Social Isolation and Sleep: Manifestation During COVID-19 Quarantines

Evaluating the risk of sleep disorders in subjects with a prior COVID-19 infection

Previous studies have reported a potential occurrence of sleep disorders in patients following a COVID-19 infection. However, these findings were based on surveys or retrospective studies with small sample sizes. This study examined if subjects with a previous COVID-19 infection in 2020 experienced sleep disorders in 2021. Using the 2019-2021 Utah All Payers Claims Database (APCD), adults (≥18 to 62 years old in 2019) covered by private insurance and Medicaid were identified. Sleep disorders were identified from the primary and secondary diagnosis in 2021. Baseline characteristics of subjects such as age, gender, race/ethnicity, type of insurance, and comorbid conditions were identified from the database. Entropy balancing was used to balance the baseline characteristics of subjects with and without a COVID-19 infection in 2020. Weighted logistic regression was used to identify significant factors that were associated with sleep disorders. A total of 413,958 subjects were included in the study. The average (SD) age was 38 (17) years old in 2019 and 58% were female. Among the subjects, about 39% had a COVID-19 infection in 2020. Those who had a COVID-19 infection in 2020 were 53% more likely to have a sleep disorder in 2021 (OR = 1.53; 95% Confidence Interval: 1.48-1.58). Sleep disorders could be one of long-term COVID-19 symptoms. More screening and observations for those who had a COVID-19 infection could be important to improve sleep related problems.

Impact of COVID-19 lockdown on sleep patterns and the related problems among nursing students

AIM

To evaluate the impact of the COVID-19 lockdown on sleep patterns and quality among nursing students in our college.

DESIGN

A cross-sectional study was carried out.

METHODS

A total of 302 nursing students aged 18-25 years, representing both genders and various academic levels, participated in this study. A pre-validated, self-administered questionnaire was used to assess sleep quality during COVID-19 and it was distributed through various social media platforms for data collection.

RESULTS

Female students comprised the majority (92.1%) of participants. Of 332 nursing students, 302 completed the questionnaire, yielding a 91% response rate. Statistically significant differences were observed before and during the COVID-19 lockdown regarding the need to sleep after waking, feeling refreshed upon waking, satisfaction with individual sleep patterns and experiencing restless and troubled sleep (p = 0.001). Additionally, approximately one-third of nursing students (32.9%) reported poor sleep quality during the COVID-19 pandemic, with minimal impact on the total sleep hours among the studied cohorts.

PUBLIC CONTRIBUTION

The COVID-19 pandemic has statistically significant impacted nursing students' sleep quality and levels. Acknowledging these challenges and planning for providing supporting measurements is essential to ensuring that nursing students can maintain their physical and mental health, which is critical for their ability to provide quality healthcare.

Prevalence of social isolation in the elderly: A systematic review and meta-analysis

Social isolation has become a global issue among the elderly, posing serious challenges to both social and public health. We assessed the prevalence of elderly social isolation and its related factors. Eight electronic databases were searched up to June 28th, 2023. A meta-analysis of the included literature was performed using Stata 16.0. The results showed that the incidence of social isolation in the elderly was 33 % [95 % CI (0.28, 0.38)]. The subgroup analysis revealed that people over 80, with a sample size under 500, assessed using the Lubben Social Network scale and Social Network Index scale, experienced higher social isolation, especially if they were living alone and lacked higher education. It is suggested to pay attention to the psychological well-being of elderly individuals living alone and lacking a high level of education. Early screening could help reduce the incidence of social isolation, and hence its implications, among the elderly.

Influence of loneliness and social isolation before and during the COVID-19 pandemic on mood, cognition and sleep

BACKGROUND

Social isolation and loneliness are public health problems and are related to poor physical and mental health in older persons, especially during the COVID-19 pandemic. We investigated the influences of social isolation and loneliness on mood, cognition and sleep quality in older persons.

METHODS

This study evaluated 82 older persons, with a median age of 69.16 years (range: 60.00-85.97). The older persons were assessed before and during the period of the COVID-19 pandemic. Cognition was assessed using the Montreal Cognitive Assessment, symptoms of depression using the Beck Depression Inventory II, symptoms of anxiety using the Beck Anxiety Inventory, quality of sleep by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, isolation by the Duke Social Support Index and three-item UCLA Loneliness Scale.

RESULTS

Our results revealed that loneliness is related to worsening anxiety symptoms (P = 0.008), and sleep quality (P = 0.011). Isolation is related to worsening sleep quality (P = 0.011). On the other hand, participants who did not isolate themselves during the pandemic felt more anxious (P = 0.021). In addition, older persons who were not isolated (P = 0.035) and had no loneliness (P = 0.007), have higher cognitive performance over time.

CONCLUSION

Loneliness is related to worsening symptoms of anxiety and sleep quality. Our results showed that social isolation is related to worsening sleep quality. On the other hand, high social support during the COVID-19 pandemic increased anxiety. Furthermore, better cognitive performance is related to non-isolated and non-lonely participants.

