Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun:36:100916.
doi: 10.1016/j.eclinm.2021.100916. Epub 2021 Jun 10.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

Zainab Alimoradi  1 , Anders Broström  2   3 , Hector W H Tsang  4 , Mark D Griffiths  5 , Shahab Haghayegh  6 , Maurice M Ohayon  7 , Chung-Ying Lin  8   9   10 , Amir H Pakpour  1   2
Affiliations

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

Zainab Alimoradi et al. EClinicalMedicine. 2021 Jun.

Abstract

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

Methods: Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

Funding: The present study received no funding.

Keywords: COVID-19; COVID-19 patients; General population; Healthcare workers; Meta-analysis; Sleep problems.

PubMed Disclaimer

Conflict of interest statement

Chung-Ying Lin was supported in part by a research grant from the Ministry of Science and Technology, Taiwan (MOST109-2327-B-006-005). All other authors have nothing to declare.

Figures

Figure 1
Figure 1
PRISMA Flowchart of selected studies
Figure 2
Figure 2
Results of quality assessment
Figure 3
Figure 3
Forest plot displaying the estimated pooled prevalence of sleep problems among health professionals
Figure 4
Figure 4
Funnel plot assessing publication bias in studies regarding prevalence of sleep problems among health professionals
Figure 5
Figure 5
Corrected funnel plot assessing publication bias in studies regarding prevalence of sleep problems among health professionals
Figure 6
Figure 6
Forest plot displaying the estimated pooled prevalence of sleep problems among general population
Figure 7
Figure 7
Funnel plot assessing publication bias in studies regarding prevalence of sleep problems among general population
Figure 8
Figure 8
Corrected funnel plot assessing publication bias in studies regarding prevalence of sleep problems among general population
Figure 9
Figure 9
Forest plot displaying the estimated pooled prevalence of sleep problems among COVID-19 patients
Figure 10
Figure 10
Funnel plot assessing publication bias in studies regarding prevalence of sleep problems among Covid patients
Figure 11
Figure 11
Forest plot displaying the estimated pooled Fishers’ Z score in association of sleep problems and depression among health professionals
Figure 12
Figure 12
Forest plot displaying the estimated pooled fishers’ Z score in association of sleep problems and anxiety among health professionals
Figure 13
Figure 13
Forest plot displaying the estimated pooled Fishers’ Z score in association of sleep problems and depression among general population
Figure 14
Figure 14
Forest plot displaying the estimated pooled Fishers’ Z score in association of sleep problems and anxiety among general population
Figure 15
Figure 15
Forest plot displaying the estimated pooled Fishers’ Z score in association of sleep problems and depression among COVID-19 patients
Figure 16
Figure 16
Forest plot displaying the estimated pooled fishers’ Z score in association of sleep problems and anxiety among Covid patients
See this image and copyright information in PMC

References

    1. Nowbar A.N., Gitto M., Howard J.P., Francis D.P., Al-Lamee R. Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors From NCD Risk Factor Collaboration. Circulation: Cardiovascular Quality and Outcomes. 2019;12 - PMC - PubMed
    1. WHO . World Health Organization; Switzerland: 2020. Coronavirus disease 2019 (COVID-19): situation report, 72.
    1. WHO . World Health Organization; Geneva, Switzerland: 2020. WHO Coronavirus Disease (COVID-19) Dashboard.
    1. Stewart-Ibarra A.M., Hargrave A., Diaz A. Psychological distress and Zika, Dengue and Chikungunya symptoms following the 2016 earthquake in Bahía de Caráquez, Ecuador. International journal of environmental research and public health. 2017;14:1516. - PMC - PubMed
    1. Tucci V., Moukaddam N., Meadows J., Shah S., Galwankar S.C., Kapur G.B. The forgotten plague: psychiatric manifestations of ebola, zika, and emerging infectious diseases. Journal of Global Infectious Diseases. 2017;9:151. - PMC - PubMed