Sleep quality among health care workers during the COVID-19 pandemic

Citation:

Badahdah AM, Khamis F, Al Mahyijari N. Sleep quality among health care workers during the COVID-19 pandemic. J Clin Sleep Med. 2020;16(9):1635.

Events such as earthquakes, hurricanes, and disease outbreaks are associated with psychiatric morbidities, including sleep disturbance. The COVID-19 pandemic has caused or aggravated pre-existing mental health conditions among frontline health care workers (HCWs).

A study¹ from China reported that 36% of hospital staff experienced insomnia during the crisis. In the high-insomnia group, females and nurses were more likely to be anxious and depressed. We examined sleep quality in a sample of 150 physicians (39.3%) and nurses (60.7%) who cared for patients with COVID-19 in Oman. Females made up 77.3% of participants. The average age was 37.62 years (standard deviation [SD] = 7.79 years).

We used 3 measures, as follows:

1. The 7-item Generalized Anxiety Disorder Scale, which rates anxiety symptoms on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day). A score of 10 or higher suggests a higher level of anxiety. The Cronbach’s α was .85.

2. The 5-item World Health Organization Well-Being Index (WHO-5), which gauges subjective well-being, uses a 6-point Likert rating scale from 0 (none of the time) to 5 (all of the time). The total scores were multiplied by 4 to create a percentage scale with a range from 0 (worst well-being) to 100 (best well-being). A score less than 50 indicates poor well-being and possible depression. The Cronbach’s α was .88.

3. The Sleep Quality Scale (SQS) is a single item of global sleep quality scored from 0 (terrible sleep) to 10 (excellent sleep). The mean scores on the 7-item Generalized Anxiety Disorder Scale, WHO-5, and SQS were 7.43 ± 4.64, 50.54 ± 22.57, and 6.82 ± 2.04, respectively.

HCWs who scored 10 or higher on the 7-item Generalized Anxiety Disorder Scale scored lower on sleep quality (mean = 5.98, SD = 2.29) than those who scored less than 10 (mean = 7.17, SD = 1.84; t = 3.26, P = .001, Cohen’s d = .57). HCWs who scored less than 50 on the WHO-5 had a lower score on sleep quality (mean = 6.29, SD = 2.08) compared with HCWs who scored above 50 (mean = 7.52, SD = 1.78; t = 3.72, P = .000, Cohen’s d = .64). No significant differences were found for sex and occupation on the SQS. The SQS was significantly positively correlated with the WHO-5 (r = .42, P = .000) but significantly negatively correlated with the 7-item Generalized Anxiety Disorder Scale (r = −.47, P = .000).

To our knowledge, this is the first study on sleep quality among HCWs from the Arab world. The findings showed that about one-third (28.9%) of the HCWs who cared for hospitalized patients with COVID-19 experienced moderate to severe anxiety. Half of the HCWs (53.8%) scored low on the WHO-5, a sign of depression. The mean SQS score of 7 indicates that 40.1% of participants had poor sleep quality. These results point to an urgent need for psychological interventions for HCWs during the COVID-19 crisis.

DISCLOSURE STATEMENT

All authors read and approved the content of this letter. Work for this study was conducted in several health facilities in Oman. The authors report no conflicts of interest.