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Background: School closure is one of the main global health policies performed worldwide during the coronavir us di sease 2019 (COVID-19) outbreak. Despite all of the advantages, there may be some risks for children who are quarantined. This study aimed to objectively measure and compares the sleep patterns of Hong Kong school students before and during the COVID-19 outbreak. Methods: Baseline assessment was performed before the first wave of the COVID-19 outbreak in Hong Kong. The sleep pattern was recorded by a physical activity monitor (Actigraph wGT3X-BT, Pensacola, Florida, USA). The follow-up assessment was conducted in early 2020. Findings: In total, 718 students were collected in the baseline . Sub sequently 1 40 students joined t he reassessment between March and April 2020. Analysis of sleep timing shows that 98.0% primary students, 78.0% secondary students and 79.9% primary school students and 58.8% secondary school students go to bed before midnight before and after the outbreak, respectively (p<0.001). Mean sleep duration (hours) was 6.81 (0.62) and 8.09 (0.07) at baseline and during the outbreak, respectively. The differences in the mean sleep features for total sleep time, sleep fragmentation index and sleep fragmentation were 0.92 (1.64), 1.64 (6.95) and 2.49 (9.18), respectively. The overall sleep quality was poorer as evidenced by delays in bedtime and wake up time, increased duration in bed, longer sleep latency, increases in the movement and fragmentation indices. Conclusion: This exceptional longitudinal study reported objective data on the change in sleep patterns before and during the COVID-19 outbreak with school closures.
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Background: The COVID-19 pandemic and subsequent social distancing measures have undermined several healthy habits that families had or were establishing prior to the start of the pandemic. This study looks at those changes through online survey to Missouri families to evaluate how COVID-19 has impacted healthy lifestyle habits in Missouri families, along with degree of social distancing and any associations in changes in employment, food scarcity issues, and health concerns. Methods: An online survey (through RedCap) was conducted during spring to summer 2020 evaluate changes during the time of initial lock down and social distancing, for families living in Missouri with children ages 2-18 years. The survey was advertised on social media and in local clinics to gather participants' responses. Results: A total of 298 responses were received from the survey. 58% of respondents noted a change in employment (35% stated now working from home, 18% noted decrease in work hours, and 5% noted they had been laid off or lost job completely). While there were no overall statistically significant changes in healthy habits during the initial lock down period in spring-summer 2020 noted, a subset analysis noted that when comparing those with a change in employment to those without a change in employment, Missouri families did note several statistically significant changes in their healthy habits. Those with a change in employment were more likely to note a decrease in their child(ren)'s physical activity, report an increase in screen time (p = 0.044), are more likely to report noticing family members eating between meals or snacking more (p = 0.004), and are also more likely to report worrying about their child(ren)'s nutrition (p = 0.049), and are more likely to note changes in their child(ren)'s sleep patterns (p = 0.021) during the pandemic. These groups were not significantly different in their self-reported income, the degree to which they socially distanced, their grocery store frequency, food scarcity, or how much they were eating out. Conclusion: Our study of Missouri families and healthy-habit maintenance during the initial months of the COVID-19 pandemic revealed that overall healthy habits were maintained during the initial months of COVID-19. However, a subset analysis comparing those who reported a change in employment vs. those who did not report a change in employment revealed that those who experienced a change in employment were more likely to report changes in healthy habits such as amount of screen time and physical activity, snacking between meals, changes in sleep, and overall concern for their child(ren)'s nutrition. This study highlights that major life events may affect healthy habit changes and families' abilities to change healthy habits during these events and can help pediatricians understand the impact of major life changes for families on healthy habit development and maintenance.
