Table 2.

Sleep disorders in healthcare givers treating COVID-19-affected patients

Author, year	Title	Sample Size	Sample (date)	Country	Study design	Data interpretation
Alshekaili, Hassan et al., 2020 [59]	Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers	1139	Healthcare workers (HCW) (April 2020)	Oman	Cross-sectional study	During the pandemic period in April, 368 (32.3%), 388 (34.1%), 271 (23.8%) and 211 (18.5%) respondents were reported to have depression, anxiety, stress and insomnia, respectively; frontline HCWs were 1.5 times more likely to report insomnia (OR = 1.586, p = 0.013), anxiety (OR = 1.557, p = 0.004) and stress (OR = 1.506, p = 0.016)
Araç, Dönmezdil 2020 [60]	Investigation of mental health among hospital workers in the COVID-19 pandemic: a cross-sectional study	198	Healthcare workers treating COVID-19 patients	Turkey	Cross-sectional study	PSQI subscores and perceived stress levels were significantly higher among the volunteers working in the emergency department than among those in other departments ( p < 0.01); risk of development of anxiety among women was 16.6 times higher than among men
Ballesio, Lombardo et al., 2020 [61]	Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID-19 outbreak	-	-	-	Review	Central health issues for frontline workers, sleep problems; association of sleep deprivation, long shifts and insomnia in hospital staff with increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout; practical advice on sleep problems for hospital staff is to be provided
Barua, Zaman et al., 2020 [62]	Psychological burden of the COVID-19 pandemic and its associated factors among frontline doctors of Bangladesh: a cross-sectional study	370	Frontline doctors treating COVID-19 patients (April to May 2020)	Bangladesh	Cross-sectional study	Among the doctors, 36.5% were reported to have anxiety, 38.4% had depression, 18.6% displayed insomnia symptoms, and 31.9% had fear of COVID-19; inadequate resources in the workplace as the single most significant predictor for all psychological outcomes, anxiety and/or depression (severe, OR 3.0, p = 0.01; moderate, OR 5.3, p = 0.000; mild, OR 2.3, p = 0.003), sleep disturbance (moderate, OR 1.9, p = 0.02) and fear of COVID-19 (severe, OR 1.9, p = 0.03; moderate, OR 1.8, p = 0.03)
Herrero, Parra-Serrano et al., 2020 [63]	Sleep characteristics in health workers exposed to the COVID-19 pandemic	170	Frontline HCWs and non-HCWs (March to April 2020)	Spain	Cross-sectional study	Self-reported insomnia, nightmares, sleepwalking, sleep terrors and lower subjective sleep quality were more frequent in the healthcare group (all p < 0.05)
Jahrami, BaHammam et al., 2020 [64]	The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19	257	Frontline HCWs and Non-HCWs (April 2020)	Bahrain	Cross-sectional study	Poor subjective sleep and moderate-high levels of stress were reported by both groups (60%); female sex and professional background were the predictors of poor sleep quality and stress
Kang, Ma et al., 2020 [65]	Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study	994	HCWs (January to February 2020)	China	Cross-sectional study	Among the medical and nursing staff during the immediate epidemic, 36.9% had subthreshold mental health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances, and 6.2% had severe disturbance (mean PHQ-9, 15.1); young women were reported to be at higher risk; 36.3% had accessed psychological materials (such as books on mental health), 50.4% had accessed psychological resources available through media (such as online push messages on mental health self-help coping methods), and 17.5% received counselling or psychotherapy
Liang, Wu et al., 2020 [66]	Mental Health in Frontline Medical Workers during the 2019 Novel Coronavirus Disease Epidemic in China: A Comparison with the General Population	2003	HCWs and non-HCWs (February to March 2020)	China	Cross-sectional study	Of the frontline medical workers, 30.43%, 20.29% and 14.49% of frontline HCWs in Hubei Province and 23.13%, 13.14% and 10.64% of frontline HCWs in other regions reported symptoms of depression, anxiety and insomnia, respectively. Of the general population, 23.33%, 16.67% and 6.67% of the general population in Hubei Province and 18.25%, 9.22% and 7.17% of the general population in other regions reported symptoms of depression, anxiety and insomnia, respectively
