Insomnia in the Italian Population During Covid-19 Outbreak: A Snapshot on One Major Risk Factor for Depression and Anxiety

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.

Cerebral glucose hypometabolism and hypoperfusion of cingulate gyrus: an imaging biomarker of autoimmune encephalitis with psychiatric symptoms

BACKGROUND

About 60% of autoimmune encephalitis (AE) patients present psychiatric symptoms, but the underlying mechanism remains unknown. This study examined the role of the cingulate cortex in such patients to identify predictive poor psychiatric factors.

METHODS

In this study, 49 AE patients and 39 healthy controls were enrolled. AE patients were further divided into two groups based on the presence/absence of psychiatric symptoms. The ratio of the standardized uptake value (SUVR) and relative cerebral blood flow (rCBF) in different regions of the cingulate cortex were calculated through positron emission tomography-computed tomography (PET/CT) and arterial spin labeling (ASL) MRI, and the results were compared among the three groups. In addition, we followed-up on the psychiatric outcomes and identified the risk factors for poor psychiatric prognosis, focusing on the cingulate cortex.

RESULTS

More than half of the AE patients (27/49) exhibited psychiatric symptoms. Agitation and thought blocking were typical psychiatric phenotypes, except for anti-glutamic acid decarboxylase 65 (GAD65) encephalitis, which mainly presented with catatonia and a depressed mood. AE patients with psychiatric symptoms experienced reduced metabolism and perfusion of the anterior cingulate cortex (ACC), midcingulate cortex (MCC), and posterior cingulate cortex (PCC). The SUVR of ACC can be used as an independent risk factor of poor psychiatric outcomes, which had an area under the ROC curve (AUC) of 0.865.

CONCLUSION

Impaired cingulate cortex function in AE may be the potential mechanism of psychiatric symptoms. Hypometabolism of ACC is an independent prognostic factor predicting an unfavorable psychiatric prognosis in AE.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Management of long-COVID-19 patients with sleep disorders: practical advice to general practitioners

Given the high prevalence of sleep disorders (e.g. insomnia) among long-COVID-19 patients (LC19Ps), approaches to tackle these disorders should not only depend on sleep specialists, but they should also involve general practitioners (GPs). Indeed, according to the World Health Organization, GPs should be on the front line in the management of LC19Ps. However, in real practice, little data with regard to the management of LC19Ps are available for GPs, which represents an embarrassing situation. Thus, the main aim of this correspondence was to provide GPs with some advice related to the management of sleep disorders in LC19Ps. The pieces advice presented in this correspondence are related to: i) Early and accurate recognition of sleep disorders, ii) General recommendations to manage sleep disorders in LC19Ps (e.g. encouraging vaccination against the virus); and iii) Specific recommendations, such as improving sleep hygiene (patients' behavior and diet), psychological or behavioral therapies (stimulus control therapy, relaxation, sleep restriction), promising tools (heart coherence, neurofeedback), and pharmacological treatment. The authors of this correspondence deeply believe that given the undesirable side effects associated with the use of hypnotics, the pharmacological approach must only be a "last resort". The authors believe that an important percentage of pharmacological prescriptions could be avoided if more focus is put on educating GPs to provide LC19Ps with more tools to deal with sleep disorders. The pieces advice presented in this correspondence are indispensable to resume the normal life of LC19Ps and to promote their mental health recovery.

Emotion regulation difficulties and sleep quality in adolescence during the early stages of the COVID-19 lockdown

INTRODUCTION

Adolescence is a period of vulnerability for emotion regulation and sleep difficulties, risks that might be compounded by intense COVID-19 lockdowns and challenges. The aim of this study was to investigate how sleep quality related to emotion regulation difficulties in adolescents during lockdown in Perú.

METHODS

Participants were 2563 adolescents enrolled in Innova school in Perú (11 - -17 years) in May 2020. Hypotheses were derived from exploring one half of the sample, preregistered at https://osf.io/fuetz/, and then confirmed in the second half of the sample. Participants completed subjective surveys of sleep quality (short PSQI) and the Difficulties in Emotion Regulation Scale Short Form (DERS-SF).

RESULTS

Worse sleep quality was robustly associated with more difficulties in emotion regulation across both samples. The association was found particularly for emotion regulation subscales related to the ability to engage in goal directed behavior in the face of distress, emotional clarity and strategies to deal with feeling distressed. In contrast, there was no robust association between sleep and the ability to regulate impulses in the context of negative emotions, and no association with the ability to accept emotions. Girls and older adolescents robustly endorsed worse sleep quality and more difficulties in emotion regulation.

LIMITATIONS

The cross-sectional nature of this study prevents us from determining the direction of the association. Data were collected using adolescent self-report which, while informative of adolescent perceptions, might diverge from objective measures of sleep or emotion regulation difficulties.

CONCLUSIONS

Our findings with adolescents in Perú contribute to our understanding of the association between sleep and emotion regulation at a broader global scale.

Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: a multi-wave study

The COVID-19 pandemic has created a significant mental health burden on the global population. Studies during the pandemic have shown that risk factors such as intolerance of uncertainty and maladaptive emotion regulation are associated with increased psychopathology. Meanwhile, protective factors such as cognitive control and cognitive flexibility have been shown to protect mental health during the pandemic. However, the potential pathways through which these risk and protective factors function to impact mental health during the pandemic remain unclear. In the present multi-wave study, 304 individuals (18 years or older, 191 Males), residing in the USA during data collection, completed weekly online assessments of validated questionnaires across a period of five weeks (27th March 2020-1st May 2020). Mediation analyses revealed that longitudinal changes in emotion regulation difficulties mediated the effect of increases in intolerance of uncertainty on increases in stress, depression, and anxiety during the COVID-19 pandemic. Further, individual differences in cognitive control and flexibility moderated the relationship between intolerance of uncertainty and emotion regulation difficulties. While intolerance of uncertainty and emotion regulation difficulties emerged as risk factors for mental health, cognitive control and flexibility seems to protect against the negative effects of the pandemic and promote stress resilience. Interventions aimed at enhancing cognitive control and flexibility might promote the protection of mental health in similar global crises in the future.

Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study

BACKGROUND

There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved.

OBJECTIVE

The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease.

METHODS

This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR).

RESULTS

The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29).

CONCLUSION

This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.

Persistent olfactory dysfunction associated with poor sleep quality and anxiety in patients with long COVID

Introduction

Poor sleep quality have been widely reported in patients with long COVID. Determining the characteristics, type, severity, and relationship of long COVID with other neurological symptoms is essential for the prognosis and management of poor sleep quality.

Methods

This cross-sectional study was conducted at a public university in the eastern Amazon region of Brazil between November 2020 and October 2022. The study involved 288 patients with long COVID with self-report neurological symptoms. One hundred thirty-one patients were evaluated by using standardised protocols: Pittsburgh sleep quality index (PSQI), Beck Anxiety Inventory, Chemosensory Clinical Research Center (CCRC), and Montreal Cognitive Assessment (MoCA). This study aimed to describe the sociodemographic and clinical characteristics of patients with long COVID with poor sleep quality and their relationship with other neurological symptoms (anxiety, cognitive impairment, and olfactory disorder).

Results

Patients with poor sleep quality were mainly women (76.3%), 44.04 ± 12.73 years old, with >12 years of education (93.1%), and had monthly incomes of up to US $240.00 (54.2%). Anxiety and olfactory disorder were more common in patients with poor sleep quality.

Discussion

Multivariate analysis shows that the prevalence of poor sleep quality was higher in patients with anxiety, and olfactory disorder is associated with poor sleep quality. In this cohort of patients with long COVID, the prevalence of poor sleep quality was highest in the group tested by PSQI and were associated with other neurological symptoms, such as anxiety and olfactory dysfunction. A previous study indicates a significant association between poor sleep quality and psychological disorders over time. Recent studies involving neuroimaging found functional and structural changes in Long COVID patients with persistent olfactory disfunction. Poor sleep quality are integral part of complex changes related to Long COVID and should be part of patient's clinical management.

Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic

PURPOSE

This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors.

METHODS

We conducted a cross-sectional survey of AYAs aged 18-49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia.

RESULTS

The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11-4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18-3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18-4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08-3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03-3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08-8.29) or unemployed (AOR 3.97, 95% CI 1.46-10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43-13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05-4.70) and being single (AOR 2.52, 95% CI 1.08-5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively.

CONCLUSIONS

The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.

Insomnia is a key risk factor for persistent anxiety and depressive symptoms: A 12-month longitudinal cohort study during the COVID-19 pandemic

BACKGROUND

Insomnia is a risk factor for affective disorders. This study examined whether individuals with insomnia symptoms early in the pandemic, either pre-existing or new-onset, were more vulnerable to anxiety and depressive symptoms over time than those who maintained normal sleep. Additionally, sleep-related factors such as pre-sleep arousal were assessed for their influence on clinically significant anxiety and depression risk.

METHODS

Using a global online survey with 3-, 6-, and 12-month follow-ups between April 2020 and May 2021, data from 2069 participants (M = 46.16 ± 13.42 years; 75.3 % female) with pre-existing, new-onset, or no insomnia symptoms was examined using mixed-effects and logistic regression models.

RESULTS

New-onset and pre-existing insomnia predicted persistent anxiety and depressive symptoms longitudinally (p's < 0.001), over other known risk factors, including age, sex, and previous psychiatric diagnoses. Anxiety and depressive symptoms in both insomnia groups remained above clinically significant thresholds at most time points, whereas normal sleepers remained subclinical. Pre-sleep arousal was found to increase the risk of clinically significant anxiety (OR = 1.05) and depressive symptoms (OR = 1.09) at 12-months. Sleep effort contributed to anxiety (OR = 1.06), whereas dysfunctional sleep-related beliefs and attitudes predicted clinically significant depression (OR = 1.22).

LIMITATIONS

Insomnia group categorization was based on self-report at baseline supported by a validated measure. High participant attrition was observed at 3-months (53 %; n = 971), but retention remained steady till 12-months (63 %, n = 779).