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Introduction: The hypothalamus plays a crucial role in regulating vital functions and circadian rhythms. Both the tumor involving the hypothalamic area and its treatment can lead to hypothalamic dysfunction, resulting in disturbances in sleep-wake patterns, sleep fragmentation, and increased daytime sleepiness. We describe two patients with craniopharyngioma who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes diagnosed as severe sleep disturbances. Case reports: Patient 1 is a 19-year-old male diagnosed with surgically treated craniopharyngioma. Subsequently, episodes of psychomotor slowing, afinalistic movements of the upper limbs diagnosed as seizures in another neurological center appeared;antiepileptic treatment was started without improvement. At the first examination in our center, excessive daytime sleepiness (EDS), fragmented nighttime sleep, episodes characterized by bimanual automatic gestures occurring during drowsy state, hypnagogic hallucinations, and sudden loss of muscle tone while awake were recognized. Actigraphy demonstrated irregular bedtimes, frequent nocturnal activity, and inappropriate daytime rest episodes. The Epworth Sleepiness Scale (ESS) showed subjective EDS (ESS=19). At PSG, hypersomnolence, severe sleep-related breathing disorder (SRBD), and no interictal and ictal seizure abnormalities were found. A BiPAP NIV was started, and antiepileptic therapy was discontinued. In the following months, PSG revealed marked improvement in SRBD and 1 SOREMP, and the MSLT a mean SOL of 6 min and 10 sec and 3 SOREMPs. These data allowed the diagnosis of secondary narcolepsy, and treatment with pitolisant was initiated with clinical improvement and reduced daytime sleepiness (ESS=9). Patient 2 is a 12-year-old male, surgically treated for craniopharyngioma at the age of 4 years, who developed episodes of myoclonic jerks, temporal and spatial disorientation, and psychomotor agitation during the lockdown period for COVID-19 emergency. Surmising paroxysmal epileptic episodes, the patient was hospitalized. The anamnestic data collection revealed a sleep-wake rhythm dysregulation, fragmented nighttime sleep, EDS, oneiric stupor-like episodes during which the patient performed simple automatic gestures mimicking daily-life activity, and severe impairment of alertness. The Long-term video-EEG, including polygraphic measurements, showed destruction of the wake-NREM sleep-REM sleep boundaries, episodes of undetermined state of vigilance, and concurrence of elements typical of different sleep stages. Moreover, a severe SRBD (AHI 19/h) has been observed. The MRI showed a volumetric increase in the post-surgical interpeduncular fossa and right paramedian cysts. Therefore, a multifactorial therapeutic plan including sleep hygiene and slow-release melatonin was started with improvement in nighttime sleep, but EDS persisted. Surgical treatment of cyst fenestration improved sleep-wake rhythm and behavior;BiPAP NIV was initiated with very poor adherence. Discussion: We aim to focus on sleep disorders as a possible complication of tumors involving the hypothalamic region. Our cases highlight that the clinical manifestation of these dysfunctions can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment that can harm patients' health and the quality of life of patients and their families. Conclusion: These findings support the need to incorporate comprehensive sleep assessment in survivors from childhood brain tumors involving the suprasellar/hypothalamic region.
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Introduction: Sleep is characterized as a condition of physical and mental rest, in which the person ignores everything going on around him. There is a scientifically proven association between sleep deprivation and unhealthy eating habits, increasing cases of emotional and uncontrolled eating leading to malnutrition. In addition, a bad night's sleep has been associated with worsening mental health, especially in times of pandemic. Objective: In light of the above, this study aimed to report the experience and stimulate reflection about the results of a poll shared on the social network Instagram with the objective of analyzing the quality of sleep of students at a public higher education institution during the COVID-19 Pandemic. Methods: This is an experience report of the extension group “Sleep and Food in times of Pandemic”, composed of students of nursing, nutrition, medicine and mathematics of a public institution of higher education. The group, through its profile on the social network Instagram, shared a sleep satisfaction scale, where users reported in posts according to the condition of their sleep on a scale between good and bad. The scale was made available publicly and online, so the answers were freely accessible to everyone who followed the group's profile. Results: The project had a large significant reach of participants, since the present was observed through the social media of we can mention Instagram e Facebook, that is, an average of 600 posts observed, of these, 34.5% of students reported having a good night's sleep during the pandemic, while 65.5% responded by pointing out a bad night's sleep. Sleep deprivation is inversely related to the regulation of the circadian cycle, is associated with neuroendocrine and metabolic functions, such as reduced leptin and increased ghrelin, increasing appetite and food intake.In parallel to this, individuals in this stressful situation tend to consume foods that are pleasing to the palate, which usually contain higher amounts of sugar and/or fat, because they serve as comfort for the stress they are going through, but may contribute to the risk of developing obesity, insulin resistance, and cardiovascular disease. Conclusion: Some protective factors can help in this change, such as maintaining a daily routine, practicing physical activity, following a dietary pattern and taking care of sleep hygiene. Finally, we emphasize the need for more studies with a more rigid methodological content.
