Association between hypersomnolence and the COVID-19 pandemic: The International COVID-19 Sleep Study (ICOSS).

BACKGROUND: The COVID-19 pandemic and related restriction measures have affected our daily life, sleep, and circadian rhythms worldwide. Their effects on hypersomnolence and fatigue remain unclear. METHODS: The International COVID-19 Sleep Study questionnaire which included items on hypersomnolence such as excessive daytime sleepiness (EDS), and excessive quantity of sleep (EQS), as well as sociodemographic factors, sleep patterns, psychological symptoms, and quality of life was distributed in 15 countries across the world from May to September in 2020. RESULTS: Altogether responses from 18,785 survey participants (65% women, median age 39 years) were available for analysis. Only 2.8% reported having had COVID-19. Compared to before the pandemic, the prevalence of EDS, EQS, and fatigue increased from 17.9% to 25.5%, 1.6%-4.9%, and 19.4%-28.3% amid the pandemic, respectively. In univariate logistic regression models, reports of having a COVID-19 were associated with EQS (OR 5.3; 95%-CI 3.6-8.0), EDS (2.6; 2.0-3.4), and fatigue (2.8; 2.1-3.6). In adjusted multivariate logistic regression, sleep duration shorter than desired (3.9; 3.2-4.7), depressive symptoms (3.1; 2.7-3.5), use of hypnotics (2.3; 1.9-2.8), and having reported COVID-19 (1.9; 1.3-2.6) remained strong predictors of EDS. Similar associations emerged for fatigue. In the multivariate model, depressive symptoms (4.1; 3.6-4.6) and reports of having COVID-19 (2.0; 1.4-2.8) remained associated with EQS. CONCLUSIONS: A large increase in EDS, EQS, and fatigue occurred due to the COVID-19 pandemic, and especially in self-reported cases of COVID-19. These findings warrant a thorough understanding of their pathophysiology to target prevention and treatment strategies for long COVID condition.

La crise sanitaire du Covid-19 et le confinement sont associés à un taux élevé de troubles du sommeil et de prise d'hypnotiques en France

Objectif La crise de la COVID-19 a perturbé les habitudes de milliards de personnes dans le monde. Pour de nombreux pays, le confinement à la maison est obligatoire et les familles sont forcées de vivre ensemble en permanence, dans des environnements souvent petits, avec leurs propres habitudes de sommeil et de veille. Le sommeil est essentiel pour nos vies et crucial pour équilibrer leur système immunitaire, la santé physique et psychologique. Méthodes Pour évaluer les problèmes de sommeil et l'utilisation des somnifères, nous avons réalisé une étude transversale d'un échantillon représentatif de la population générale en France (1005 sujets). Nous avons utilisé les mêmes éléments autodéclarés de plaintes de sommeil au cours des 8 derniers jours, tirés de l'échelle du Duke Health Profile, que ceux utilisés depuis 1995 dans les Baromètres de la santé français, une série d'enquêtes transversales sur diverses questions de santé publique. Résultats Après deux semaines de confinement, 74 % des participants ont signalé des plaintes de sommeil, comparativement à des taux de prévalence de 44 % à 49 % au cours des 25 dernières années. Les femmes ont déclaré plus de problèmes de sommeil que les hommes : 31 % contre 16 %. Les jeunes (18-35 ans) plus fréquemment que leurs aînés (79 % contre 72 % des 35 ans et plus) : 60 % ont déclaré que ces problèmes augmentaient avec le confinement, contre 51 % de leurs aînés. Enfin, 16 % des participants ont déclaré avoir pris des somnifères au cours des 12 derniers mois et 41 % d'entre eux ont déclaré avoir consommé ces médicaments depuis le début du confinement. Conclusion Ces résultats suggèrent que la crise de la COVID-19 est associée à de graves troubles du sommeil au sein de la population française, en particulier chez les jeunes.

Sleep symptoms are essential features of long-COVID - Comparing healthy controls with COVID-19 cases of different severity in the international COVID sleep study (ICOSS-II).

