Abstract
This study aims to investigate sleep patterns and quality in patients who had SARS-CoV-2 (COVID-19) infection and to determine the sleep quality and pattern among patients. A cross-sectional design was used to assess sleeping patterns during the post-COVID-19 era for recovered individuals from April 1st, 2022, to June 1st, 2022. The participants had to meet the following requirements: both genders, ages 18 to 70, and previously infected with COVID-19. The prevalence of low sleep quality among the recovered individuals during post-COVID-19 era was 834 (40.6%), and the prevalence of disturbance in sleep quality was 1308 (63.6%). Lower economic status and younger ages in twenties and thirties experienced more disturbances in sleep patterns than other older ages. Many predictors were determined the quality of sleep. These predictors were age (B = .105, P = .00), income (B = .05, P = .035) and educational level (B = .20, P = .006). To sum up, our study found that the prevalence of low sleep quality among the recovered individuals during post-COVID-19 era was moderate, and the prevalence of disturbance in sleep quality was high. The predictors of quality of sleep were age, income, and educational level. Practitioners should be trained to evaluate and manage sleep disturbances, as this comprehensive approach has the potential to reduce mental distress and prevent the consequences of sleep disturbances.
Keywords: COVID-19, quality, recovered individuals, sleep
1. Introduction
Sleep problems and lethargy, as well as neuropsychiatric dysfunction (e.g., dizziness, memory impairment, and attention), are prevalent long-term symptoms of SARS-CoV-2 (COVID-19) infection.[1] Studies have shown that approximately 30% of people who recovered from COVID-19 suffered post-COVID sleep difficulties that lasted up to a year after the infection.[2–4] Newly diagnosed insomnia and various sleep disorders, including sleep apnea and restlessness, are consistently cited sleep problems that continue for several months after COVID-19 infection. Given the–bi-directional causality between sleep and the immune response, sleep is likely to be essential for recovery in people with COVID-19 infection.[5] On the 1 hand, sleep is thought to be a crucial modulator of the immune system, so poor quality sleep can be detrimental to the immune system.[5,6] Sleep is a critical biological function for preserving one’s health and well-being by regulating the body’s internal balance. Sleep quality improves physical and mental health,[7–9] whereas sleep issues have a detrimental impact on the body’s circadian rhythm, which affects the body’s immune response.[5,7,10]
According to a study, the severity of the clinical manifestations of SARS-CoV-2 infection may be linked to circadian rhythm and sleep disruption.[11,12] There is a link between sleep disturbances and infectious illness hazards, the occurrence and advancement of numerous diseases, including depression and other psychiatric disorders.[13,14] Despite reports revealing poor in hospitalized patients, sleep quality is important, and sleeping issues in recovered COVID-19 people require more research.[15,16] Sleep disorders may exacerbate the consequences of COVID-19 on physical and mental health.[17] Compared to COVID-19 patients who did not have sleep disturbances, patients with sleep disturbances reported a greater rate of hospital-acquired infections, broader hospital stays, and a more significant requirement for ICU entrance.[17,18]
Poor sleep quality and patterns have been linked to post-COVID-19 post-traumatic stress disease in Chinese and Italian populations. Moreover, the post-recovery standard of living for many recovered individuals was severely compromised.[19] It has been demonstrated in several studies that not only adequate sleep reduce the risk of non-communicable diseases [20] but that it also boosts protection from a variety of viral illnesses, reducing the risk of COVID-19 consequences.[21,22] It worth to mention this is the first study in Jordan that addressed the sleeping pattern and quality during post COVID-19 era. This study aimed to investigate sleep patterns and quality in patients who had COVID-19 infection and to determine the predictors of sleep patterns and quality during post COVID-19 era.
