Association of poor sleep with stress, anxiety, emotional support, social isolation, and depression during the COVID-19 pandemic

Introduction The COVID-19 pandemic has impacted multiple facets of daily living: personal finances, physical activity, and mental and physical health. These changes can result in additional stress and negatively affect sleep. It is important for sleep medicine providers to understand how their patients are impacted by these changes to optimize their care. In this study, we evaluated the association of poor sleep with stress, anxiety, emotional support, social isolation, and depression among sleep medicine clinic patients during the COVID-19 pandemic. Methods Sleep medicine clinic patients were distributed an online survey at baseline followed by a 6-month follow-up survey (December 2020 - May 2021). Participants answered questions regarding Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (sleep disturbance and sleep-related impairments), and COVID-19 testing. Stepwise linear regression was performed using SAS to determine if self-reported poor sleep predicted stress, anxiety, emotional support, social isolation, and depression. This study was approved by Baylor College of Medicine IRB. Informed consent was obtained from all subjects involved in the study. Results Eighty-one adults completed baseline survey, and 54 adults (mean age 55.2±18.4 years, 61% female, 70% Caucasian) completed 6-month follow-up survey. At baseline, anxiety had a significant effect on sleep disturbance (0.43±0.11, p=0.0001), sleep-related impairments (0.53±0.12, p=0.0001) and ISI (0.28±0.08, p=0.0004). Upon follow-up, an increase in ISI predicted higher perceived stress (0.18±0.07, p=0.013) and worse anxiety (0.61±0.16, p=0.0003). An increase in sleep disturbance predicted a decrease in emotional support (0.25±0.12, p=0.038). Additionally, an increase in sleep-related impairments predicted an increase in social isolation (0.39±0.11, p=0.0002) and depression (0.57±0.07, p<0.0001). Interestingly, only 3 participants tested positive for COVID-19. Conclusion In this study of sleep medicine clinic patients during the COVID-19 pandemic, we observed that poor sleep predicted greater stress, anxiety, social isolation, and depression along with less emotional support. This study illustrates the importance of addressing stress management, mental health (anxiety, depression), and emotional support when treating sleep medicine clinic patients during the COVID-19 pandemic. Support (If Any) National Institutes of Health (NIH) Grant #R01NR018342 (PI: Nowakowski);Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development;Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413)

Longitudinal Analysis Evaluating Self-Reported CPAP Use for OSA during the COVID-19 Pandemic.

Continuous positive airway pressure therapy (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA), but CPAP adherence remains suboptimal. The COVID-19 pandemic significantly altered sleep medicine services and aspects of daily living for sleep medicine patients, which may further compromise CPAP adherence. Sleep medicine patients were distributed an online survey at baseline and six months later (January-May 2021). Participants answered questions regarding CPAP use (any changes in CPAP use, sleep quality with CPAP use, CPAP use as advised, and changes in daily habits). Eighty-one adults completed the baseline survey, and 54 adults completed the follow-up survey. Twenty-seven participants reported a diagnosis of OSA and were prescribed CPAP (mean age 58 ± 18.2 years, 48% female, 67% Caucasian). Longitudinal analysis with chi-square association testing showed significant changes in CPAP use as advised and significant improvements in sleep quality with CPAP use when comparing the baseline to six-month follow-up survey. Additionally, logistic regression was performed to determine if pre-pandemic sleep study results (apnea-hypopnea index and respiratory disturbance index) predicted self-reported CPAP use during the pandemic, though no association was found. Throughout the pandemic, sleep medicine patients improved their CPAP use as advised and reported significant improvements in sleep quality with CPAP use.