchers and practitioners'

Understanding how the work environment impacts health behaviours is essential to a life course approach in public health nutrition. A roundtable event 'Workplace Diet and Health - priorities for researchers and practitioners' was held by the Nutrition Society in October 2022. The overarching aims of the roundtable event were to consider (i) the relevance of nutritional wellbeing for employers and organisations, (ii) the research priorities for workplace diet and health and (iii) how researchers and practitioners can work with stakeholders in the development and testing of workplace diet and health interventions and nutritional education. Participants represented a range of stakeholders including dietetic and nutrition professionals working in workplace health, academics and science communication with an interest in workplace diet and health, non-governmental organisations and providers of workplace nutritional health and wellbeing programmes. All roundtable participants agreed that good nutrition and access to healthy food at work was part of corporate responsibility comparable to that of health and safety provision. It was recognised that nutritional wellbeing was not seen as a priority by many companies due to the complexity and wide range of employee health and wellbeing options available and the perceived lack of clear financial benefit. Three priority areas were identified and agreed upon by roundtable participants: (1) strengthening the evidence base to demonstrate the tangible benefit of nutritional wellbeing interventions in the workplace, (2) creating a knowledge exchange hub to share best practices and experiences of working across sectors and (3) expand stakeholder engagement in workplace nutritional wellbeing.

'This is the last episode': the association between problematic binge-watching and loneliness, emotion regulation, and sleep-related factors in poor sleepers

Evidence on the relation between binge-watching and sleep quality is still scarce and inconsistent and none has taken into account both the healthy and pathological dimensions of the phenomenon. This study aimed at filling this gap by investigating both aspects in healthy participants with high and low sleep quality. Further, we aimed at identifying sociodemographic, psychological and sleep-related determinants of problematic binge-watching in poor sleepers. We first conducted independent comparisons between good (n = 253) and poor sleepers (n = 209) on different binge-watching symptoms and motives, assessed through 'Binge-watching Engagement and Symptoms' and 'Watching TV Series Motives' questionnaires, respectively. Then, we focused on the problematic aspects of binge-watching in poor sleepers, investigating the role of emotion regulation, loneliness, and sleep-related factors using hierarchical multiple regressions. Comparisons between the two groups revealed a greater extent of binge-watching behaviour (t = -2.80, p = 0.005) and greater use of this practise to cope with negative emotions (t = -4.17, p < 0.001) in poor sleepers. In addition, hierarchical multiple regressions showed that gender (β = -0.166, p = 0.008), alcohol consumption (β = -0.135, p = 0.035), emotional dysregulation (β = 0.260, p = 0.001; β = 0.298, p < 0.001), feelings of loneliness (β = 0.159, p = 0.029; β = 0.199, p = 0.003), and daytime sleepiness (β = 0.149, p = 0.016) are significant determinants of problematic binge-watching in this population. In addition to showing for the first time the relationship between sleep quality and different aspects of binge-watching, our findings indicate that emotional dysregulation, feelings of loneliness, and daytime sleepiness play a key role in determining problematic binge-watching in poor sleepers, possibly due to the existence of a pathological vicious circle between these factors in poor sleepers.

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.

Habitual Sleep Patterns and Chronic Sleep Problems in Relation to Sex, Age, and Circadian Preference in a Population-Based Sample of Norwegian Adults

Sleep patterns and problems vary in relation to internal (e.g., sex, age, circadian preference) and external (e.g., social structures) factors. The main aim of the present study was to describe habitual sleep patterns and chronic sleep problems in a population-based sample of Norwegian adults. During spring 2022, a sample of 1028 adults completed an online survey on sleep habits and problems. Response rate was 33.5%. The survey included the Munich ChronoType Questionnaire and items on circadian preference and chronic sleep problems. Mean workday sleep duration was 7:19 h (±199 min), and shorter in males (p = 0.035) and evening persons (p = 0.003). Short workday sleep duration (<6 h) was reported by 3.1% and was associated with evening preference (p = 0.001). Mean social jetlag was 0:51 h (±75 min), and longer in males (p = 0.036), younger adults (p < 0.001) and evening persons (p < 0.001). Long social jetlag (≥2 h) was reported by 11.2% and associated with younger age (p < 0.001) and evening preference (p < 0.001). Chronic sleep problems (≥3 months) were reported by 44.1%, and associated with female sex (p < 0.001) and evening preference (p = 0.002). Results underscore the importance of considering evening circadian preference as a risk factor for short workday sleep duration, long social jetlag and self-reported chronic sleep problems.

Sleep Disturbance and Immunological Consequences of COVID-19

The overarching importance of sleep was further emphasized during the pandemic of COVID-19. The subjects infected by COVID-19 frequently experience sleep disturbances; some are long-lasting problems and decrease the quality of life. Insomnia is the most studied sleep disorder associated with COVID-19. Insomnia affects patients who have experienced an infection and the general population. Good sleep is important in maintaining mental and physical health, including immune system functions. The interconnections between insomnia, the immune system, and COVID-19 are complex. Insomnia triggers numerous immune system dysregulations and makes individuals more vulnerable to respiratory infections. This narrative review overviews the influence of the COVID-19 pandemic on the immune system through sleep disorders.

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.