2. Method
A cross-sectional design was used to assess sleeping patterns during the post-COVID-19 era for recovered individuals from April 1st, 2022, to June 1st, 2022. The participants had to meet the following requirements: both genders, ages 18 to 70, and previously infected with COVID-19. The participants were excluded if they have previous sleeping disorders. The sample size of the study was calculated using G-Power 3.1., Universitat Kiel, Germany (RRID:SCR_013726), based on convenience/quota sample method, small effect size, alpha of 0.05 and power of 0.95. The required minimum number of subjects was 2000. The surveys were sent to 2280 participants
2.1. Instrument
The demographic part includes questions about age, gender, relationship status, educational level, profession, and place of living. The insomnia severity index consists of 7 items that assess: The intensity of sleep-onset (initial); Maintaining sleep (middle); Early in the morning awakening (terminal) problems; Enjoyment with current sleeping habits; Interruption with everyday activities; Noticeability of deficits contributed to the sleeping disorder, and; Level of inconvenience caused by the sleeping disorder. Each of these components is evaluated on a 5-point Likert - type scale (“0” not at all, “4” extremely).[23]’ Total ranging from 0 to 28, with higher scores reflecting more severe insomnia. The Cronbach alpha is 0.87.[24] Sleep quality was measured with number from 0 to 10. As the number increased means better quality of sleeping.
2.2. Data collection
After having the Institutional Review Boards approval from Jordan University of Science and Technology (#70/2022), data collection took a period of 3 months from April until June 2022. The researcher had collected data after approaching the recovered patients from COVID-19. The participants who met the eligibility criteria were invited to participate in this study. Second, the researcher identified himself to the potential participants, explained the nature and purpose of the study, and invited them to participate. Those who agreed to participate in the study received an electronic copy of the consent form with the electronic survey. At the same time, the researcher was available when help was needed.
2.3. Ethical consideration
This study was approved by Jordan University of Science and Technology Institutional Review Boards (#70/2022). The participants agreed to participate after reading the cover page attached to the survey that guarantees anonymity, no obligations to participate, and the right to withdraw at any time.
2.4. Data analysis
The Windows version of the Statistical Package for Social Science (SPSS Version 27, IBM SPSS Stastics, Chicago) was utilized to conduct statistical analysis. The normality of the data was first confirmed using the Kolmogorov–Smirnov testing (1-sample), and then the categorical data were interpreted using numbers and percentages. The term “statistical significance” was used to describe the significance of a (p .05) when multiple regression was used to determine the predictors of sleep quality and sleep patterns.
3. Results
3.1. Demographic characteristics
The study includes 2055 participants of all ages. The response rate was 90%. The number of females was 1182 (57.5), and the number of males was 873 (42.5). See Table 1
Table 1.
Demographic characteristics of the participants (N = 2055).
| Character | Sub-category | Number | Percentage | |
|---|---|---|---|---|
| Gender | Male | 873 | 42.5 | |
| Female | 1182 | 57.5 | ||
| What is your work status? | Unemployed | 849 | 41.4 | |
| Employed | 970 | 47.2 | ||
| Retired | 236 | 11.4 | ||
| What is your income level in Jordanian Dinar (1JD) = 1.4US$) | < 400 Jordanian dinars | 1117 | 54.4 | |
| 401–800 | 765 | 37.2 | ||
| > 800 | 153 | 8.4 | ||
| What is your educational level? | ≤ Secondary school | 529 | 25.7 | |
| Diploma | 248 | 12.1 | ||
| University student | 368 | 17.9 | ||
| Bachelor’s | 695 | 33.8 | ||
| Postgraduate | 215 | 10.5 | ||
| What is your marital status | Not married | 620 | 30.2 | |
| Married | 1435 | 69.8 | ||
| Where do you live? | City | 1130 | 55.0 | |
| Village | 925 | 45.0 | ||
| Do you smoke? | No | 1214 | 59.1 | |
| Yes | 841 | 40.9 | ||
| How many times did you get COVID-19? | Once | 1122 | 54.6 | |
| Twice | 836 | 40.7 | ||
| More than twice | 97 | 4.7 | ||
| What type of vaccination did you receive? | None | 224 | 10.9 | |
| Pfizer | 547 | 26.6 | ||
| AstraZeneca | 942 | 45.8 | ||
| Others | 342 | 16.7 | ||
COVID-19 = SARS-CoV-2.
3.2. Description of sleep quality and sleep pattern among participants
The prevalence of low sleep quality among the recovered individuals during post-COVID-19 era was 834 (40.6%), and the prevalence of disturbance in sleep quality was 1308 (63.6%).
