Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire

Markku Partinen^{1

2}, Brigitte Holzinger³, Charles M Morin⁴, Colin Espie⁵, Frances Chung⁶, Thomas Penzel⁷, Christian Benedict⁸, Courtney J Bolstad⁹, Jonathan Cedernaes^{10

11}, Rachel Ngan Yin Chan¹², Yves Dauvilliers¹³, Luigi De Gennaro^{14

15}, Fang Han¹⁶, Yuichi Inoue^{17

18}, Kentaro Matsui^{19

20}, Damien Leger^{21

22}, Ana Suely Cunha²³, Ilona Merikanto²⁴, Sergio Mota-Rolim^{25

26}, Michael Nadorff⁹, Giuseppe Plazzi^{27

28}, Jules Schneider⁵, Mariusz Sieminski²⁹, Yun-Kwok Wing¹², Bjørn Bjorvatn^{30

31}

Affiliations

¹ Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland markku.partinen@helsinki.fi.
² Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
³ Institute for Dream and Consciousness Research, Medical University of Vienna, Wien, Austria.
⁴ Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada.
⁵ Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
⁶ Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada.
⁷ Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
⁸ Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden.
⁹ Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
¹⁰ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹¹ Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹² Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
¹³ National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Centre Montpellier, Montpellier, France.
¹⁴ Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
¹⁵ IRCCS Fondazione Santa Lucia, Roma, Italy.
¹⁶ Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China.
¹⁷ Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan.
¹⁸ Neuropsychiatric Research Institute, Japan Somnology Center, Tokyo, Japan.
¹⁹ Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan.
²⁰ Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Japan.
²¹ Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France.
²² VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Universite de Paris, Paris, France.
²³ Production Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil.
²⁴ Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
²⁵ Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil.
²⁶ Physiology and Behavior Department, Federal University of Rio Grande do Norte, Natal, Brazil.
²⁷ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
²⁸ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²⁹ Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
³⁰ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
³¹ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

PMID: 34903540
PMCID: PMC8671846
DOI: 10.1136/bmjopen-2021-050672

Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire

Markku Partinen et al. BMJ Open. 2021.

. 2021 Dec 13;11(12):e050672.

doi: 10.1136/bmjopen-2021-050672.

Authors

Affiliations

¹ Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland markku.partinen@helsinki.fi.
² Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
³ Institute for Dream and Consciousness Research, Medical University of Vienna, Wien, Austria.
⁴ Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada.
⁵ Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
⁶ Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada.
⁷ Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
⁸ Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden.
⁹ Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
¹⁰ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
¹¹ Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹² Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
¹³ National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Centre Montpellier, Montpellier, France.
¹⁴ Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
¹⁵ IRCCS Fondazione Santa Lucia, Roma, Italy.
¹⁶ Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China.
¹⁷ Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan.
¹⁸ Neuropsychiatric Research Institute, Japan Somnology Center, Tokyo, Japan.
¹⁹ Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan.
²⁰ Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Japan.
²¹ Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France.
²² VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Universite de Paris, Paris, France.
²³ Production Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil.
²⁴ Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
²⁵ Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil.
²⁶ Physiology and Behavior Department, Federal University of Rio Grande do Norte, Natal, Brazil.
²⁷ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
²⁸ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²⁹ Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
³⁰ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
³¹ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

PMID: 34903540
PMCID: PMC8671846
DOI: 10.1136/bmjopen-2021-050672

Abstract

Objectives: Sleep is important for human health and well-being. No previous study has assessed whether the COVID-19 pandemic impacts sleep and daytime function across the globe.

Methods: This large-scale international survey used a harmonised questionnaire. Fourteen countries participated during the period of May-August 2020. Sleep and daytime problems (poor sleep quality, sleep onset and maintenance problems, nightmares, hypnotic use, fatigue and excessive sleepiness) occurring 'before' and 'during' the pandemic were investigated. In total, 25 484 people participated and 22 151 (86.9%) responded to the key parameters and were included. Effects of COVID-19, confinement and financial suffering were considered. In the fully adjusted logistic regression models, results (weighted and stratified by country) were adjusted for gender, age, marital status, educational level, ethnicity, presence of sleep problems before COVID-19 and severity of the COVID-19 pandemic in each country at the time of the survey.