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.

Serological Evidence and Self-reported Outcomes in Patients with Adrenal Insufficiency during the First Waves of COVID-19 in North-East Italy

OBJECTIVE

COVID-19 is a potentially serious new infection first reported in North East Italy in Spring, 2020. Patients with adrenal insufficiency (AI) have a known increased risk of infections that could precipitate to adrenal crisis. Even COVID-19-related psycho-social impact could affect their health, requiring a dynamic adaptation of daily glucocorticoid (GC) therapy. The aim of this study was to evaluate the incidence of COVID-19 infection and self-reported outcomes in AI patients after the first pandemic waves.

METHODS

It was an open-label, cross-sectional monocentric study on 84 (65 primary, 19 secondary) AI patients resident in Veneto and followed-up in our clinical Endocrine Unit. All patients underwent serological investigation of anti-SARS-CoV2 IgG, answered the purpose-built "ADDICOVID" questionnaire in August, 2020, and were re-contacted to reevaluate COVID-19 infection occurrence in March-April, 2021.

RESULTS

All patients resulted negative to the serological test for anti-SARS-CoV2 IgG at the end of the first pandemic wave. After the third wave, COVID-19 infection occurred in 8 patients without the need for hospitalization. Half patients felt an increased risk of COVID-19 infection, significantly associated with increased stress and GC stress dose. Only one patient reported stress-correlated adrenal crisis. The majority of AI workers changed working habits, significantly reducing COVID- 19-related stress.

CONCLUSION

AI patients did not show an increased incidence of COVID-19, but the perception of increased COVID-19 infection risk significantly impacted their psychological well-being, working habits, and GC daily doses. Therapeutic patient education is crucial, especially for AI workers, to prevent and treat situations that could lead to an adrenal crisis.

Neuropsychiatric Outcomes and Sleep Dysfunction in COVID-19 Patients: Risk Factors and Mechanisms

The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.

Anxious-Withdrawal and Sleep Problems during Adolescence: The Moderating Role of Peer Difficulties

Anxious-withdrawal is a well-established individual risk factor for psychosocial difficulties during adolescence. It is unknown, however, whether it also places youth at increased risk for physical health problems, such as sleep difficulties. This study examines the concurrent and prospective associations between anxious-withdrawal and six types of sleep difficulties (i.e., sleeping too much, sleeping too little, talking/walking in sleep, being overtired, nightmares, and general trouble sleeping). We further evaluate whether these associations differ for adolescents who are high versus low in exclusion and victimization. The participants were 395 adolescents (Mage = 13.61 years; 35% ethnic minority) who completed peer nominations of anxious-withdrawal, exclusion, and victimization at Time 1 (T1). Their mothers completed reports of sleep difficulties at T1 and at Time 2 (T2). Path analyses revealed unique associations between anxious-withdrawal and several types of sleep difficulties (e.g., sleeping too much) at T1. Analyses also revealed a significant interaction effect between T1 anxious-withdrawal and exclusion/victimization such that anxious-withdrawal was prospectively associated with trouble sleeping only for those young adolescents who are highly excluded/victimized. Our findings are the first to link anxious-withdrawal to a physical health outcome in adolescence and point to the need for future research to not only examine anxious-withdrawal and physical health but also to include assessments of peer difficulties.

Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19

Background

Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.

Methods

An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.

Results

After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.

Conclusion

Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.

Insomnia symptoms predict longer COVID-19 symptom duration

OBJECTIVE

/Background: The goal of the present study was to assess the prevalence and incidence of insomnia in the United States during the COVID-19 pandemic, and whether, among those that contracted COVID-19, insomnia predicted worse outcomes (e.g., symptoms of greater frequency, duration, or severity).

METHODS

A nationwide sample of 2980 adults living in the United States were surveyed online at two points during the COVID-19 pandemic (T1 = April-June 2020; T2 = January-March 2021). Insomnia symptoms were assessed at both time points using the Insomnia Severity Index (ISI). The T2 survey also asked questions regarding COVID-19 testing and symptoms.

RESULTS

The prevalence of insomnia (defined as ISI ≥15) was 15% at T1 and 13% at T2. The incidence rate of insomnia (i.e., new cases from T1 to T2) was 5.6%. Participants with insomnia were not more likely to contract COVID-19 relative to those participants without insomnia. Among those participants in our sample that contracted the virus during the study interval (n = 149), there were no significant group differences in COVID-19 symptom outcomes, with one exception, participants with insomnia were more likely to report a longer symptom duration (insomnia = 24.8 sick days, no insomnia = 16.1 sick days).

CONCLUSIONS

The present study suggests the prevalence of insomnia in the U.S. population remained high during the COVID-19 pandemic. The data also support that insomnia may be related to experiencing more chronic COVID-19 symptoms. These findings have more general implications for the role of sleep and insomnia on immune functioning.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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