Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis

Abstract

Background: Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic.

Methods: We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020.

Results: A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1% (95% CI 36.2-42.0%); the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1-39.9%) and 41.8% (95% CI 33.6-50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression.

Conclusions: Over one third of our sample present insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustains high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.

Keywords: COVID-19; China; Insomnia; Sleep.

Fig. 1

PRISMA flow diagram of study inclusion. PRISMA=Preferred Reporting Items for Systematic Review and Meta-analysis protocols checklist.

Fig. 2

Milestone events of China during the outbreak and epidemic of COVID-19. These milestone events mainly refer to “Fighting Covid-19, China in Action”. Fangcang shelter hospitals: large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centers, into health-care facilities. Red color, acute phase of COVID-19 pandemic in China. Yellow color, transition period of COVID-19 pandemic in China. Both red and yellow periods indicate the early stage of COVID-19 pandemic in China; Green color depicts the period of COVID-19 under control in China (late stage of COVID-19 pandemic in China). The “early stage” of COVID-19 pandemic in China was defined as the time between December 2019 and April 1st, 2020, and the “late stage” of COVID-19 pandemic in China was the time after April 1st, 2020. WTO=World Trade Organization.

Fig. 3

Prevalence of insomnia symptoms among specific sub-populations. Error bars indicate the 95% confidence interval.

Fig. 4

Forest plot of prevalence of insomnia symptoms during the early and late stages of COVID-19 pandemic in China. The “early stage” of COVID-19 pandemic in China was defined as the time between December 2019 and April 1st, 2020, and the “late stage” of COVID-19 pandemic in China was the time after April 1st, 2020.