Many people report suffering from post-acute sequelae of COVID-19 or "long-COVID", but there are still open questions on what actually constitutes long-COVID and how prevalent it is. The current definition of post-acute sequelae of COVID-19 is based on voting using the Delphi-method by the WHO post-COVID-19 working group. It emphasizes long-lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post-acute sequelae of COVID-19. In this international survey study consisting of 13,628 subjects aged 18-99 years from 16 countries of Asia, Europe, North America and South America (May-Dec 2021), we show that post-acute sequelae of COVID-19 symptoms were more prevalent amongst the more severe COVID-19 cases, i.e. those requiring hospitalisation for COVID-19. We also found that long-lasting sleep symptoms are at the core of post-acute sequelae of COVID-19 and associate with the COVID-19 severity when COVID-19 cases are compared with COVID-negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long-lasting symptoms after hospitalisation for COVID-19. Understanding the importance of sleep-related symptoms in post-acute sequelae of COVID-19 has a clinical relevance when diagnosing and treating long-COVID.

Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study.

There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.

Persistent short nighttime sleep duration is associated with a greater post-COVID risk in fully mRNA-vaccinated individuals.

Short nighttime sleep duration impairs the immune response to virus vaccination, and long nighttime sleep duration is associated with poor health status. Thus, we hypothesized that short (<6 h) and long (>9 h) nighttime sleepers have a higher post-COVID risk than normal nighttime sleepers, despite two doses of mRNA vaccine (which has previously been linked to lower odds of long-lasting COVID-19 symptoms). Post-COVID was defined as experiencing at least one core COVID-19 symptom for at least three months (e.g., shortness of breath). Multivariate logistic regression adjusting for age, sex, BMI, and other factors showed in 9717 respondents (age span 18-99) that two mRNA vaccinations lowered the risk of suffering from post-COVID by about 21% (p < 0.001). When restricting the analysis to double-vaccinated respondents (n = 5918), short and long sleepers exhibited a greater post-COVID risk than normal sleepers (adjusted OR [95%-CI], 1.56 [1.29, 1.88] and 1.87 [1.32, 2.66], respectively). Among respondents with persistent sleep duration patterns during the pandemic compared to before the pandemic, short but not long sleep duration was significantly associated with the post-COVID risk (adjusted OR [95%-CI], 1.59 [1.24, 2.03] and 1.18 [0.70, 1.97], respectively). No significant association between sleep duration and post-COVID symptoms was observed in those reporting positive SARS-CoV-2 test results (n = 538). Our findings suggest that two mRNA vaccinations against SARS-CoV-2 are associated with a lower post-COVID risk. However, this protection may be less pronounced among those sleeping less than 6 h per night. Our findings warrant replication in cohorts with individuals with confirmed SARS-CoV-2 infection.

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey.

Purpose: The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored. Patients and Methods: For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS). Results: The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS. Conclusion: Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.

Incidence of PTSD in the French population a month after the COVID-19 pandemic-related lockdown: evidence from a national longitudinal survey.

BACKGROUND: In view of experts' warnings about the potential negative mental health consequences of the sudden nationwide lockdowns implemented in many countries to limit the spread of the COVID-19 pandemic, we sought to study the incidence of posttraumatic stress disorder (PTSD) after traumatic events related to this unprecedented lockdown in the French general population. METHODS: This longitudinal study among adults (aged =18) consisted of two surveys: the first during the last days of the lockdown and the second a month later. We estimated PTSD incidence with the PCL-5 and ran multiple Poisson regression models to identify factors associated with PTSD. RESULTS: Among the 1736 participants, 30.1% reported at least one traumatic event. PTSD incidence was 17.5% (95% confidence interval CI = 15.7-19.3). It was higher in participants who reported multiple traumatic events, who had high COVID-19-related media use, who had general anxiety disorder (GAD-7) during the lockdown, and who had GAD, depression (PHQ-9), or sleep problems 1 month later. In addition, 43.1% of people with PTSD reported suicidal thoughts. CONCLUSIONS: These results should help clinicians to target people who are at high risk of developing PTSD after a pandemic-related lockdown and could benefit from preventive measures. Collaboration between the media and mental health professionals could be envisioned to inform the population about care resources. Follow-up recommendations should also be disseminated to general practitioners to facilitate PTSD screening and ensure that they are aware of the appropriate management.