Changes in sleep quality and sleep disturbances in the general population from before to during the COVID-19 lockdown: A systematic review and meta-analysis

Introduction

This systematic review and meta-analysis aims to explore changes in sleep quality and sleep disturbances in the general population from before to during the COVID-19 lockdown.

Methods

The protocol was registered in PROSPERO (CRD42021256378) and the PRISMA guidelines were followed. The major databases and gray literature were systematically searched from inception to 28/05/2021 to identify observational studies evaluating sleep changes in the general population during the lockdown with respect to the pre-lockdown period. A random effects meta-analysis was undertaken for studies reporting (a) the means of the Pittsburgh Sleep Quality Index (PSQI) global scores or the means of the sleep onset latency (SOL) times (minutes - min) before and during the lockdown, (b) the percentages of poor sleep quality before and during the lockdown, or (c) the percentages of changes in sleep quality. Subgroup analysis by risk of bias and measurement tool utilized was carried out. A narrative synthesis on sleep efficiency, sleep disturbances, insomnia and sleep medication consumption was also performed.

Results

Sixty-three studies were included. A decline in sleep quality, reflected in a pooled increase in the PSQI global scores (standardized mean difference (SMD) = 0.26; 95% CI 0.17-0.34) and in SOL (SMD = 0.38 min; 95% CI 0.30-0.45) were found. The percentage of individuals with poor sleep quality increased during the lockdown (pooled relative risk 1.4; 95% CI 1.24-1.61). Moreover, 57.3% (95% CI 50.01-61.55) of the individuals reported a change in sleep quality; in 37.3% (95% CI 34.27-40.39) of these, it was a worsening. The studies included in the systematic review reported a decrease in sleep efficiency and an increase in sleep disturbances, insomnia, and in sleep medication consumption.

Discussion

Timely interventions are warranted in view of the decline in sleep quality and the increase in sleep disturbances uncovered and their potentially negative impact on health. Further research and in particular longitudinal studies using validated instruments examining the long-term impact of the lockdown on sleep variables is needed.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256378, identifier CRD42021256378.

Association between quarantine and sleep disturbance in Hong Kong adults: The mediating role of COVID-19 mental impact and distress

BACKGROUND

COVID-19 quarantine has been associated with increased sleep problems and prolonged psychological responses to the pandemic could mediate this relationship. The present study attempted to examine the mediating role of COVID-19 mental impact and distress between quarantine and sleep disturbance.

METHODS

The present study recruited 438 adults (109 with quarantine experience) in Hong Kong via an online survey between August and October 2021. The respondents completed a self-report questionnaire on quarantine, Mental Impact and Distress Scale: COVID-19 (MIDc), and Pittsburgh Sleep Quality Index (PSQI). The MIDc was treated as a latent mediator and continuous PSQI factor and poor sleep quality (PSQI score > 5) were the study outcomes. We evaluated the direct and indirect effects of quarantine on sleep disturbance via MIDc using structural equation modeling. Analyses were adjusted for gender, age, education level, knowing confirmed COVID-19 cases, COVID-19 frontline work, and primary income source of the family.

RESULTS

More than half (62.8%) of the sample reported poor sleep quality. Quarantine was associated with significantly higher levels of MIDc and sleep disturbance (Cohen d = 0.23 - 0.43, p < 0.05). In the structural equation model, the MIDc mediated the relationship between quarantine and sleep disturbance (αβ = 0.152, 95% CI = 0.071 to 0.235). Quarantine significantly increased the proportion of poor sleep quality by 10.7% (95% CI = 0.050 to 0.171) indirectly via MIDc.

CONCLUSIONS

The results provide empirical support to the mediating role of the MIDc as psychological responses in the relationship between quarantine and sleep disturbance.

The role of sleep and dreams in long‐ COVID

Recent investigations show that many people affected by SARS-CoV2 (COVID-19) report persistent symptoms 2-3 months from the onset of the infection. Here, we report the Italian findings from the second International COVID-19 Sleep Study survey, aiming to investigate sleep and dream alterations in participants with post-acute symptoms, and identify the best determinants of these alterations among patients with long-COVID. Data from 383 participants who have had COVID-19 were collected through a web-survey (May-November 2021). Descriptive analyses were performed to outline the sociodemographic characteristics of long-COVID (N = 270, with at least two long-lasting symptoms) and short-COVID (N = 113, with none or one long-lasting symptom) participants. They were then compared concerning sleep and dream measures. We performed multiple linear regressions considering as dependent variables sleep and dream parameters discriminating the long-COVID group. Age, gender, work status, financial burden, COVID-19 severity and the level of care were significantly different between long-COVID and short-COVID subjects. The long-COVID group showed greater sleep alterations (sleep quality, daytime sleepiness, sleep inertia, naps, insomnia, sleep apnea, nightmares) compared with the short-COVID group. We also found that the number of long-COVID symptoms, psychological factors and age were the best explanatory variables of sleep and oneiric alterations. Our findings highlight that sleep alterations are part of the clinical presentation of the long-COVID syndrome. Moreover, psychological status and the number of post-acute symptoms should be considered as state-like variables modulating the sleep problems in long-COVID individuals. Finally, according to previous investigations, oneiric alterations are confirmed as a reliable mental health index.