Regarding sleep quality. The number of participants who reported a score worsened quality of sleep was 60%. The participants reported many sleep problems during the post-COVID-19 era. Regarding sleep difficulty, 52% of participants suffered from moderate to very high degrees. For stay sleep, 52.5% of participants reported difficulty staying asleep. For waking-up early, almost 58 reported moderate to very high level of inability of waking-up early. See Table 2
Table 2.
Response of the participants for the sleep quality (N = 2055).
| Not at all (0) | % | Mild (1) | % | Moderate (2) | % | High (3) | % | Very high (4) | % | |
|---|---|---|---|---|---|---|---|---|---|---|
| Sleep Difficulty | 493 | 24.0 | 497 | 24.2 | 774 | 37.7 | 208 | 10.1 | 83 | 4.0 |
| Stay Sleep | 494 | 24.0 | 490 | 23.8 | 750 | 36.5 | 243 | 11.8 | 78 | 3.8 |
| Wake Early | 424 | 20.6 | 442 | 21.5 | 669 | 32.6 | 367 | 17.9 | 153 | 7.4 |
| Sleep On Physical | 353 | 17.2 | 570 | 27.7 | 634 | 30.9 | 371 | 18.1 | 127 | 6.2 |
| Sleep Problem | 354 | 17.2 | 537 | 26.1 | 647 | 31.5 | 379 | 18.4 | 138 | 6.7 |
| Anxious Sleep | 996 | 48.5 | 594 | 28.9 | 329 | 16.0 | 136 | 6.6 | 0 | 0.0 |
| COVID-19 Impact Sleep | 602 | 29.3 | 530 | 25.8 | 521 | 25.4 | 275 | 13.4 | 127 | 6.2 |
COVID-19 = SARS-CoV-2.
3.3. Predictors of sleep patterns among recovered individuals
The model was significant (F = 5.6, P = .01), which means many predictors determined the sleep pattern. These predictors were age (B=. -06, P = .037) and income level (B=. -49, P = .042). This means lower economic status and younger ages in twenties and thirties experienced more disturbances in sleep patterns than other older ages. See Table 3
Table 3.
Predictors of sleep patterns among participants during post-COVID-19 era (N = 2055).
| Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
|---|---|---|---|---|---|---|
| B | Std. Error | Beta | ||||
| 1 | (Constant) | 10.190 | 1.615 | 6.310 | .000 | |
| Age | -.024 | .012 | -.063 | -2.082 | .037 | |
| Gender | .358 | .313 | .032 | 1.144 | .253 | |
| What is your work status? | .162 | .111 | .040 | 1.463 | .144 | |
| What is your income level in Jordanian Dinar (1JD) = 1.4US$) | -.381 | .188 | -.049 | -2.031 | .042 | |
| What is your educational level? | .003 | .094 | .001 | .035 | .972 | |
| What is your marital status? | -.074 | .311 | -.007 | -.239 | .811 | |
| Where do you live? | -.009 | .251 | -.001 | -.035 | .972 | |
| Do you smoke? | .067 | .271 | .006 | .246 | .806 | |
COVID-19 = SARS-CoV-2.
a. Dependent Variable: Sleep patterns.
3.4. Sleep quality predictors, according to participants
The model was significant (F = 5.33, P = .001). This means many predictors were determined the quality of sleep. These predictors were age (B = .105, P = .00), income (B = .05, P = .035) and educational level (B = .20, P = .006). This means that younger age, less income, and higher educational level experienced low sleep quality compared to others. See Table 4
Table 4.