Liu, Jiang et al., 2020 [67]	The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study	140	HCWs (February to March 2020)	China	Quasi-experimental intervention study	By practising diaphragmatic breathing relaxation: significant reductions in global sleep quality (p < 0.01), subjective sleep quality (p < 0.001), sleep latency (p < 0.01), sleep duration (p < 0.001), sleep disturbances (p < 0.001), habitual sleep efficiency (p < 0.015), daytime dysfunction (p < 0.001), and anxiety (p < 0.001) in frontline HCWs
Qi, Xu et al., 2020 [68]	The evaluation of sleep disturbances for Chinese frontline medical workers under the outbreak of COVID-19	1306	HCWs (February 2020)	China	Cross-sectional study	Among frontline HCWs: higher prevalence of sleep disturbances (p < 0.001) and worse sleep quality (p < 0.001), as well as reported anxiety (p < 0.001) and depression (p < 0.001) compared to non-frontline HCWs
Şahin, Aker et al., 2020 [69]	Prevalence of Depression, Anxiety, Distress and Insomnia and Related Factors in Healthcare Workers During COVID-19 Pandemic in Turkey	939	HCWs (April to May 2020)	Turkey	Cross-sectional study	Overall: 77.6% participants exhibited depression, 60.2% anxiety, 50.4% insomnia and 76.4% distress symptoms; females, frontline work, being tested positive for COVID-19, individuals with a history of psychiatric illness and individuals in psychiatric treatment were at greater risk for depression, anxiety, insomnia and distress symptoms
Stojanov, Malobabic et al., 2020 [70]	Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19	83	HCWs	Serbia	Cross-sectional study	Low quality of sleep and poor health-related quality of life were correlated with high health anxiety and severe depressive symptoms; higher scores of anxiety (p < 0.01) and lower scores on mental health (p < 0.01) as independent predictors for low subjective quality of sleep and self-rated depression;
Tu, He et al., 2020 [71]	Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study	100	Frontline HCWs (February 2020)	China	Cross-sectional study	A total of 76%, 81%, 45% and 19% reported difficulty initiating sleep, difficulty maintaining sleep or early morning awakening, nightmares and using hypnotics, respectively. Among the HCWs, 60% reported poor sleep quality, 46% suffered depression symptoms, and 40% exhibited anxiety symptoms. Sleep quality (OR = 3.16, 95% CI, 1.17–8.52) and anxiety symptoms (OR = 8.07, 95% CI, 2.92–22.33) were significantly associated with depression symptoms. Depression symptoms (OR = 3.24, 95% CI, 1.19–8.79) were associated with poor sleep quality
Wang, Zhang et al., 2020 [72]	Psychological impact of coronavirus disease (2019) (COVID-19) epidemic on medical staff in different posts in China: A multicenter study	274	HCWs (February to March 2020)	China	Multicentre cross-sectional study	Total scores of anxiety, depression, sleep quality and stress were statistically different among HCWs in Hubei and outside Hubei; increased risk of exposure to COVID-19 was linked to an increased tendency of anxiety, depression and lower subjective sleep quality (p < 0.05); HCWs in Hubei had the highest prevalence of anxiety (20%), depression (22%) and insomnia (26%); non-frontline HCWs outside Hubei had the lowest prevalence of anxiety (7.4%), depression (4.4%) and insomnia (10.3%) (adjusted p < 0.05); the combined prevalence of anxiety, depression and insomnia of staff in Hubei was estimated to be 38%; among the participants, 69.4% may need psychological support
Wang, Song et al., 2020 [73]	Sleep Disturbance and Psychological Profiles of Medical Staff and Non-Medical Staff During the Early Outbreak of COVID-19 in Hubei Province, China	2001	HCWs (March 2020)	China	Cross-sectional study	Among the HCWs, 61.6%, 35% and 22.6% reported sleep problems, depressive symptoms and anxiety, respectively; higher prevalence of sleep disorders for frontline HCWs compared to non-frontline and non-medical staff; significant predictors for poor sleep quality, medical occupation, family burden, bereavement, anxiety and depression
