Uncertainty stress and self-rated health during the early stage of the COVID-19 outbreak.

Objectives: The COVID-19 crisis caused unparalleled uncertainty stress and health-related symptoms among Chinese residents. This study aimed to characterize stress status during the early stage of the pandemic and explore the inner mechanism between uncertainty stress and self-rated health. Setting/participants: A cross-sectional design was conducted online from February 7 to 14, 2020. A total of 2534 Chinese participants were surveyed. Main outcome measures: Uncertainty stress, negative affect, sleep quality, and health status were measured by self-report. A sequential mediation model using bootstrapping method was applied to test these relationships. Results: Age, place of residence, marital status, occupation, household annual income, infection, and quarantine status significantly correlated with uncertainty stress. Higher uncertainty stress was negatively related with self-rated health (r = -0.256, p < 0.01) and positively associated with higher negative emotions (r = 0.646, p < 0.01). The sequential mediation model found total indirect effect (ß = -0.014, 95%C.I. = -0.017-0.010) and direct effect (ß = -0.010, 95%C.I. = -0.015-0.005) were significant in the relationship between uncertainty stress and self-rated health with mediating by negative affect and subjective sleep quality. Conclusions: Findings provided evidence-based information for stakeholders designing and implementing intervention strategies by providing psychological consultation services and public education to manage uncertainty stress and minimize the damage of negative affect and poor sleep.

Effect of Seat Angle when Sleeping in a Car on Quality of Sleep and Its Impact on Calculation Performance the Following Day.

The number of occasions to stay in a car overnight is increasing during disasters; however, the effects on sleep and the impact on daytime functioning are not well understood. We investigated the effect of seat angle when sleeping in a car and its impact on calculation performance the following day. Fifteen healthy males participated in three trials (sleeping in a car with the front seat angled at 45° and 60° in a laboratory and sleeping at home); sleep and calculation performance the following day were compared. Increased wake after sleep onset and decreased slow-wave sleep were observed in the 60° trial, that is, near-vertical, compared with the others. Subjective sleep quality and calculation performance in the 45° and 60° trials were poorer than those in the home trial. The effect of seat angle on sleep was confirmed objectively, but not subjectively, suggesting that a large seat angle might cause sleep impairment.

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

OBJECTIVE: We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems. METHODS: Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses. RESULTS: A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality. CONCLUSIONS: We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status

Background: An outbreak of the 2019 novel coronavirus (COVID-19) has been ongoing in China since January 2020. The threat of infection affects the work and life of most of the population and may also damage sleep. This study aims to examine the subjective sleep status and mental health of the population during the peak of the COVID-19 epidemic. Method: The datawere collected through an online questionnaire with a sample of 5461 individuals in China fromFebruary 5, 2020, to February 23, 2020. Participantswere divided into four groups based on their degree of threat fromCOVID-19:Group 1wasmost closely associatedwith COVID-19, including inpatients diagnosed with COVID-19, first-line hospital workers and first-line management staff;Group 2 included outpatients diagnosed with COVID-19 and patients who developed a fever and visited the hospital;Group 3 included people related to Group 1 or 2, such as their colleagues, relatives, friends and rescuers;and Group 4 was the farthest removed fromcontact with COVID-19, covering the general public affected by COVID-19 prevention strategies. The Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS) were used. Results: Threat degree of COVID-19 (groups) had significant correlations with insomnia, depression, anxiety, and stress (p <0.05, p<0.01). Age, gender, and area (Hubei province or other provinces) had significant correlations with insomnia (p < 0.01). A total of 1380 (24.46%) participants were suspected of having major depression based on the PHQ-9. Additionally, 1042 (18.47%) participants were suspected of having generalized anxiety disorder based on the GAD-7. A total of 892 (15.8%) of the participants had Acute Stress Disorder (ASD) according to the ASDS. The prevalence of clinical insomnia during the outbreakwas 20.05% (1131) according to the ISI. The factors of satisfaction with the current sleep pattern and howperceptible the symptoms of the current sleep pattern are to other people (p < 0.05) and the middle (difficulty staying asleep) and terminal (waking up too early) (p < 0.01) factors of the ISI were significantly different across groups. A total of 1129 (20.01%) participants spent more than one hour awake in bed. Conclusion: The results indicated that insomnia is more severe in people who are female, young, living in the epicenter and experiencing a high degree of threat from COVID-19. As prevention and treatment efforts continue with regard to COVID-19, the general public has developed poor sleep hygiene habits, which deserve attention. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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.

Risk Perception, Perception of Collective Efficacy and Sleep Quality in Chinese Adults during COVID-19 Pandemic in Hong Kong: A Cross-Sectional Study.

BACKGROUND: Only a few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. The purpose of our study is to propose and test a theoretical model to understand the relationships between COVID-19 risk appraisals-risk perception and perception of collective coordinated defense (PCCD) in particular-and subjective sleep quality in Chinese adults in Hong Kong during the COVID-19 pandemic. COVID-19-related fear and rumination were examined as potential mediators of the relationships. METHODS: Data were collected using a self-report online questionnaire from a convenience sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. RESULTS: Risk perception and PCCD were found to predict poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model was an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. This study indicated that both perception of high risks of contracting COVID-19 and anticipations of collective disease preventive efforts had adverse effects on subjective sleep quality via increasing COVID-19-related fear. CONCLUSIONS: These findings underscore the need for addressing sleep problems induced by psychological consequences of the pandemic. While policy makers often deliver public messaging campaigns that frame disease prevention as a collective goal, developing evidence-based coping strategies to combat COVID-19 adverse impacts on psychological health is equally important.