Predictors of sleep quality among participants during post-COVID-19 era (N = 2055).
| Model | UN SC | SC | t | Sig. | 95.0 Confidence Intervals for B | ||||
|---|---|---|---|---|---|---|---|---|---|
| B | Std. Error | Beta | Lower Bound | Upper Bound | |||||
| 1 | (Constant) | 5.292 | .770 | 6.875 | .000 | 3.782 | 6.802 | ||
| Age | .019 | .005 | .105 | 3.535 | .000 | .009 | .030 | ||
| Gender | -.134 | .146 | -.026 | -.920 | .358 | -.420 | .152 | ||
| What is your work status? | .028 | .052 | .015 | .542 | .588 | -.073 | .130 | ||
| What is your income level in Jordanian Dinar (1JD) = 1.4US$) | .185 | .088 | .051 | 2.112 | .035 | .013 | .357 | ||
| What is your educational level? | .000 | .044 | .020 | .006 | .995 | -.086 | .086 | ||
| What is your marital status | .000 | .003 | -.002 | -.079 | .937 | -.006 | .006 | ||
| Where do you live? | .062 | .145 | .012 | .428 | .669 | -.222 | .347 | ||
| Do you smoke? | -.133 | .117 | -.025 | -1.131 | .258 | -.363 | .097 | ||
| How many times did you get COVID-19? | -.162 | .098 | -.037 | -1.646 | .100 | -.355 | .031 | ||
| What type of vaccine do you have? | .089 | .062 | .032 | 1.428 | .153 | -.033 | .211 | ||
COVID-19 = SARS-CoV-2.
a. Dependent Variable: sleep quality.
4. Discussion
To the best of our knowledge, this is the first national study to examine the impact of the COVID-19 era on sleep quality and sleep patterns among recovered individuals from COVID-19 infection. Researchers found that after recovery, COVID-19 patients still complained of poor sleep quality and disturbances in sleep patterns. Many other studies have supported the finding of our study.[17,18]
4.1. Prevalence and description of sleep quality and sleep disturbances among participants
The present study found that the prevalence of low sleep quality among the recovered individuals during post-COVID-19 era was 40.6%, and the prevalence of disturbance in sleep quality was 63.6%, regarding the sleep quality. Similarly, the prevalence of poor sleep quality in the public during the COVID-19 pandemic was revealed in many studies based on sleep instrument instruments scores.[19,25–27] The consequences of COVID-19-related quarantine on sleep quality from many individuals remain debatable. According to 2 studies, roughly half of the participants’ sleep quality deteriorated during the quarantine in Italy and Australia.[28–30] Similarly, other studies found that almost 33% of participants had worsened sleep quality.[6,31,32] In the general population, symptoms of sleep disturbance frequently overlapped with many other psychiatric diseases such as depression.[33] A study among 11 countries found that a quarantine reduced the prevalence of low sleep quality.[34] The findings could point to societal resilience to the persistent danger of viral infection as well as changes in daily life. The disparities in sleep disturbance proportions and changes across countries may be explained, at least in part, by differences in pandemic control policy and general perception of the COVID-19 crisis.[16,17] Interestingly, Kocevska et al, reported that 20 of pre-pandemic deep sleep had exacerbated sleep issues during postCOVID-19 era, while a 25% of respondents with pre-pandemic low quality sleep had improved sleep during the COVID-19 pandemic.[35] They contended that the impacts of COVID-19 on sleep quality are not uniform, emphasizing individual differences in response to the COVID-19 crisis.
4.2. Predictors of sleep pattern
Our study found that many predictors were determined the pattern of sleep. These predictors were age and income level. This means lower economic status and younger age in twenties and thirties were experienced more disturbances in sleep pattern than other older ages. A study found an association between the duration of recovery from COVID-19 and the severity of sleep pattern disturbances was shown to be statistically significant,[36] which is in keeping with a study that sleep patterns and sleep quality were found to be more prevalent. Prevalent in the immediate post COVID-19 (36). This conclusion was also in line with a study that found that sleep disturbances were widespread even 1 year following a critical illness, particularly after intensive care.[37] According to latest research in 2 countries, females are a greater chance than males of suffering from sleep disorders in China and Italy.[38,39] Moreover, the study includes age and gender as moderate or severe low quality sleep indicators in the examined population. Patients from urban regions had a positive and statistically significant connection with the average insomnia severity score, consistent with research that revealed that cases following COVID-19 of sleep difficulties were highly prevalent compared to rural regions in metropolitan areas and cities.[26]
4.3. Predictors of sleep quality
Our study found that many predictors determined the quality of sleep. These predictors were age, income, and educational level. The effects of age on sleep quality during the COVID-19 pandemic appear contentious. Two studies found that people over the age of 30 were more likely to experience sleep disturbances during the COVID-19 pandemic,[37,40] correlating with previous findings that the prevalence of low-quality of sleep elevated with age.[41,42] The age-related worsening sleep quality is because of increased stress that many experiences from COVID-19 infection. On the other hand, data from The Cococel Group revealed a rise in the incidence of low sleep quality in young people aged 18 to 34 years compared to older people.[43] Two cross-sectional studies consistently reported increased sleep issues in university students from normal to quarantine.[44,45] It could be understood by their daytime low-quality sleep and stress as a result of significant changes in their daily lives and studies as a result of home COVID-19 quarantine and changes in lifestyle. As a result, it is possible that the impacts of age on sleep during the COVID-19 pandemic are complex and inconclusive and may be impacted by other lifestyle influences.