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Introduction: Sleep disorders and anxiety are common complaints during childhood. Mothers' anxiety and depression symptoms might also affect children's sleep quality in a negative way. Considering that both sleep and anxiety disorders might be affected by environmental factors, the social distancing and other circumstances related to the COVID-19 pandemic might increase the prevalence of anxiety and sleep complaints among mothers and their children. Objective: To analyse the correlation between anxiety and sleep quality in mothers and children from 2 to 10 years old. Methods: Mothers of children from 2 to 10 years old were invited to participate. The participants filled an online survey through Google forms, including a socio-demographic survey, anxiety and sleep questionnaires, both of their own (as a self-report) and of their children. Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety and Stress Scale (DASS-21) were used to analyse symptoms on the mothers, while Children's Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL - both 1/2-5 and 6-18 years old versions) were used to analyse the children. The questionnaire was made available from August 2020 to January 2021. Data analysis was based on a Spearman correlation matrix and statistical significance level was set at 5%. Results: A total of 179 mothers were included in this study. Self-reported sleep quality decreased during the pandemic in 55% of the mothers. In relation to children, 40% of mothers reported that they noticed worsening of their sleep quality and 63% reported increased anxiety symptoms. Positive statistic significant correlations were observed between maternal sleep quality (PSQI) and maternal anxiety symptoms (DASS-21) (rho: 0.578, p<0.001), and between both mothers (PSQI) and children (CSHQ) sleep quality (rho: 0.318, p<0.001). A correlation between maternal sleep quality and anxiety symptoms in the children (CBCL) was observed only for children from 6-10 years old (rho:0,399, p=0.001), but not for those from 2-5 years old. Conclusion: The COVID-19 pandemic has been a challenge to both maternal and children sleep and behavior. During this period, decreased sleep quality in the mothers was correlated with increased anxiety in both mothers and children, as well as with decreased sleep quality in the children.
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Introduction: Sleep quality is influenced by several aspects, including factors related to the environment as well as psychological causes. In this context, the pandemic caused by the new SARS-Cov2 (severe acute respiratory syndrome coronavirus 2) had a large influence on the population's mental health, increasing levels of anxiety and stress, consequently reflected on the sleep quality. This is so also true for medical students;as a result of the scenario generated by the pandemic, in-person classes were replaced by distance education, which, added to the chaotic situation of fear, anxiety, frustration and social isolation, is interfering negatively in students' lives, and in their sleep. Objective: To analyze the sleep quality of medical students at a medical school in the interior of São Paulo state during the covid-19 pandemic. Methods: This is a crosssectional study that invited 544 students from De six years of the course, from a medical school in the interior of the state of São Paulo, to answer the Pittsburgh Sleep Quality Index (PSQI) and a questionnaire on aspects that may influence sleep. The REDCap platform was used to send, via email, the link to the questionnaires, which were available from September 28th to October 5th, 2020. Results: Of the 544 students invited, 375 answered the questionnaires. The mean score of PSQI was 8.63 (SD=3.16), with 82.4% (309 out of 375) of students having a poor sleep quality (PSQI>5). We observed an association between the quality of sleep given by the PSQI and the student's perception of anxiety (P<0.001), stress (P<0.001) and adaptation to distance education (P<0.001). The results for the seven components of the PSQI were analyzed for three study groups (1-2-year student, 3-4-year student and 5-6-year student) and associations were observed between the three studied groups and sleep duration, with students in the last two years sleeping less (<5/5-6h) than the remaining students, and with daytime dysfunction, with students in the first two years showing the highest percentage (75.5%). Conclusion: Sleep quality is poor in medical students, being associated with student's perception of anxiety, stress and difficulties in adapting to distance education. Active interventions should be implemented to improve sleep hygiene in medical students.