Results: The responders were mostly women (64%) with a mean age 41.8 (SD 15.9) years (median 39, range 18-95). Altogether, 3.0% reported having had COVID-19; 42.2% reported having been in confinement; and 55.9% had suffered financially. All sleep and daytime problems worsened during the pandemic by about 10% or more. Also, some participants reported improvements in sleep and daytime function. For example, sleep quality worsened in about 20% of subjects and improved in about 5%. COVID-19 was particularly associated with poor sleep quality, early morning awakening and daytime sleepiness. Confinement was associated with poor sleep quality, problems falling asleep and decreased use of hypnotics. Financial suffering was associated with all sleep and daytime problems, including nightmares and fatigue, even in the fully adjusted logistic regression models.

Conclusions: Sleep problems, fatigue and excessive sleepiness increased significantly worldwide during the first phase of the COVID-19 pandemic. Problems were associated with confinement and especially with financial suffering.

Keywords: COVID-19; anxiety disorders; epidemiology; neurology; sleep medicine; social medicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: FC reports grants from Ontario Ministry of Health Innovation Grant and University Health Network Foundation, and personal fees from Masimo Inc and Takeda Pharma, outside the submitted work. In addition, University Health Network has a patent STOP-Bang questionnaire pending. YI reports personal fees and other from Astellas Pharma, personal fees from Eisai, other from Idorsia Pharmaceuticals Japan, grants from Koike Medical, personal fees from Otsuka Pharmaceutical and grants from Philips Japan outside the submitted work; DL reports grants from grants from Philips (Netherlands), Vanda (USA), Sanofi, Vitalaire International, Merck, and Janssen, Jazz and TYTHM outside the submitted work; KM reports personal fees from Eisai, Meiji Seika Pharma, Mochida, MSD, Otsuka Pharmaceutical and Yoshitomi Pharmaceutical, outside the submitted work; MP reports personal fees and other from Bioprojet, other from Jazz Pharmaceuticals, personal fees from UCB-Pharma, GSK, Takeda and Orion, personal fees and other from MSD and Umecrine, outside the submitted work. MP reports personal fees and other from Bioprojet, other from Jazz Pharmaceuticals, personal fees from UCB-Pharma, GSK, Takeda and Orion, personal fees and other from MSD and Umecrine, outside the submitted work; TP reports personal fees from Jazz Pharmaceuticals, personal fees from Bayer Healthcare, Neuwirth and Löwenstein Medical, outside the submitted work, and Shareholder of The Siestagroup GmbH, Advanced Sleep Research GmbH, Nukute; GP reports personal fees from UCB-Pharma, Jazz pharmaceuticals, Bioprojet,Idorsia, Takeda, outside the submitted work; Y-KW reports grants from Research Grant Council General Research Fund, grants from Health and Medical Research Fund, personal fees from Eisai Inc, personal fees from Eisai Co., Ltd, other from Lundbeck HK Limited, outside the submitted work.

Figures

**Figure 1**
(A, B) Prevalence of all sleep problems before and during the pandemic. There was a statistically significant difference in the prevalence before and during the pandemic for all sleep problems (p<0.0001). Error bars represent SD.

See this image and copyright information in PMC

References

1. WHO COVID-19 Dashboard . Who coronavirus disease (COVID-19) Dashboard, 2021. Available: https://covid19whoint/ [Accessed 19th Sep 2021].
1. Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ 2016;355:i5210. 10.1136/bmj.i5210 - DOI - PubMed
1. Sivertsen B, Øverland S, Bjorvatn B, et al. Does insomnia predict sick leave? the Hordaland health study. J Psychosom Res 2009;66:67–74. 10.1016/j.jpsychores.2008.06.011 - DOI - PubMed
1. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch 2012;463:121–37. 10.1007/s00424-011-1044-0 - DOI - PMC - PubMed
1. Zhang J, Xu D, Xie B, et al. Poor-sleep is associated with slow recovery from lymphopenia and an increased need for ICU care in hospitalized patients with COVID-19: a retrospective cohort study. Brain Behav Immun 2020;88:50–8. 10.1016/j.bbi.2020.05.075 - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire

Affiliations

Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical