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
Bjørn Bjorvatn,
Frances Chung,
Kentaro Matsui,
Christian Benedict,
Damien Léger,
Giuseppe Plazzi,
Yuichi Inoue,
Yves Dauvilliers,
Colin Espie,
Fang Han,
Luigi De Gennaro,
Markku Partinen,
Brigitte Holzinger,
Charles M Morin,
Thomas Penzel,
Courtney J Bolstad,
Jonathan Cedernaes,
Rachel Ngan Yin Chan,
Ana Suely Cunha,
Ilona Merikanto,
Sergio Mota-Rolim,
Michael Nadorff,
Jules Schneider,
Mariusz Sieminski,
Yun-Kwok Wing
Affiliations
Bjørn Bjorvatn
Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
Frances Chung
1 Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Kentaro Matsui
Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan
Christian Benedict
Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden
Damien Léger
Centre du sommeil et de la vigilance, Hôtel Dieu, APHP, Paris, France
Giuseppe Plazzi
IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
Yuichi Inoue
Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan
Yves Dauvilliers
6Unité du Sommeil, Département de Neurologie, Hôpital Gui-de-Chauliac, Université Montpellier, INSERM 1061, Montpellier, France
Colin Espie
Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
Fang Han
Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, China
Luigi De Gennaro
Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy
Markku Partinen
Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland
Brigitte Holzinger
Institute for Dream and Consciousness Research, Medical University of Vienna, Wien, Austria
Charles M Morin
Centre d’étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada
Thomas Penzel
Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
Courtney J Bolstad
Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
Jonathan Cedernaes
Department of Medical Sciences, Uppsala University, Uppsala, Sweden
Rachel Ngan Yin Chan
Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Ana Suely Cunha
Production Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil
Ilona Merikanto
Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Sergio Mota-Rolim
Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil
Michael Nadorff
Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
Jules Schneider
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Mariusz Sieminski
Medical University of Gdansk, Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Gdansk, Poland
Yun-Kwok Wing
Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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.