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Introduction: Social isolation, as a result of the coronavirus pandemic, favored the exposure of elderly people to stressors that may have compromised the quality of sleep. Objective: To verify the quality of sleep of elderly people in the face of the COVID-19 pandemic. Methods: A study was carried out with 305 elderly from 61 cities, recruited through social networks, from February- June/2021. The online questionnaire included general data (city, age, gender, skin, color, education level). Questions were asked about the practice of Physical Activity (PA), the quality of sleep during the pandemic (Mini Sleep Questionnaire/MSQ altered sleep score ≥ 25;EPWORTH-sleepiness score ≥ 10 points) and whether was diagnosed with COVID-19. Results: Out of 305 individuals who participated, 71% were between 60 to 69 years, and 72% were women. In addition, 59.5% practiced some type of physical activity, 9.5% contracted the SARS-CoV2 virus, 65% reported that their sleep pattern was not altered by the pandemic, 28.8% had impaired sleep quality, 72% were not taking sleep medication. The sleepiness was within the normal range. The relation of sleep quality of elderly practitioners of PA did not show statistically significant difference in relation to those who did not practice it during the pandemic. Sleep quality and the diagnosis of COVID-19 did not present relevant statistical data either. Although the individuals did not show any change in sleep quality during the pandemic, the data signaled a poor quality of sleep in the elderly surveyed, with a score showing an overall mean (MSQ) of 31.7 indicating severe difficulty in sleeping. In this study, women had a higher sleep quality score (32.6) than men (29.5), signaling the worsening of sleep in females. Elderly people in age group 70 years more demonstrated a better sleep pattern than age group 60 to 69 years. There was a statistically significant difference in the quality of sleep of the elderly who snored (33.1) compared to those who did not snore (28.0) and those who took a nap during the day (32.7) and those who did not take a nap (30,4). Tiredness was also shown to be a sign of worsening sleep quality when related to those who were not tired during the day. Conclusion: The results suggest that there were no significant changes in the sleep pattern of the elderly during the period evaluated in the pandemic. The changes found were similar in the literature for this population.
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Introduction: A 19-year-old non-verbal male with history of CHARGE syndrome, severe autism, intellectual disability, coloboma with blindness OD and severely imparied vision OS, deafness, self-injurious and aggressive behavior, Tetralogy of Fallot status post repair, pulmonary valve replacement, hypertension, hypothyroidism, megacolon, gastrostomy tube dependence, eosinophilic esophagitis and chronic kidney disease with an irregular sleep cycle who has failed multiple medications for insomnia has shown treatment success with suvorexant. Report of Cases: This patient's sleep schedule ranges from 1.5 to 5 hour segments at various times of day or night including naps at school with occasional longer periods of sleep up to 10 hours and longer periods of wakefulness up to 22 hours who has been treated with the following medications: trazodone, clonidine, hydroxyzine, diphenhydramine, quetiapine, gabapentin, mirtazapine, eszopiclone, melatonin and ramelteon. His behavioral problems have been treated with olanzapine. He continued to be aggressive and difficult to direct. His parents reported exhaustion. Then, suvorexant 5mg was added at bedtime while the following sleep medications were continued: gabapentin total daily dose of 1500mg (300mg in morning and 3pm;900mg at bedtime, 300mg one hour later if still awake), ramelteon 8mg, mirtazapine 7.5mg and olanzapine 10mg at bedtime and bid prn aggressive behavior. He also takes the following daily medications: bisacodyl, polyethylene glycol, simethicone, hyoscyamine, cholecalciferol, aspirin, levothyroxine, hypoallergenic nutritional formula, starch and albuterol prn. With the addition of suvorexant 5mg, he had been able to get 9.5 hours of consolidated sleep at night with improvement in his behavior until he contracted Covid-19 and regressed. The suvorexant dose was increased to 10mg which again improved his insomnia and behavior. Conclusion: Various medications have either not worked at all or have worked suboptimally for insomnia in this medically complex patient who has an irregular Circadian rhythm disorder. Adding an orexin receptor antagonist as a novel mechanism to his regimen has shown promise. At this time, this patient has been stable for one month with suvorexant 10mg at bedtime after regression on the 5mg dose that coincided with a Covid-19 infection. We are proceeding with cautious optimism.
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Introduction: Novel coronavirus disease or COVID-19, an acute respiratory illness caused by a newly discovered SARS-CoV-2 virus emerged in December 2019. Objectives: The main objective of the study is to find the epidemiology of sleeping disorders among doctors during COVID-19 pandemic in Pakistan. Material and methods: This cross sectional study was conducted in Sir Ganga Ram Hospital Lahore during June 2021 to December 2021. A questionnaire was used to collect the data. Among the topics covered in the survey were questions regarding the quality of one's night's sleep, where one keeps infection control supplies, how one copes with stress and depression, how one learns about COVID-19 on the internet, how one views risk, and other personal information. The survey was completed over the internet. Results: The data was collected from 200 patients. Over half (55.0 percent) were married and under the age of 35. (49.1%). The majority of respondents (57.8%) spend more than two hours a day on social media. The great majority of them came from the upper echelons of the workforce. There were 38.3%, 29.8%, and 29.1%, respectively, of those who reported a worse sleep quality following the onset of COVID-19, according to their weighted proportions. Conclusion: It is concluded that COVID-19 is widely spreading in Pakistani doctors. Mental health disorders and poor sleep quality are more widespread in the medical field because of the heightened danger of exposure during pandemic illnesses.
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Background: Poor management in healthcare institutions can have significant consequences for the workplace and for the physical and mental health of its workers. The exposure to unsustainable pressure and demand can impair the worker's performance and the quality of care provided. Four common issues are sleeping troubles, stress, burnout, and depressive symptoms. Several of these risks were exacerbated during the COVID-19 pandemic, especially among healthcare workers working with patients either suspected of, or confirmed, COVID-19 infection. Methods: Using the Copenhagen Psychosocial Questionnaire (COPSOQ) II questionnaire, we aimed to assess the psychosocial risks among a sample of 235 healthcare workers deployed in COVID-19-related services in the Local Health Unit of Baixo Alentejo (Portugal). The participants filled out a questionnaire, which comprised ten sociodemographic questions and the Euro-Portuguese medium version of the COPSOQ II questionnaire. Data collection occurred February 15th-28th 2021. As recommended by the COPSOQ authors, tertiles cut-off points of 33.3 and 66.6 (percentage scale) were used, rendering a traffic light risk classification where green represents a favourable situation, red a health risk and yellow an intermediate risk. [1] The results were processed with qualitative and quantitative descriptive statistical analysis. To compare groups relative to each outcome, t-tests were used for variables with two categories. Whenever data was not normally distributed, Mann-Whitney tests were used. For variables with more than two groups non-parametric Kruskal-Wallis was applied. Bonferroni correction was also applied, testing each individual hypothesis at the level of significance of αi=0.05/29. Note that a statistically significant difference between two groups does not necessarily yield a different risk colour. The mean (and categorial) values of the COPSOQ's sleep, stress, burnout and depressive symptoms domains were also compared to a dataset from a previous assessment (same institution) performed in 2017 [2]. Results: Except for depressive symptoms in the paediatric and general emergency services, domains such as stress, burnout, sleep issues and depressive symptoms showed an intermediate health risk. The burnout domain showed the highest level of risk among nurses and operational assistants working in the Intensive Care Unit. Several associations, with sociodemographic variables, are also discussed, such as a statistically significant association between the burnout domain and the number of hours spent in COVID-19 services, as well as (in medical doctors) time of service with COVID-19 patients, or between stress and age group. Overall, comparing with a similar evaluation made in 2017 [1], depressive symptoms worsened in nurses, slightly ameliorated in medical doctors, while the rest of the four domains remained in the yellow risk category, even though most of them exhibited a numerical aggravation, though not sufficient to change risk category. Conclusions: Working in COVID-19 services can worsen sleep troubles, stress, burnout and depressive symptoms among health care workers. These results support the assessment of psychosocial stressors in healthcare units, to promote risk reduction policies in healthcare workers through workplace reforms. Accessible occupational services, therapeutic and rehabilitative strategies are also crucial. Neuropharmaceuticals may play a role in improving some health hazards in unhealthy workplaces. No conflict of interest
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Objective: To determine the impact of excessive screen use on sleep habits in children during COVID-19 pandemic using Children’s Sleep Habits Questionnaire. Study Design: Cross-sectional descriptive survey. Place & Duration of Study: Conducted from 1st July to 30th November 2020, in the Department of Pediatric Medicine Unit II, King Edward Medical University/Mayo Hospital, Lahore. Material and Methods: A 22-item likert scaled online questionnaire, assessing children’s sleep habits (Children’s Sleep Habits Questionnaire) before and during the Covid-19 pandemic, was circulated among parents having a child from 2-10 years age. Responses were analyzed with SPSS V.26 Results: Out of 102 children, majority 46 (45.1%) were between 6 and 10 years, the type of screen used most was mobiles i.e. 28 (27.5%) followed by TV/mobile 21 (20.6%). There was marked increase in their screen time/per day from <2hrs before pandemic in 63 (61.8%) to >2 hours during pandemic in 81 (79.4%). As a result, sleep habits were significantly affected during the pandemic, especially in the domains of bed time, sleep behavior and morning wake up. During pandemic, children slept late at night 91 (89.3%), majority sleeping >8 hrs/day (p=0.000), could not wake up early in the morning (p=0.000), and remained tired (p=0.026) and sleepy (p=0.005) whole day. Conclusion: Excessive screen use during the pandemic was associated with altered sleep habits in children.