Efficacité de la TCC de l’insomnie de groupe pratiquée en présentiel ou en distanciel avant, pendant et après le confinement COVID-19

Objectif Comparer l’efficacité de la TCCi de groupe pratiquée en distanciel ou en présentiel, et sur 2 ans autour du pic de la pandémie COVID-19. Méthodes Il s’agit d’une étude clinique rétrospective chez des patients atteints d’insomnie chronique et pris en charge au centre du sommeil et de la vigilance de l’Hôtel-Dieu. Les analyses portent sur trois groupes de patients traités respectivement : en présentiel avant (« pré-COVID ») et après (« post-COVID ») le confinement, et en distanciel pendant ce dernier (« COVID »). La TCCi, pratiquée par deux thérapeutes, comportait 6 séances hebdomadaires de 2h chacune, et une séance de suivi 2 mois plus tard. Les évaluations étaient recueillies à partir de questionnaires renseignés par les patients : au moment du diagnostic, juste avant la première séance de TCC, après la 6e séance et deux mois plus tard. La comparaison inter-groupes porte sur les scores de l’ISI, de la BDI(II) et de la BAI, ainsi que ceux de la qualité de vie (SF-12) et les données des agendas du sommeil (temps total de sommeil, latence d’endormissement, temps d’éveil intra-sommeil). Résultats Les résultats indiquent que les scores d’ISI, BDI(II) et BAI à l’inclusion sont identiques dans les 3 groupes. De plus, on observe la même diminution de ces scores à 6 semaines (notamment une baisse de 7 points de l’ISI), qui se maintient à deux mois. Conclusion La pandémie n’a pas modifié le profil des patients pris en charge par TTC à l’Hôtel-Dieu. De plus, la TCCi est aussi efficace en distanciel qu’en présentiel, ce qui permet d’envisager des perspectives futures d’élargissement de sa pratique.

Nightmares in People with COVID-19: Did Coronavirus Infect Our Dreams?

INTRODUCTION: A growing number of studies have demonstrated that the coronavirus disease-19 (COVID-19) pandemic has severely affected sleep and dream activity in healthy people. To date, no investigation has examined dream activity specifically in COVID-19 patients. METHODS: As part of the International COVID-19 Sleep Study (ICOSS), we compared 544 COVID-19 participants with 544 matched-controls. A within-subjects comparison between pre-pandemic and pandemic periods computed separately for controls and COVID-19 participants were performed on dream recall and nightmare frequency (DRF; NF). Also, non-parametric comparisons between controls and COVID-19 participants were carried out. Further, we compared psychological measures between the groups collected during pandemic. Ordinal logistic regression to detect the best predictors of NF was performed. RESULTS: We found that people reported greater dream activity during the pandemic. Comparisons between controls and COVID-19 participants revealed a) no difference between groups concerning DRF in the pre-pandemic period and during the pandemic; b) no difference between groups concerning nightmare frequency in the pre-pandemic period; and c) COVID-19 participants reported significantly higher NF than controls during pandemic (p = 0.003). Additionally, we showed that a) anxiety, depression, post-traumatic stress-disorder (PTSD) symptom scores were higher in COVID-19 participants than controls; and b) quality of life and health as well as wellbeing (WHO-5) scores were significantly higher in controls than COVID-19 participants. Finally, ordinal logistic regression indicates that DRF (p < 0.001), PTSD (p < 0.001), anxiety (p = 0.018), insomnia (p = 0.039), COVID-19 severity (p = 0.014), sleep duration (p = 0.003) and age (p = 0.001) predicted NF. DISCUSSION: Our work shows strong associations between increased nightmares in those reporting having had COVID-19. This suggests that the more that people were affected by COVID-19, the greater the impact upon dream activity and quality of life.

Évaluation polysomnographique des troubles du sommeil chez des patients COVID-long

Objectif Le COVID-19 est une maladie polymorphe en termes de présentation clinique, de sévérité et de durée. La HAS a établi trois critères diagnostiques de « COVID-long » : une forme symptomatique de la maladie, un ou plusieurs symptômes initiaux 4 semaines après le début de la maladie, non expliquée par un autre diagnostic. De nombreux patients COVID-long décrivent des troubles du sommeil, sur la base d’études cliniques sans polysomnographie (PSG). Notre objectif a été d’évaluer ces troubles du sommeil par un enregistrement PSG. Méthodes Vingt-deux patients COVID-long ont été adressés pour réalisation d’une PSG au centre du sommeil et de la vigilance de l’Hôtel-Dieu. Critères inclusion : critères HAS du COVID-long et critères ICSD3 de l’insomnie chronique. Critères d’exclusion : trouble du sommeil antérieur au COVID. Résultats Vingt-deux patients (13 femmes, 9 hommes), âgés de 45,9±12,8 ;IMC, 24,26±4,61. Vingt et un patients/22 présentent les critères PSG d’insomnie. Un seul patient présente un SAS avec un IAH>15. Cinquante pour cent ont un TST<6 heures temps de sommeil total (TST) 352,8±78,2min ;latence d’endormissement 28,5±23,7 minutes (norme :<30min) ;temps d’éveil intra-sommeil 77,7min 45,3±45,3 (norme :<30min). Conclusion À notre connaissance il s’agit de la première étude polysomnographique de patients COVID-long souffrant de troubles du sommeil. Nos résultats confirment la haute prévalence de troubles objectifs PSG chez ces patients.

Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire.

OBJECTIVES: Sleep is important for human health and well-being. No previous study has assessed whether the COVID-19 pandemic impacts sleep and daytime function across the globe. METHODS: This large-scale international survey used a harmonised questionnaire. Fourteen countries participated during the period of May-August 2020. Sleep and daytime problems (poor sleep quality, sleep onset and maintenance problems, nightmares, hypnotic use, fatigue and excessive sleepiness) occurring 'before' and 'during' the pandemic were investigated. In total, 25 484 people participated and 22 151 (86.9%) responded to the key parameters and were included. Effects of COVID-19, confinement and financial suffering were considered. In the fully adjusted logistic regression models, results (weighted and stratified by country) were adjusted for gender, age, marital status, educational level, ethnicity, presence of sleep problems before COVID-19 and severity of the COVID-19 pandemic in each country at the time of the survey. RESULTS: The responders were mostly women (64%) with a mean age 41.8 (SD 15.9) years (median 39, range 18-95). Altogether, 3.0% reported having had COVID-19; 42.2% reported having been in confinement; and 55.9% had suffered financially. All sleep and daytime problems worsened during the pandemic by about 10% or more. Also, some participants reported improvements in sleep and daytime function. For example, sleep quality worsened in about 20% of subjects and improved in about 5%. COVID-19 was particularly associated with poor sleep quality, early morning awakening and daytime sleepiness. Confinement was associated with poor sleep quality, problems falling asleep and decreased use of hypnotics. Financial suffering was associated with all sleep and daytime problems, including nightmares and fatigue, even in the fully adjusted logistic regression models. CONCLUSIONS: Sleep problems, fatigue and excessive sleepiness increased significantly worldwide during the first phase of the COVID-19 pandemic. Problems were associated with confinement and especially with financial suffering.

Sleep and COVID-19. A Case Report of a Mild COVID-19 Patient Monitored by Consumer-Targeted Sleep Wearables.

Since its first description in Wuhan, China, the novel Coronavirus (SARS-CoV-2) has spread rapidly around the world. The management of this major pandemic requires a close coordination between clinicians, scientists, and public health services in order to detect and promptly treat patients needing intensive care. The development of consumer wearable monitoring devices offers physicians new opportunities for the continuous monitoring of patients at home. This clinical case presents an original description of 55 days of SARS-CoV-2-induced physiological changes in a patient who routinely uses sleep-monitoring devices. We observed that sleep was specifically affected during COVID-19 (Total Sleep time, TST, and Wake after sleep onset, WASO), within a seemingly bidirectional manner. Sleep status prior to infection (e.g., chronic sleep deprivation or sleep disorders) may affect disease progression, and sleep could be considered as a biomarker of interest for monitoring COVID-19 progression. The use of habitual data represents an opportunity to evaluate pathologic states and improve clinical care.

Social Jetlag Changes During the COVID-19 Pandemic as a Predictor of Insomnia - A Multi-National Survey Study.