Day-to-day associations between nightly sleep and next-day well-being amid the COVID-19 pandemic in North America.

OBJECTIVE: Sleep may be especially important for maintaining health and well-being in daily life amid the stress of the coronavirus disease 2019 (COVID-19) pandemic. This preregistered study examined the associations of sleep quality, duration, and efficiency with next-day physical symptoms, affect, and stressors during the COVID-19 pandemic in North America, in addition to evaluating individual differences in COVID-19 threat as a moderator. METHOD: From mid-March to early August 2020, 1025 adults from Canada and the United States aged 18-91 reported COVID-19 threat at baseline and subsequently completed twice-daily diaries for one week about their sleep, negative affect, stressors, and physical symptoms. RESULTS: Within-persons, nights with better-than-usual sleep quality predicted lower next-day negative affect, physical symptoms, and stressor occurrence. Better-than-usual sleep efficiency and longer-than-usual sleep duration also predicted lower next-day physical symptoms. COVID-19 threat ratings moderated several of these associations, such that individuals with higher COVID-19 threat showed weaker within-person associations of sleep duration and efficiency with next-day well-being, compared to individuals with lower-to-moderate levels of COVID-19 threat. For the reversed direction of association, stressor occurrence predicted shorter-than-usual sleep that night, but no other links between daily well-being and subsequent sleep were observed. DISCUSSION: Sleep quality, efficiency, and duration were important predictors of daily health and well-being during the COVID-19 pandemic, but the protective associations between sleep and next-day well-being were attenuated among people with higher COVID-19 threat. These findings highlight the role of heightened stress contexts when considering the benefits of sleep on daily health and well-being.

Exploring the association between mental health and subjective sleep quality during the COVID-19 pandemic among Bangladeshi university students.

The outbreak of new coronavirus disease (COVID-19) has triggered a global panic, affecting the mental well-being of people of all ages, including students. The aim of this study was to explore the relationship between self-reported mental health concerns and subjective sleep quality of the Bangladeshi university students during the COVID-19 pandemic. A web-based cross-sectional study was conducted to maintain the social distancing recommended by the World Health Organization. There were 1,317 student responses from 49 universities across Bangladesh. Data was analyzed by executing both bi-variate and multivariate analysis. Findings indicate that 27.1%, 51.0%, 45.9%, and 86.0% of students had poor subjective sleep quality, anxiety, depression, and fear of COVID-19, respectively. Anxiety (AOR = 1.09, 95% CI: 1.06-1.12, p < 0.001) was a risk factor for increasing the poor subjective sleep quality of university students. In contrast, the odds of poor subjective sleep quality were lower with increasing the score of depression (AOR = 0.88, 95% CI: 0.86-0.90, p < 0.001) and fear of COVID-19 (AOR = 0.97, 95% CI: 0.94-0.99, p < 0.05). Compared to public university students, private university students were more likely to report poor subjective sleep quality since the pandemic began. Therefore, it is strongly recommended that psychiatric conditions of university students should be monitored during the COVID-19 epidemic, and necessary strategies, such as allocation of resources, implementation of awareness programs, establishment of psychological counselling unit, should carefully be devised.

Prevalence of and risk factors associated with sleep disturbances among HPCD exposed to COVID-19 in China.

OBJECTIVE: To assess sleep disturbances and associated factors among front-line healthcare providers who have been called upon for, dispatched (HPCD) and exposed to COVID-19 in China. METHODS: This cross-sectional, survey-based, isolation area-stratified study collected demographic data, sleep status and emotional measurements from 1036 HPCD in nine medical institutions from March 5 to 9, 2020 in Wuhan, China, which was the epicenter of the epidemic. HPCD who worked in isolation areas with COVID-19 were eligible for inclusion. The severity of symptoms of sleep disorders, insomnia and emotional self-efficacy were assessed by the Chinese versions of the 10-item Self-rating sleeping situation scale, the seven-item Insomnia Severity Index and the 12-item Regulatory emotional self-efficacy questionnaire, respectively. Univariate analysis was performed to identify factors associated with sleep disturbances. A structural equation model (SEM) was constructed via AMOS to explore the relationship among the four components. RESULTS: A total of 1036 out of 1075 contacted individuals completed the survey, with a participation rate of 96.4%. A total of 925 (89.3%) were aged 20-39 years, and 755 (72.9%) were women. Among all participants, 874 (84.4%) were nurses, and 162 (15.6%) were physicians; 538 (51.9%) worked in intensive care isolation units; 843 (81.4%) worked in isolation areas for 4 h straight, and 395 (38.1%) perceived COVID-19 peer exposure. A considerable proportion of participants reported symptoms of sleep disorders (543, 52.4%). Exposure status and length of work were the main factors affecting sleep status, which had indirect effects on sleep status by mediating regulatory emotional self-efficacy. CONCLUSIONS: In this survey of HPCD for patients with COVID-19 in China, participants reported experiencing sleep disturbance burdens, especially those having exposure experience and working long shifts. Regulatory emotional self-efficacy (RESE) is an important resource for alleviating sleep disturbances and improving sleep quality. These findings emphasize the importance of being prepared to support HPCD through psychological interventions.