There is a gender difference in the prevalence of sleep issues. When confronted with the COVID-19 crisis, females appeared to be more prone to sleep problems and decreased quality of sleep than males.[37,46] On the other hand, a study found that females mentioned a higher sleep quality and low depressive distress compared to males.[47] Furthermore, other factors impacted living area,[33,37] education experience,[48–50] marital status,[51] and having a mental disorder[48,52] were also linked to decreasing quality of sleep during the COVID-19 pandemic.
5. Limitations
There are many limitations that facing of this study. Firstly, this study used a cross-sectional study which limit the generalizability of the finding to other participants. Another limitation is using of self-report survey to collect data from the participants. However, the study is included very large number of the participant which restrict the participants to use self-report measure.
6. Implications
The present results indicate that more consideration should be given to individuals who recovered from COVID-19. Access to medical resources for emotional first aid during the pandemic should be improved and possibly delivered via telemedicine.[53] Acknowledging and treating sleep disturbances is especially important during stressful times such as the COVID-19 pandemic, and practitioners should be trained to evaluate and manage sleep disturbances, as this comprehensive approach can reduce mental distress and prevent consequences of sleep disturbances.
7. Conclusion
To sum up, our study found that the prevalence of low sleep quality among the recovered individuals during post-COVID-19 era was moderate, and the prevalence of disturbance in sleep quality was high. The predictors of quality of sleep were age, income, and educational level. Our study found that lower economic status and younger ages in twenties and thirties experienced more disturbances in sleep pattern than other older ages. practitioners should be trained to evaluate and manage sleep disturbances, as this comprehensive approach has the potential to reduce mental distress and prevent consequences of sleep disturbances.
Author contributions
Conceptualization: Karem H Alzoubi, Basheer Khasawneh.
Data curation: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Formal analysis: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Funding acquisition: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Investigation: Sawsan Abuhammad, Omar F Khabour, Basheer Khasawneh.
Methodology: Sawsan Abuhammad, Basheer Khasawneh.
Project administration: Shaher Hamaideh, Basheer Khasawneh.
Resources: Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh.
Software: Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Supervision: Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Validation: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Visualization: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Basheer Khasawneh.
Writing – original draft: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Writing – review & editing: Sawsan Abuhammad, Karem H Alzoubi, Omar F Khabour, Shaher Hamaideh, Basheer Khasawneh.
Correction
This article was originally published with incorrect affiliations for Basheer Khasawneh. Basheer Khasawneh’s affiliation has been corrected from affiliations e and f to affiliation f.
Abbreviations:
- COVID-19 =
- SARS-CoV-2
The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.
The authors have no funding and conflicts of interest to disclose.
This project was supported by a grant (MPH/01/14/2021) from the Scientific Research Funds, Ministry of Higher Education and Scientific Research, Amman, Jordan.
How to cite this article: Abuhammad S, Alzoubi KH, Khabour OF, Hamaideh S, Khasawneh B. Sleep quality and sleep patterns among recovered individuals during post-COVID-19 among Jordanian: A cross-sectional national study. Medicine 2023;102:3(e32737).
Contributor Information
Karem H Alzoubi, Email: khalzoubi@just.edu.jo.
Omar F Khabour, Email: khabour@just.edu.jo.
Shaher Hamaideh, Email: shaherhamaideh2011@gmail.com.
Basheer Khasawneh, Email: nasralrabadi1984@gmail.com.
References
- [1].Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021;38:101019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [2].Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Gupta R, Grover S, Basu A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatr. 2020;62:370. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev. 2019;7:23–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Garrigues E, Janvier P, Kherabi Y, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81:e4–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Besher Gharaibeh IA-b, Sawsan A, Mother G. Sleep quality among different classes of heart failure patients in Jordan: a STROBE compliant cross-sectional study. Medicine (Baltimore). 2022;14:34–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Gharaibeh B, Al-Absi I, Abuhammad S, et al. Sleep quality among different classes of heart failure patients in Jordan: a STROBE compliant cross-sectional study. Medicine (Baltimore). 2022;101:e32069e32069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Gharaibeh B, Al-Absi I, Abuhammad S, et al. Dimensions of sleep characteristics and predictors of sleep quality among heart failure patients: a strobe compliant cross-sectional study in Jorda. Medicine (Baltimore). 2022;6:41–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Suliman LAE-M, Ali REM, Shehata MEDA, et al. Predictors of sleepiness in obstructive sleep-apnea syndrome: a cross-sectional study. Egypt J Chest Dis Tuberculosis. 2022;71:353. [Google Scholar]
- [11].Faubel R, Lopez-Garcia E, Guallar-Castillón P, et al. Sleep duration and health-related quality of life among older adults: a population-based cohort in Spain. Sleep. 2009;32:1059–68. [PMC free article] [PubMed] [Google Scholar]
- [12].Magee CA, Caputi P, Iverson DC. Relationships between self-rated health, quality of life and sleep duration in middle aged and elderly Australians. Sleep Med. 2011;12:346–50. [DOI] [PubMed] [Google Scholar]
- [13].Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11:1–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Chow CM. Sleep and wellbeing, now and in the future. MDPI. 2020;4:56–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Perrin R, Riste L, Hann M, et al. Into the looking glass: post-viral syndrome post COVID-19. Med Hypotheses. 2020;144:110055. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Gill CM, Piggott LM, Kent BD. Sleep medicine and coronavirus disease 2019. Curr Opin Pulm Med. 2021;27:529–34. [DOI] [PubMed] [Google Scholar]
- [17].Alzueta E, Perrin PB, Yuksel D, et al. An international study of post-COVID sleep health. Sleep Health. 2022;23:67–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Fernández-de-las-Peñas C, Torres-Macho J, Elvira-Martínez CM, et al. Obesity is associated with a greater number of long-term post-COVID symptoms and poor sleep quality: a multicentre case-control study. Int J Clin Pract. 2021;75:e14917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [19].Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Lucassen EA, Rother KI, Cizza G. Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci. 2012;1264:110–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [21].Paules CI, Marston HD, Fauci AS. Coronavirus infections – more than just the common cold. JAMA. 2020;323:707–8. [DOI] [PubMed] [Google Scholar]
- [22].Taquet M, Dercon Q, Harrison PJ. Six-month sequelae of post-vaccination SARS-CoV-2 infection: a retrospective cohort study of 10,024 breakthrough infections. Brain Behav Immun. 2022;103:154–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [23].Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307. [DOI] [PubMed] [Google Scholar]
- [24].Suleiman KH, Yates BC. Translating the insomnia severity index into Arabic. J Nurs Scholarsh. 2011;43:49–53. [DOI] [PubMed] [Google Scholar]
- [25].Bartoszek A, Walkowiak D, Bartoszek A, et al. Mental well-being (depression, loneliness, insomnia, daily life fatigue) during COVID-19 related home-confinement – a study from Poland. Int J Environ Res Public Health. 2020;17:74177417. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [26].Yu BY-M, Yeung W-F, Lam JC-S, et al. Prevalence of sleep disturbances during COVID-19 outbreak in an urban Chinese population: a cross-sectional study. Sleep Med. 2020;74:18–24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [27].Killgore WD, Cloonan SA, Taylor EC, et al. Suicidal ideation during the COVID-19 pandemic: the role of insomnia. Psychiatry Res. 2020;290:113134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [28].Cellini N, Canale N, Mioni G, et al. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020;29:e13074. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [29].Goularte JF, Serafim SD, Colombo R, et al. COVID-19 and mental health in Brazil: psychiatric symptoms in the general population. J Psychiatr Res. 2021;132:32–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [30].Barrea L, Pugliese G, Framondi L, et al. Does Sars-Cov-2 threaten our dreams?. Effect of quarantine on sleep quality and body mass index. J Transl Med. 2020;18:1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [31].Wu C, Hu X, Song J, et al. Mental health status and related influencing factors of COVID-19 survivors in Wuhan, China. Clin Transl Med. 2020;10:e52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [32].Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594–600. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [33].Casagrande M, Favieri F, Tambelli R, et al. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med. 2020;75:12–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [34].Riiser K, Helseth S, Haraldstad K, et al. Adolescents’ health literacy, health protective measures, and health-related quality of life during the Covid-19 pandemic. PLoS One. 2020;15:e0238161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [35].Kocevska D, Blanken TF, Van Someren EJ, et al. Sleep quality during the COVID-19 pandemic: not one size fits all. Sleep Med. 2020;76:86–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [36].McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med. 2020;16:1645–1645. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [37].Wang S, Xie L, Xu Y, et al. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med (Oxf). 2020;70:364–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [38].Xia L, Chen C, Liu Z, et al. Prevalence of sleep disturbances and sleep quality in Chinese healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Front Psychiatry. 2021;12:646342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [39].Bruni O, Malorgio E, Doria M, et al. Changes in sleep patterns and disturbances in children and adolescents in Italy during the Covid-19 outbreak. Sleep Med. 2022;91:166–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [40].Ara T, Rahman MM, Hossain MA, et al. Identifying the associated risk factors of sleep disturbance during the COVID-19 lockdown in Bangladesh: a web-based survey. Front Psychiatry. 2020;11:580268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [41].Kim HJ, Kim RE, Kim S, et al. Sex differences in deterioration of sleep properties associated with aging: a 12-year longitudinal cohort study. J Clin Sleep Med. 2021;17:964–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [42].Czeisler CA, Dumont M, Duffy J, et al. Association of sleep-wake habits in older people with changes in output of circadian pacemaker. Lancet. 1992;340:933–6. [DOI] [PubMed] [Google Scholar]
- [43].Beck F, Léger D, Fressard L, et al. Covid-19 health crisis and lockdown associated with high level of sleep complaints and hypnotic uptake at the population level. J Sleep Res. 2021;30:e13119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [44].Kaparounaki CK, Patsali ME, Mousa D-PV, et al. University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry Res. 2020;290:113111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [45].Marelli S, Castelnuovo A, Somma A, et al. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2021;268:8–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [46].Li Y, Qin Q, Sun Q, et al. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020;16:1417–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [47].Salfi F, Lauriola M, Amicucci G, et al. Gender-related time course of sleep disturbances and psychological symptoms during the COVID-19 lockdown: a longitudinal study on the Italian population. Neurobiol Stress. 2020;13:100259. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [48].Fu W, Wang C, Zou L, et al. Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China. Transl Psychiatry. 2020;10:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [49].Kokou-Kpolou CK, Megalakaki O, Laimou D, et al. Insomnia during COVID-19 pandemic and lockdown: prevalence, severity, and associated risk factors in French population. Psychiatry Res. 2020;290:113128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [50].Rossi R, Socci V, Talevi D, et al. COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Front Psychiatry. 2020;10:12–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [51].Shi L, Lu Z-A, Que J-Y, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Network Open. 2020;3:e2014053e20140–53-e. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [52].Léger D, Beck F, Fressard L, et al. Poor sleep associated with overuse of media during the COVID-19 lockdown. Sleep. 2020;11:34–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [53].Muflih SM, Al-Azzam S, Abuhammad S, et al. Pharmacists’ experience, competence and perception of telepharmacy technology in response to COVID-19. Int J Clin Pract. 2021;75:e14209. [DOI] [PMC free article] [PubMed] [Google Scholar]