Wu, Wei et al., 2020 [74]	Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China	120	HCWs	China	Cross-sectional study	Higher scores of somatisation, depression, anxiety and terror in frontline HCWs ( p < 0.05); frontline HCWs reported lower subjective sleep quality ( p < 0.05); medical staff who exercised according to the exercise recommendations reported better psychological stress and higher sleep quality
Xiao, Zhang et al., 2020 [75]	The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China	180	Frontline HCWs (January to February 2020)	China	Cross-sectional study	Significant positive association between levels of social support of HCWs and self-efficacy and sleep-quality ( all, p < 0.01); social support was negatively correlated with anxiety and stress (all, p < 0.01); anxiety, stress and self-efficacy as mediating variables associated with social support and sleep quality
Zhan, Liu et al., 2020 [76]	Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey	1794	Frontline HCWs (March 2020)	China	Cross-sectional study	Prevalence of insomnia among participants, 52.8%; predictors for insomnia, gender, working experience, chronic diseases, midday nap duration, exposure to COVID-19 patients, frequency of night shifts, psychological support, negative personal experiences due to COVID-19, degree of fear of COVID-19, fatigue and perceived stress
Zhang, Yang et al., 2020 [77]	Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak	1563	HCWs (January to February 2020)	China	Cross-sectional study	Insomnia symptoms were reported by 36.1%; associated with insomnia symptoms, (lower) education level (p < 0.05), occupation as a doctor (p < 0.01), exposure to COVID-19 (p < 0.05), fear of COVID-19 infection (p < 0.001), perceived lack of psychological support (p = 0.001), uncertainty regarding effective disease control (p < 0.05)
Zhang, Shi et al., 2020 [78]	Posttraumatic stress disorder symptoms in healthcare workers after the peak of the COVID-19 outbreak: A survey of a large tertiary care hospital in Wuhan	642	HCWs (June 2020)	China	Cross-sectional study	Prevalence of probable PTSD symptoms, 20.87%; among HCWs with PTSD, varying degrees of anxiety, depression, somatic symptoms and insomnia were reported by 88.88%, 82.09%, 100% and 95.52%, respectively; HCWs with probable PTSD had higher scores on depression scale (HADS), patient health questionnaire (PHQ-15) and insomnia (ISI) than non-PTSD HCWS; protective factors against probable PTSD, testing negative for COVID-19 (p < 0.01), perceived sufficient social support ( p < 0.01), family members tested negative for COVID-19 ( p < 0.05)
Zhou, Wang et al., 2020 [79]	The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID-19 epidemic: Workload should be concerned	1705	Frontline HCWs and non-HCWs (February to March 2020)	China	Cross-sectional study	The prevalence of depression, anxiety, somatisation symptoms, insomnia and suicide risk in frontline HCWs were 57.6%, 45.4%, 12.0%, 32.0% and 13.0%, respectively; among frontline HCWs, daily working hours were associated with all psychological disturbance (all, p < 0.01) and female sex was associated with anxiety (p < 0.05), body mass index with anxiety and insomnia (both, p < 0.05); age was negatively associated with depression, anxiety and insomnia (all, p < 0.01)
Zhuo, Gao et al., 2020 [80]	Stress and sleep: a survey based on wearable sleep trackers among medical and nursing staff in Wuhan during the COVID-19 pandemic	26	HCWs with insomnia symptoms (March 2020)	China	Cross-sectional study	Among participants, 38.5% demonstrated moderate to severe sleep apnoea–hypopnea syndrome (SAHS); comorbid moderate to severe SAHS was linked to higher scores on insomnia and worse mental health status (both, p < 0.05); insomnia symptoms were negatively correlated with deep sleep (p < 0.05); male sex was identified as a potential risk factor for insomnia with comorbid SAHS (OR = 11.56)