PURPOSE: Lifestyle and work habits have been drastically altered by restrictions due to the COVID-19 pandemic. Whether the associated changes in sleep timing modulate the risk of suffering from symptoms of insomnia, the most prevalent sleep disorder, is however incompletely understood. Here, we evaluate the association between the early pandemic-associated change in 1) the magnitude of social jetlag (SJL) - ie, the difference between sleep timing on working vs free days - and 2) symptoms of insomnia. PATIENTS AND METHODS: A total of 14,968 anonymous participants (mean age: 40 years; 64% females) responded to a standardized internet-based survey distributed across 14 countries. Using logistic multivariate regression, we examined the association between the degree of social jetlag and symptoms of insomnia, controlling for important confounders like social restriction extension, country specific COVID-19 severity and psychological distress, for example. RESULTS: In response to the pandemic, participants reported later sleep timing, especially during workdays. Most participants (46%) exhibited a reduction in their SJL, whereas 20% increased it; and 34% reported no change in SJL. Notably, we found that both increased and decreased SJL, as a result of the COVID-19 pandemic, were associated with later sleep midpoint (indicating a later chronotype) as well as more recurrent and moderate-to-severe symptoms of insomnia (about 23-54% higher odds ratio than subjects with unchanged SJL). Primarily those with reduced SJL shifted their bedtimes to a later timepoint, compared with those without changes in SJL. CONCLUSION: Our findings offer important insights into how self-reported changes to the stability of sleep/wake timing, as reflected by changes in SJL, can be a critical marker of the risk of experiencing insomnia-related symptoms - even when individuals manage to reduce their social jetlag. These findings emphasize the clinical importance of analyzing sleep-wake regularity.

How our Dreams Changed During the COVID-19 Pandemic: Effects and Correlates of Dream Recall Frequency - a Multinational Study on 19,355 Adults.

OBJECTIVE: Many have reported odd dreams during the pandemic. Given that dreams are associated with mental health, understanding these changes could provide crucial information about wellbeing during the pandemic. This study explored associations between COVID-19 and dream recall frequency (DRF), and related social, health, and mental health factors. METHODS: We conducted a cross-sectional web survey of 19,355 individuals in 14 countries from May to July 2020. We collected data on COVID-19, mental health, sleep and DRF during the pandemic. We performed McNemar Tests to compare low (<3 nights per week) and high DRF (≥3 nights per week) before and during COVID-19 and to evaluate changes in sleep variables segmented by DRF. Chi-square tests were conducted to compare characteristics between low and high DRF. Logistic regression analyses were conducted to examine associations between various independent variables and DRF. RESULTS: Reports of high DRF during the pandemic were higher than before the pandemic (P<0.001). Female gender (aOR=1.25, 95% CI 1.10-1.41), nightmares (aOR=4.22, 95% CI 3.45-5.17), sleep talking (aOR= 2.36, 1.73-3.23), sleep maintenance problems (aOR=1.34, 95% CI 1.15-1.56), symptoms of REM sleep behavior disorder (RBD; aOR=1.24, 95% CI 1.09-1.41) and repeated disturbing thoughts (posttraumatic stress disorder (PTSD) symptoms) were associated with high DRF. Age group 55-64 years (aOR=0.69, 95% CI 0.58-0.83) reported less high DRF than younger participants. Unadjusted OR showed associations between depression, anxiety, and DRF; however, in adjusted regression depression (aOR= 0.71, 0.59-0.86) and anxiety (aOR=0.79, 95% CI 0.66-0.94) were negatively associated with high DRF. CONCLUSION AND RELEVANCE: DRF was higher than pre-pandemic levels across four continents. DRF was associated with gender and parasomnias like nightmares and RBD symptoms, sleep maintenance problems, PTSD symptoms and negatively associated with depression and anxiety. The results implicate that COVID-19 is reflected in our dreams as an expression of the emotional intensity of the pandemic.

Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic-multinational study on 19 267 adults.

STUDY OBJECTIVES: Individual circadian type is a ubiquitous trait defining sleep, with eveningness often associated with poorer sleep and mental health than morningness. However, it is unknown whether COVID-19 pandemic has differentially affected sleep and mental health depending on the circadian type. Here, the differences in sleep and mental health between circadian types are examined globally before and during the COVID-19 pandemic. METHODS: The sample collected between May and August 2020 across 12 countries/regions consisted of 19 267 adults with information on their circadian type. Statistical analyses were performed by using Complex Sample procedures, stratified by country and weighted by the number of inhabitants in the country/area of interest and by the relative number of responders in that country/area. RESULTS: Evening-types had poorer mental health, well-being, and quality of life or health than other circadian types during the pandemic. Sleep-wake schedules were delayed especially on working days, and evening-types reported an increase in sleep duration. Sleep problems increased in all circadian types, but especially among evening-types, moderated by financial suffering and confinement. Intermediate-types were less vulnerable to sleep changes, although morningness protected from most sleep problems. These findings were confirmed after adjusting for age, sex, duration of the confinement, or socio-economic status during the pandemic. CONCLUSIONS: These findings indicate an alarming increase in sleep and mental health problems, especially among evening-types as compared to other circadian types during the pandemic.

Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study.

IMPORTANCE AND STUDY OBJECTIVE: The COVID-19 pandemic has produced unprecedented changes in social, work, and leisure activities, which all have had major impact on sleep and psychological well-being. This study documented the prevalence of clinical cases of insomnia, anxiety, and depression and selected risk factors (COVID-19, confinement, financial burden, social isolation) during the first wave of the pandemic in 13 countries throughout the world. DESIGN AND PARTICIPANTS: International, multi-center, harmonized survey of 22 330 adults (mean age = 41.9 years old, range 18-95; 65.6% women) from the general population in 13 countries and four continents. Participants were invited to complete a standardized web-based survey about sleep and psychological symptoms during the first wave of the COVID-19 pandemic from May to August 2020. RESULTS: Clinical insomnia symptoms were reported by 36.7% (95% CI, 36.0-37.4) of respondents and 17.4% (95% CI, 16.9-17.9) met criteria for a probable insomnia disorder. There were 25.6% (95% CI, 25.0-26.2) with probable anxiety and 23.1% (95% CI, 22.5-23.6) with probable depression. Rates of insomnia symptoms (>40%) and insomnia disorder (>25%) were significantly higher in women, younger age groups, and in residents of Brazil, Canada, Norway, Poland, USA, and United Kingdom compared to residents from Asian countries (China and Japan, 8% for disorder and 22%-25% for symptoms) (all Ps < 0.01). Proportions of insomnia cases were significantly higher among participants who completed the survey earlier in the first wave of the pandemic relative to those who completed it later. Risks of insomnia were higher among participants who reported having had COVID-19, who reported greater financial burden, were in confinement for a period of four to five weeks, and living alone or with more than five people in same household. These associations remained significant after controlling for age, sex, and psychological symptoms. CONCLUSION AND RELEVANCE: Insomnia, anxiety, and depression were very prevalent during the first wave of the COVID-19 pandemic. Public health prevention programs are needed to prevent chronicity and reduce long-term adverse outcomes associated with chronic insomnia and mental health problems.

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study.

PURPOSE: Obstructive sleep apnea (OSA) may increase the risk of severe COVID-19; however, the level of potential modulation has not yet been established. The objective of the study was to determine the association between high risk of OSA, comorbidities, and increased risk for COVID-19, hospitalization, and intensive care unit (ICU) treatment. METHODS: We conducted a cross-sectional population-based web survey in adults in 14 countries/regions. The survey included sociodemographic variables and comorbidities. Participants were asked questions about COVID-19, hospitalization, and ICU treatment. Standardized questionnaire (STOP questionnaire for high risk of OSA) was included. Multivariable logistic regression was conducted adjusting for various factors. RESULTS: Out of 26,539 respondents, 20,598 (35.4% male) completed the survey. Mean age and BMI of participants were 41.5 ± 16.0 years and 24.0 ± 5.0 kg/m2, respectively. The prevalence of physician-diagnosed OSA was 4.1% and high risk of OSA was 9.5%. We found that high risk of OSA (adjusted odds ratio (aOR) 1.72, 95% confidence interval (CI): 1.20, 2.47) and diabetes (aOR 2.07, 95% CI: 1.23, 3.48) were associated with reporting of a COVID-19 diagnosis. High risk for OSA (aOR 2.11, 95% CI: 1.10-4.01), being male (aOR: 2.82, 95% CI: 1.55-5.12), having diabetes (aOR: 3.93, 95% CI: 1.70-9.12), and having depression (aOR: 2.33, 95% CI: 1.15-4.77) were associated with increased risk of hospitalization or ICU treatment. CONCLUSIONS: Participants at high risk of OSA had increased odds of having COVID-19 and were two times more likely to be hospitalized or treated in ICU.