CONCLUSIONS

Insomnia is a modifiable risk factor for persistent anxiety and depressive symptoms that needs to be addressed in mental healthcare. Additionally, pre-sleep arousal may be an important transdiagnostic process linking insomnia with affective disorders.

Public Health Residents' Anonymous Survey in Italy (PHRASI): Study Protocol for a Cross-Sectional Study for a Multidimensional Assessment of Mental Health and Its Determinants

The COVID-19 pandemic has evolved into a severe psychosocial crisis affecting patients, their relatives, friends, and healthcare professionals. In Italy, public health residents (PHRs) remain essential to the national response to the pandemic. To assess their mental sphere, the "Public Mental Health" working group of the medical residents' Assembly of the Italian Society of Hygiene and Preventive Medicine has designed the Public Health Residents' Anonymous Survey in Italy (PHRASI). This is a nation-wide cross-sectional study based on an 88-item self-administered voluntary survey that evaluates how sociodemographic variables are associated with mental issues, including wellness, eating disorders, sleeplessness, alcohol misuse, depression, and anxiety. Data will be gathered by disseminating a Google Forms link across the Assembly network of medical residents. All PHRs enrolled in a four-year program in one of the Italian postgraduate schools of public health will be qualified as participants. PHRASI aims to draw a comprehensive and detailed picture of the mental health state of Italian PHRs. PHRs are a significant group of healthcare professionals that may serve as a future benchmark for developing and enacting regulations intended to support the mental health of healthcare professionals.

Social distancing and trouble sleeping during COVID-19 pandemic among older adults in Europe: Mediating and moderating effects

PURPOSE

We examined the association between social distancing and trouble sleeping during the COVID-19 outbreak in adults 65+, and underlying potential mechanisms.

METHODS

We used data from the extensive Survey of Health, Aging, and Retirement in Europe (SHARE). Logistic regression analysis tested the direct and indirect associations between social distancing and trouble sleeping during the pandemic, the mediation effect of depression, and the moderating-mediation effects of perceived economic status and employment status.

FINDINGS

Social distancing was associated with a higher probability of sleeping problems, partially mediated by depression and moderated by employment status and perceived economic status. Depression had a greater effect on trouble sleeping among those unemployed and those who perceived their economic status as difficult or partially difficult.

CONCLUSION

COVID-19 policy of lockdowns and physical distancing has negative consequences on sleeping and the development of depressive symptoms among older adults.

CLINICAL AND POLICY RELEVANCE

Clinicians should be aware of sleep problems in older adults during the pandemic and after, and try to reduce depressive symptoms. Policymakers should determine future policies and regulations that encourage employment among older adults and improve their economic resilience during pandemics.

Effects of dysfunctional beliefs about sleep on sleep quality and mental health among patients with COVID-19 treated in Fangcang shelter hospitals

Introduction

With the COVID-19 pandemic in China, a large number of mild or ordinary confirmed cases have been sent to Fangcang shelter hospitals for treatment. We aimed to investigate the mental health condition of Fangcang patients 2 years after the pandemic when patients knew more about COVID-19 and the virus was less virulent. We focused on the effect of dysfunctional beliefs and attitudes about sleep on depression, anxiety, and insomnia.

Methods

A total of 1,014 patients from two large Fangcang shelter hospitals in Shanghai between 22 April and 8 May 2022 completed a set of questionnaires comprising: the Dysfunctional Beliefs and Attitudes about Sleep scale, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Insomnia Severity Index scale.

Results

Results show that the positive screening rates for anxiety, depression, and insomnia among tested patients were 55.3, 27.0, and 47.8%, respectively. Patients were more likely to report higher anxiety, depression, and insomnia, and to endorse affective and sleep disorders if they were: female, aged 18-40 years, with undergraduate course or above, white-collar employees, or those who thought the pandemic would have severe economic effects. About 51.4% of the participants had dysfunctional beliefs about sleep to varying degrees. Compared with patients who had accurate beliefs about sleep, the ratios of insomnia, anxiety, and depression were significantly higher among patients with dysfunctional beliefs about sleep.

Discussion

Attention should be paid to the mental health problems of patients in Fangcang shelter hospitals. The results indicate that dysfunctional beliefs about sleep significantly increased anxiety, depression, and insomnia of Fangcang patients.

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.

Sleep and Daily Positive Emotions – Is Heart Rate Variability a Mediator?

Abstract. Sleep quality is considered a basic dimension of emotional health. The psychophysiological mechanisms underlying the associations between sleep quality and positive emotions are still largely unknown, yet autonomic regulation may play a role. This study employed a two-day ecological momentary assessment methodology in a sample of young adults to investigate whether subjective sleep quality reported in the morning was associated with daily positive emotional experience and whether this association was mediated by heart rate variability (HRV), a measure of cardiac vagal tone. Sleep quality was assessed using an electronic sleep diary upon awakening, while resting HRV and positive emotions were inspected at random times throughout the day using photoplethysmography and an electronic diary, respectively. Relevant confounding variables such as smoking, alcohol intake, and physical exercise between each measurement were also assessed. The sample included 121 participants (64.8% females, Mage = 25.97 ± 5.32 years). After controlling for relevant confounders including health behaviors and psychiatric comorbidities, mediation analysis revealed that greater sleep quality positively predicted daily HRV (β = .289, p < .001) which, in turn, had a direct influence on positive emotions (β = .244, p = .006). Also, sleep quality directly predicted positive emotional experience (β = .272, p = .001). Lastly, the model showed an indirect effect between sleep quality and positive emotions via HRV (β = .071, 95% BCI [.011, .146]). Results support the view of HRV as a process variable linking sleep to positive emotions. Experimental data is needed to consolidate the present findings.

Longitudinal associations between stress and sleep disturbances during COVID‐19

The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8-10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (β = 0.203; p < 0.001), even after controlling for baseline sleep disturbances. Results remained significant even after controlling for the effects of covariates including age, sex, depression and anxiety symptoms, and referring to psychological services (β = 0.179; p < 0.05). Findings confirm the high prevalence of stress symptoms during the COVID-19 pandemic and provide first longitudinal evidence for the effects of perceived stress on sleep disturbances during the pandemic.

The prevalence and severity of insomnia symptoms during COVID-19: A global systematic review and individual participant data meta-analysis

INTRODUCTION

There have been no previous meta-analytic studies that have looked at the prevalence of insomnia symptoms in different COVID-19 groups using a single assessment instrument to evaluate insomnia symptoms while maintaining data homogeneity. The current review's associated goal is to undertake an individual participant data (IPD) analysis to further investigate past meta-analyses, a method that has been shown to be more robust than standard meta-analyses.

MEETHODS

Only studies that used the Insomnia Severity Index (ISI) to assess insomnia are used in this analysis. The IPDMA was performed and registered in PROSPERO in compliance with the PRISMA IPD Statement (CRD42021275817). From November 2019 to August 2021, researchers explored seventeen databases and six preprint services for relevant studies.

RESULTS

The pooled estimate of insomnia symptoms (subthreshold and clinically significant) was 52.57%. An estimated 16.66% of the population suffered from clinically significant insomnia, of which 13.75% suffered from moderate insomnia, and 2.50% suffered from severe insomnia. The different populations' grouping had no statistically significant differences in the prevalence of insomnia symptoms. Insomnia symptoms did not appear to be associated with age or sex.

CONCLUSION

Our findings imply that the COVID-19 pandemic is linked to a significant rise in subthreshold insomnia symptoms, but not to moderate or severe insomnia. Educating people from all walks of life about the importance of sleep and the risk of acquiring insomnia symptoms during this or future pandemics should be a top concern.

Mental health prior to and during the COVID-19 pandemic in individuals with bipolar disorder: Insights from prospective longitudinal data

OBJECTIVES

Many studies have examined the impact of COVID-19 on the mental health of the public, but few have focused on individuals with existing severe mental illness with longitudinal data before and during the pandemic.

AIMS

To investigate the impact of the COVID-19 pandemic on the mental health of people with bipolar disorder (BD).

METHODS

In an ongoing study of people with BD who used an online mood monitoring tool, True Colours, 356 participants provided weekly data on their mental health. Symptoms of depression, mania, insomnia, and suicidal thoughts were compared in 2019 and 2020. From May 2020, participants also provided weekly data on the effect of the COVID-19 pandemic on anxiety, coping strategies, access to care, and medications.

RESULTS

On average, symptoms of depression, mania, insomnia, and suicidal thoughts did not significantly differ in 2020 compared to 2019, but there was evidence of heterogeneity. There were high rates of anxiety about the pandemic and its impact on coping strategies, which increased to over 70% of responders in January 2021. A significant proportion of participants reported difficulty accessing routine care (27%) and medications (21%).

CONCLUSIONS

Although mood symptoms did not significantly increase during the pandemic overall, we observed heterogeneity among our BD sample and other impacted areas. Individuals' unique histories and psychosocial circumstances are key and should be explored in future qualitative studies. The significant impacts of the pandemic may take time to manifest, particularly among those who are socioeconomically disadvantaged, highlighting the need for further long-term prospective studies.

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

Introduction

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

Objective

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

Methods

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

Results

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

Conclusion

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

The Relationship between Mental Disorders and the COVID-19 Pandemic—Course, Risk Factors, and Potential Consequences

In this review the authors discuss that COVID-19 has already had a direct impact on the physical health of many people and that it appears to have put at risk the mental health of large populations. In this review, we also discuss the relationship between mental disorders and the SARS-CoV-2 infection. We convey the disorders’ risk factors and the more serious mental disorder consequences of COVID-19. People with mental health disorders could be more susceptible to the emotional responses brought on by the COVID-19 epidemic. The COVID-19 pandemic may adversely influence the mental health of patients with already diagnosed mental disorders. For the aim of dealing better with the psychological problems of people afflicted by the COVID-19 pandemic, new psychological procedures are required.

Post-acute COVID-19 syndrome and its prolonged effects: An updated systematic review

Objective

This systematic review aimed at estimating the prevalence of post-acute COVID-19 symptoms in view of published literature that studied prolonged clinical manifestations after recovery from acute COVID-19 infection.