La crise sanitaire du Covid-19 et le confinement sont associés à un taux élevé de troubles du sommeil et de prise d’hypnotiques en France

Objectif La crise de la COVID-19 a perturbé les habitudes de milliards de personnes dans le monde. Pour de nombreux pays, le confinement à la maison est obligatoire et les familles sont forcées de vivre ensemble en permanence, dans des environnements souvent petits, avec leurs propres habitudes de sommeil et de veille. Le sommeil est essentiel pour nos vies et crucial pour équilibrer leur système immunitaire, la santé physique et psychologique. Méthodes Pour évaluer les problèmes de sommeil et l’utilisation des somnifères, nous avons réalisé une étude transversale d’un échantillon représentatif de la population générale en France (1005 sujets). Nous avons utilisé les mêmes éléments autodéclarés de plaintes de sommeil au cours des 8 derniers jours, tirés de l’échelle du Duke Health Profile, que ceux utilisés depuis 1995 dans les Baromètres de la santé français, une série d’enquêtes transversales sur diverses questions de santé publique. Résultats Après deux semaines de confinement, 74 % des participants ont signalé des plaintes de sommeil, comparativement à des taux de prévalence de 44 % à 49 % au cours des 25 dernières années. Les femmes ont déclaré plus de problèmes de sommeil que les hommes : 31 % contre 16 %. Les jeunes (18-35 ans) plus fréquemment que leurs aînés (79 % contre 72 % des 35 ans et plus) : 60 % ont déclaré que ces problèmes augmentaient avec le confinement, contre 51 % de leurs aînés. Enfin, 16 % des participants ont déclaré avoir pris des somnifères au cours des 12 derniers mois et 41 % d’entre eux ont déclaré avoir consommé ces médicaments depuis le début du confinement. Conclusion Ces résultats suggèrent que la crise de la COVID-19 est associée à de graves troubles du sommeil au sein de la population française, en particulier chez les jeunes.

Thérapie Comportementale et Cognitive de l’insomnie (TCCi) en séances de groupe par visioconférence pendant la période de confinement

Objectif Examiner la possibilité et l’efficacité de la transposition d’un protocole de TCCi de groupe à des visioconférences de groupe (eg-TCCi) pendant le confinement dû à l’épidémie de COVID-19. Méthodes 39 patients insomniaques (49,2±2,3 ans, 34 femmes) de la consultation du Centre du Sommeil de l’Hôtel-Dieu ont suivi le protocole eg-TCCi. Chaque groupe réunissait 4 à 6 patients (sur “skype”) en séance hebdomadaire pendant 6 semaines consécutives. Chaque séance comprenait un bilan de 15-30min, le déroulé d’une vidéo éducative conçue pour la TCCi, et 10min pour les consignes et questions. Les données de l’ISI, BDI-II, BAI, agenda du sommeil et qualité de vie (SF12) étaient évaluées avant et après la TCCi puis à 2 mois de suivi. Les résultats sont comparés à ceux obtenus chez 39 patients appariés en genre et en âge ayant suivi le protocole de TCCi de groupe en face-à-face avant le confinement. Résultats À la base, tous les scores sont identiques pour les patients de chaque protocole. Dans le groupe eg-TCCi, on observe une diminution significative des scores moyens d’ISI, BDI et BAI à 6 semaines, qui se maintient à 2 mois de suivi (l’ISI passe de 18,2±0,6 à 10,3±0,9 et l’insomnie est totalement résolue chez un quart des patients). La qualité de vie est augmentée. Ces résultats sont les mêmes que dans les groupes traités en face-à-face. Conclusion La TCCi par visioconférence en groupe est aussi efficace qu’en face-à-face. Elle a permis de poursuivre le traitement des patients pendant la période de confinement. Plus avant, son développement permettrait un plus large accès à cette prise en charge en France.

Would we recover better sleep at the end of Covid-19? A relative improvement observed at the population level with the end of the lockdown in France.

BACKGROUND: The outbreak of the Covid-19 pandemic and the accompanying lockdown measures have had a major impact on societies around the world, leading to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement. METHODS: As part of an epidemiological survey on Covid and Confinement (COCONEL), we enquired on sleep disorders using two items in 4 repetitive cross-sectional surveys. The first took place during the first week of the French confinement (March 31 to April 2; N = 1005 participants). The second took place in the middle of this period (April 15-17; N = 1005). The two last surveys were held at the end of the confinement (May 7-10; N = 2003) and one month after the end (June 10-12; N = 1736). Using a random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 and 4). RESULTS: The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after the end of confinement. One quarter of the population reported that their sleep was better one month after the end of the confinement. Sleep improvement was reported more often by women and people aged less than 65. Such improvement was less frequent among those who were still highly exposed to the pandemic's media coverage after the end of the confinement. CONCLUSION: The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease in sleep problems occurred mainly among people with mild sleep problems during the confinement. Further research is needed to assess the long-term effects of the Covid-19 pandemic and its confinement period on sleep quality in the general population.