Methods

Relevant databases were searched for extraction of articles. For data synthesis, based on the distribution of quantitative variables, they were expressed as mean ± standard deviation (SD) or median and interquartile range (IQR). Qualitative variables were presented as frequency (n) and percentages (%).

Results

Twenty-one articles qualified for the final analysis. The most common persistent clinical manifestations were fatigue (54.11%), dyspnea (24.38%), alopecia (23.21%), hyperhidrosis (23.6%), insomnia (25.98%), anxiety (17.29%), and arthralgia (16.35%). In addition to these symptoms, new-onset hypertension, diabetes, neuropsychiatric disorders, and bladder incontinence were also reported.

Conclusion

Clinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection. Multidisciplinary care along with regular follow-up must be provided to such patients.

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Clinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection.

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Prolonged symptoms and signs are being reported in observational studies and case reports every day. Although such symptoms are usually experienced in survivors of critical illness, the post-acute effects of COVID-19 are equally being reported in patients with mild severity of disease who do not require hospitalization.

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Necessary future research includes stratification of these post-acute effects with gender, age, and comorbid conditions in acute, subacute, and chronic phases of the disease.

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

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

Psychological impact of the quarantine during the COVID-19 pandemic on the general European adult population: a systematic review of the evidence

AIMS

Due to the coronavirus disease 2019 (COVID-19) different countries implemented quarantine measures to limit the spread of the virus. Many studies analysed the mental health consequences of restrictive confinement, some of which focused their attention on specific populations. The general public's mental health also requires significant attention, however. This study aimed to evaluate the effects of the COVID-19 quarantine on the general population's mental health in different European countries. Risk and protective factors associated with the psychological symptoms were analysed.

METHODS

A systematic search was conducted on four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 2021, and following eligibility criteria were selected for this review. One thousand three hundred thirty-five (1335) studies were screened, 105 of which were included. Via network analysis, the current study investigated the pathways that underlie possible risk factors for mental health outcomes.

RESULTS

Anxiety, depression, distress and post-traumatic symptoms are frequently experienced during the COVID-19 quarantine and are often associated with changes in sleeping and eating habits. Some socio-demographic and COVID-19-related variables were found to be risk factors for an individual's wellbeing. In particular, being female, young, having a low income, being unemployed and having COVID-19-like symptoms or chronic disorders, were found to be the most common risk factors for mental health symptoms.

CONCLUSIONS

The COVID-19 pandemic represented an unprecedented threat to mental health globally. In order to prevent psychological morbidity and offer support tailored to short-, medium- and long-term negative outcomes, it is essential to identify the direct and indirect psychosocial effects of the lockdown and quarantine measures, especially in certain vulnerable groups. In addition to measures to reduce the curve of viral transmission, policy makers should urgently take into consideration provisions to alleviate hazards to mental health.

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

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

Discrepancy Between Desired Time in Bed and Desired Total Sleep Time, Insomnia, Depression, and Dysfunctional Beliefs About Sleep Among the General Population

OBJECTIVE

The aim of this study was to explore the factors that can influence the severity of insomnia in the general population. We also aimed to examine whether sleep effort mediates the association between dysfunctional beliefs about sleep or the discrepancy between desired time in bed and desired total sleep time (DBST) and insomnia severity in individuals.

METHODS

A total of 387 participants enrolled in this e-survey study. The symptoms were rated using the insomnia severity index (ISI), Patients Health Questionnaire-9 items, Dysfunctional Beliefs about Sleep-2 items, Glasgow Sleep Effort Scale, and Stress and Anxiety to Viral Epidemics-6 items. In addition, we defined a new sleep index named the DBST index. A linear regression analysis was performed to explore the factors predicting ISI scores, and mediation analysis was implemented to explore whether persistent preoccupation with sleep mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity.

RESULTS

A linear regression analysis investigated depression (β=0.17, p<0.001), sleep effort (β=0.50, p<0.001), dysfunctional beliefs about sleep (β=0.13, p=0.001), and DBST (β=0.09, p=0.014) (adjusted R2=0.50, F=65.7, p<0.001). Additionally, we observed that persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and DBST on insomnia severity.

CONCLUSION

Depression, preoccupation with sleep, dysfunctional beliefs about sleep, and DBST influenced the insomnia severity of the general population. We also observed that a persistent preoccupation with sleep partially mediated the influence of dysfunctional beliefs about sleep and the DBST index on insomnia severity.

The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness

BACKGROUND

There is evidence that the COVID-19 pandemic has negatively affected mental health, but most studies have been conducted in the general population.

AIMS

To identify factors associated with mental health during the COVID-19 pandemic in individuals with pre-existing mental illness.

METHOD

Participants (N = 2869, 78% women, ages 18-94 years) from a UK cohort (the National Centre for Mental Health) with a history of mental illness completed a cross-sectional online survey in June to August 2020. Mental health assessments were the GAD-7 (anxiety), PHQ-9 (depression) and WHO-5 (well-being) questionnaires, and a self-report question on whether their mental health had changed during the pandemic. Regressions examined associations between mental health outcomes and hypothesised risk factors. Secondary analyses examined associations between specific mental health diagnoses and mental health.

RESULTS

A total of 60% of participants reported that mental health had worsened during the pandemic. Younger age, difficulty accessing mental health services, low income, income affected by COVID-19, worry about COVID-19, reduced sleep and increased alcohol/drug use were associated with increased depression and anxiety symptoms and reduced well-being. Feeling socially supported by friends/family/services was associated with better mental health and well-being. Participants with a history of anxiety, depression, post-traumatic stress disorder or eating disorder were more likely to report that mental health had worsened during the pandemic than individuals without a history of these diagnoses.

CONCLUSIONS

We identified factors associated with worse mental health during the COVID-19 pandemic in individuals with pre-existing mental illness, in addition to specific groups potentially at elevated risk of poor mental health during the pandemic.

Sleep disorders and COVID-19

This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.

Changes in sleep behavior, sleep problems, and psychological distress/health-related quality of life of young Japanese individuals before and during the COVID-19 pandemic

Social restrictions during the coronavirus disease (COVID-19) pandemic have impacted sleep behavior and sleep problems, and their related daytime functioning in young adults. However, no studies have examined such changes in young individuals from countries with mild infection intensity and social restrictions. Therefore, we focused on sleep behaviors and sleep issues in young people in Japan. This study was conducted before and after the pandemic (October 2019 and May 2020, respectively). In total, 2,222 (1,371 students and 851 workers) individuals participated and completed anonymous Web-based questionnaires concerning demographic characteristics, sleep behaviors, sleep problems using the Japanese version of the Epworth Sleepiness Scale (JESS) and the Athens Insomnia Scale (AIS-J), psychological distress using the Japanese version of the Kessler Psychological Distress Scale, and health-related quality of life (HRQoL) evaluated with the Short Form-8 (SF-8). A significantly delayed sleep phase was observed in the second survey compared to the first (p < .001) and was more pronounced in students than in workers (p < .001). The total sleep time, social jetlag degree, and JESS, AIS-J, and SF-8 scores were significantly improved after the pandemic (p < .001, p < .001, p < .001, p < .001, p < .05, and p < .001, respectively). Careful monitoring of whether these modest changes can lead to adjustment concerns is needed.

Wellbeing in Workers during COVID-19 Pandemic: The Mediating Role of Self-Compassion in the Relationship between Personal Resources and Exhaustion

Italy was the second country to be affected by COVID-19 in early 2020, after China. The confrontation with the pandemic led to great changes in the world of work and, consequently, to the personal world of workers. In such a challenging situation, it is essential to be able to rely on resources that facilitate individual coping. The aim of this study was to understand the association between personal resources (optimism and humor) and exhaustion, and the role of self-compassion in this relationship. A structural equation model (SEM) was used to test the hypotheses on a heterogeneous sample of 422 Italian workers during the first lockdown in April–May 2020. The results revealed that optimism and humor were positively associated with self-compassion; optimism and humor also had a negative association with exhaustion; and self-compassion had a mediating role between the two personal resources and exhaustion. These results confirmed the importance of personal resources in maintaining workers’ wellbeing during a challenging period such as the pandemic. The present study also contributes to the body of knowledge on self-compassion, a relatively new construct that has been little studied in the organizational field.

Does cognitive flexibility change the nature of the relationship between intolerance of uncertainty and psychological symptoms during the COVID-19 outbreak in Turkey?

The COVID-19 pandemic has significantly affected the mental health of the general population worldwide. The study aimed to determine the associations of the intolerance of uncertainty (IU) and cognitive flexibility (CF) with a variety of psychological symptoms and to examine the impact of IU on psychological symptoms through the moderating role of CF. The Brief Symptom Inventory, Intolerance of Uncertainty Scale-12, and Cognitive Control and Flexibility Questionnaire were applied to a sample of 3004 adults living in Turkey. The results of the analysis indicated that CF moderated the effect of IU on psychology symptoms. The slope analysis revealed a weakening association between IU and psychological symptoms with the introduction of a high CF level introduced to the model. The findings highlighted the importance of IU as a potential risk factor for developing psychological symptoms while CF appears as a potential protective factor during the COVID-19 pandemic.

Insomnia and Related Factors During the Delta Wave of the COVID-19 Pandemic in the Kingdom of Bahrain: A Cross-Sectional Study

PURPOSE

This study aims to estimate the prevalence of insomnia and related risk factors during the Delta wave of the COVID-19 pandemic in the Kingdom of Bahrain.

METHODS

An analytical cross-sectional study included 646 individuals from the general population aged 18 years and over, living in the Kingdom of Bahrain during the Delta wave of the pandemic. Data were collected by an anonymous online questionnaire using the snowball-sampling technique between June and August 2021. We used the Insomnia Severity Index (ISI) and the generalized anxiety disorder scale (GAD-7) to measure the level of insomnia and anxiety, respectively.

RESULTS

A total of 646 individuals participated in the study. Most of the participants were females (86%). The mean age was 38.7 ± 12.7 years (age range 18-89) and around half of the participants were 35 years or older. Clinical insomnia was reported by 20% [95% CI, 16.9-20.0] of the participants, and 50.1% [95% CI, 46.2-50.1] had subclinical insomnia according to ISI. The proportion of insomnia was significantly higher among females, healthcare workers, participants with lower educational levels, a lower or decreased monthly income during the pandemic, or participants who reported anxiety symptoms (all P < 0.01). Scales of anxiety and insomnia revealed a high correlation (r² = 0.347, P< 0.01). The logistic regression model confirmed that factors independently associated with insomnia are female gender (OR=1.94, 95% CI, 1.00-3.76, P < 0.050) as well as presence of anxiety (GAD-7 score ≥ 5) [OR=12.98, 95% CI, 5.61-30.00, P < 0.001].

CONCLUSION

The burden of insomnia was significant among the general population in the Kingdom of Bahrain during the Delta wave of the COVID-19 pandemic despite the low severity of this variant. Mental health programs are a high priority during the pandemic and afterward. Detection of insomnia could be used to treat some mental health problems at an early stage.

Persistence of the Effects of the COVID-19 Lockdown on Sleep: A Longitudinal Study

The effects of the COVID-19 pandemic on sleep have been widely documented, but longitudinal evaluations during different phases of the “COVID-19 era” are needed to disentangle the specific consequences of the r145estrictive measures on sleep variables. The aim of this study was to assess the immediate effect of the lockdown’s end on sleep and sleep-related dimensions in an Italian sample, also considering the stress and depressive symptoms. We used an online survey to longitudinally collect data on sociodemographic, environmental, clinical, sleep, and sleep-related variables in two time points: during and immediately after the lockdown. The final sample included 102 participants. The large prevalence of poor sleep quality, clinically relevant pre-sleep arousal, and depressive symptoms, as well as poor sleep quality and pre-sleep arousal score observed during the lockdown, remained stable after its end. On the other hand, the prevalence of moderate-to-severe event-related stress and intrusive symptom scores exhibited a drastic reduction after the end of home confinement. Both bedtime and rise time were anticipated after the lockdown, while sleep quality exhibited only a trend of post-lockdown sleep disturbance reduction. Our findings point to a reduced stress level (specific for the intrusive symptomatology) after the end of the lockdown and persistence of sleep problems, suggesting two non-mutually exclusive hypotheses: (a) the strict restrictive measures are not the main cause of sleep problems during the pandemic and (b) home confinement induces long-lasting effects on sleep observable after its end, and a longer period of time might be needed to observe an improvement.

Neuropsychiatrische Post-COVID-Symptome

Die durch das Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) hervorgerufene Coronavirus Disease 2019 (COVID-19) kann zum Teil anhaltende schwerwiegende Folgen haben.Die COVID-19-Pandemie stellt für die Gesellschaft und das Gesundheitssystem eine in der jüngeren Vergangenheit einzigartige Belastung dar. Es ist davon auszugehen, dass auch nach dem Abklingen der Pandemie die COVID-19-Erkrankung in der ärztlichen Tätigkeit präsent bleiben wird. Dieser Artikel soll einen Überblick über neuropsychiatrische post-akute COVID-19-Symptome geben.

Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability

Background

The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales.

Results

Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings — the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status.

Discussion

Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05719-9.

Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy

Objective

The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, and many studies point to large modifications in several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during the pandemic has been substantially overlooked. Since hyperarousal represents one of the main factors for the development and the perpetuation of chronic insomnia disorder, the assessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinically relevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and pre-sleep arousal in an Italian sample during the COVID-19 lockdown.

Methods

We used an online survey to collect self-reported sociodemographic, environmental, clinical, sleep, and sleep-related data. Our final sample included 761 participants.

Results

Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results show that almost half of the sample suffered from clinically relevant levels of at least one component (ie, cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleep quality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related measures, depressive and event-related stress symptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components. Moreover, specific sociodemographic and environmental variables were uniquely related to sleep quality, cognitive or somatic pre-sleep arousal.

Conclusions

These findings suggest that the assessment of specific sleep-related factors (ie, pre-sleep arousal), together with more global measures of sleep quality, may be crucial to depict the complex impact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.

[Long COVID: long-term symptoms and morphological/radiological correlates]

Hintergrund

Neurologische, pulmonale, kardiale und gastrointestinale Funktionsstörungen können in der postakuten Phase fortbestehen und ein Long-COVID-Syndrom bilden, das auch als postakute Folgeerscheinungen der SARS-CoV-2-Infektion (PASC) bezeichnet wird. Einige Patienten entwickeln trotz einer zu Beginn relativ milden Erkrankung anhaltende und schwächende Symptome und werden als „COVID-19 long haulers“ bezeichnet.

Fragestellung

Vorstellung von Symptomen, Anzeichen und Biomarkern bei Patienten, die zuvor an COVID-19 erkrankt waren und Erörterung der möglichen zugrunde liegenden Mechanismen und Folgen.

Methoden

Bestehende Literatur und berichtete Fälle sowie Expertenmeinungen werden analysiert und diskutiert.

Ergebnisse

Das Long-COVID-Syndrom betrifft Überlebende von COVID-19 in allen Schweregraden der Erkrankung, selbst in leichten bis mittelschweren Fällen und bei jüngeren Erwachsenen, die keine Beatmungsunterstützung oder Krankenhaus- bzw. Intensivpflege benötigten. Problematisch ist, dass bei vielen Langzeitüberlebenden nie ein Labornachweis für COVID-19 erbracht wurde, was die Skepsis weckt, dass ihre anhaltenden Symptome eine physiologische Grundlage haben. Andererseits können einige Symptome, die bei einer postakuten COVID-19-Erkrankung auftreten, Folge einer kritischen Erkrankung oder eine Nebenwirkung von Behandlungen sein.

Schlussfolgerung

Da es sich bei COVID-19 um eine neue Krankheit handelt, lässt sich nicht feststellen, wie lange diese Auswirkungen anhalten werden. Eine langfristige Überwachung der postakuten COVID-19-Symptome und ein Screening auf häufige Komorbiditäten sind unerlässlich.

More than 50 long-term effects of COVID-19: a systematic review and meta-analysis

COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

Validation study of the Italian version of the Sleep Hygiene Index

Sleep hygiene rules are a set of behavioural and environmental recommendations that promote healthy and good quality sleep, playing a role in insomnia disorder. The Sleep Hygiene Index (SHI) is a self-report questionnaire developed to evaluate the practice of sleep hygiene behaviours with adequate psychometric properties in different samples. The present study aimed to translate the original version of the SHI into the Italian language and evaluate the psychometric properties of this instrument in the Italian adult population. After the translation of the SHI from the original English version into the Italian version, factorial structure, internal consistency, as well as convergent and discriminant validity were estimated. The principal component analysis showed a four-factor solution for the SHI, accounting for 52.03% of the total sample variance (F1 = 25.65%, F2 = 10.00%, F3 = 8.48% and F4 = 7.90%). Factor 1 comprised items regarding arousal; Factor 2 comprised items regarding regular sleep habits; Factor 3 comprised items about sleep environment; and Factor 4 comprised items on sleep-disrupted behaviours. The Italian version of the SHI can be regarded as a reliable tool with adequate concurrent and predictive validity for assessing sleep hygiene in Italian adults with or without insomnia symptoms.

Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis

The outbreak of the novel coronavirus disease 2019 (COVID‐19) changed lifestyles worldwide and subsequently induced individuals’ sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID‐19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta‐analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID‐19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline and Newcastle–Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta‐analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%–29%) for female participants and 27% (95% CI 24%–30%) for male participants. Although in both gender subgroups, patients with COVID‐19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta‐regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.

Diurnal preference and depressive symptomatology: a meta-analysis

Eveningness, a preference for later sleep and rise times, has been associated with a number of negative outcomes in terms of both physical and mental health. A large body of evidence links eveningness to Major Depressive Disorder (MDD). However, to date, evidence quantifying this association is limited. The current meta-analysis included 43 effect sizes from a total 27,996 participants. Using a random-effects model it was demonstrated that eveningness is associated with a small effect size (Fisher's Z = - 2.4, 95% CI [- 0.27. - 0.21], p < 0.001). Substantial heterogeneity between studies was observed, with meta-regression analyses demonstrating a significant effect of mean age on the association between diurnal preference and depression. There was also evidence of potential publication bias as assessed by visual inspection of funnel plots and Egger's test. The association between diurnal preference and depression is small in magnitude and heterogenous. A better understanding of the mechanistic underpinnings linking diurnal preference to depression and suitably powered prospective studies that allow causal inference are required.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

BACKGROUND

The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

METHODS

Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

FINDINGS

168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

INTERPRETATION

Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

FUNDING

The present study received no funding.

More Than 50 Long-Term Effects of COVID-19: A Systematic Review and Meta-Analysis

Background. COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. Methods . LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1 st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I 2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. Results. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). Conclusions . In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, the severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis

COVID-19, caused by SARS-CoV-2, can involve sequelae and other medical complications that last weeks to months after initial recovery, which has come to be called Long-COVID or COVID long-haulers. This systematic review and meta-analysis aims to identify studies assessing long-term effects of COVID-19 and estimates the prevalence of each symptom, sign, or laboratory parameter of patients at a post-COVID-19 stage. LitCOVID (PubMed and Medline) and Embase were searched by two independent researchers. All articles with original data for detecting long-term COVID-19 published before 1st of January 2021 and with a minimum of 100 patients were included. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. Heterogeneity was assessed using I2 statistics. This systematic review followed Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines, although the study protocol was not registered. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included. The follow-up time ranged from 14 to 110 days post-viral infection. The age of the study participants ranged between 17 and 87 years. It was estimated that 80% (95% CI 65-92) of the patients that were infected with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). All meta-analyses showed medium (n=2) to high heterogeneity (n=13). In order to have a better understanding, future studies need to stratify by sex, age, previous comorbidities, severity of COVID-19 (ranging from asymptomatic to severe), and duration of each symptom. From the clinical perspective, multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.