Prevalence and risk factors of sleep disturbance in adults with underlying health conditions during the ongoing COVID-19 pandemic

Abstract

To determine the prevalence of sleep disturbance during the coronavirus disease 2019 (COVID-19) pandemic among US adults who are more vulnerable to complications because of age and co-morbid conditions, and to identify associated sociodemographic and psychosocial factors. Cross-sectional survey linked to 3 active clinical trials and 2 cohort studies, conducted between 11/30/2020 and 3/3/2021. Five academic internal medicine practices and 2 federally qualified health centers. A total of 715 adults ages 23 to 91 years living with one or more chronic conditions. A fifth (20%) of participants reported poor sleep. Black adults were twice as likely to report poor sleep compared to Whites. Self-reported poor physical function (51%), stress (42%), depression (28%), and anxiety (36%) were also common and all significantly associated with poor sleep. Age ≥70 years and having been vaccinated for COVID-19 were protective against poor sleep. Sex, education, income, alcohol use, and employment status were not significantly associated with sleep quality. In this diverse sample of adults with chronic conditions, by race, ethnicity, and socioeconomic status, disparities in sleep health amid the ongoing pandemic were apparent. Worse physical function and mental health were associated with poor sleep and should be considered targets for health system interventions to prevent the many subsequent consequences of disturbed sleep on health outcomes. Measurements: self-reported sleep quality, physical function, stress, depression, and anxiety. Abbreviations: AUDIT-C = the 3-question alcohol use disorders identification test, C3 = the COVID-19 & chronic conditions study, CDC = the centers for disease control and prevention, CHAI = the consumer health activation index, COPD = chronic obstructive pulmonary disease, COVID-19 = coronavirus disease 2019, FDA = US Food and Drug Administration, MESA = multi-ethnic study of atherosclerosis study, PROMIS = Patient-Reported Outcomes Information System, PROMIS-SD = Patient-Reported Outcomes Information System Sleep Disturbance Battery, PSQI = Pittsburgh sleep quality index, PSS-10 = Cohen's 10-item perceived stress scale, VOC = variant of concern.

Sleep Quality among Older Adults in Brazil during the Coronavirus Disease 2019 Pandemic: The Role of Physical Activity

“…These results corroborate those of previous reports from different countries and with patients in different age ranges, such as studies conducted in Israel (age range: 60 to 92 years), 7 Bangladesh (age range: 18 to 75 years), 9 the United States (age range: 23 to 91 years), 11 and Japan (age range: 20 to 86 years), 13 which also reported worsening sleep quality during the pandemic. More comprehensive research, such as the international cross-sectional study by Mandelkorn et al, 17 which analyzed the sleep quality of 2,562 adults with a mean age of 45.18 AE 14.46 years from 49 countries, reported that 40% of the sample revealed a decrease in sleep quality during the pandemic.…”

“…A cross-sectional study was performed using a convenience sample of 290 older adults (aged ≥ 60 years) from 61 Brazilian cities. Based on previous studies 10 11 that reported that between 20% and 29% of older adults experienced poor sleep quality or deterioration of sleep quality during the pandemic, the sample size was estimated considering a prevalence of 25% in older adults with sleep problems, a sampling error of 5%, and a 95% confidence level. As such, the minimum sample size was calculated to be of 289 subjects.…”

“…In a research by Kim et al 11 , 20.0% of the sample (715 adults in total, aged between 23 and 91 years) perceived worsening sleep quality during the pandemic, impaired physical capacity, and perceived stress and symptoms of anxiety and depression were highly prevalent and significantly associated.…”

Association between psychological discomforts and sleep quality among people living with HIV/AIDS

“…At the same time, no significant difference was found in the mean age of individuals, gender, or BMI based on sleep quality. Studies have been done examining sleep as it relates to age in PLWH [5,37,38], and gender [39,40]. There have been mixed results on both variables in past research, and this could warrant further examination.…”

Global burden of sleep disturbances among older adults and the disparities by geographical regions and pandemic periods

“…We included five different sleep disturbances: 1) sleep disorders (sleep problems in 19 studies using self-constructed items ( Amerio et al, 2023 ; Collinge & Bath, 2023 ; Corley et al, 2021 ; Gokseven et al, 2022 ; Gustavsson & Beckman, 2020 ; Ikeda et al, 2022 ; Kapusta et al, 2023 ; Makizako et al, 2021 ; Nakai et al, 2022 ; Okely et al, 2020 ; Osiogo et al, 2021 ; Paiva et al, 2021 ; Perelman, Xavier, & Barros, 2022 ; Rodríguez-Gómez et al, 2022 ; Sampaio Brito, de Lima, Mascarenhas, Mota, & Leite, 2021 ; Sapara et al, 2021 ; van der Velden, Marchand, Das, Muffels, & Bosmans, 2022 ; Yilmaz & Onal, 2023 ; Yurumez Korkmaz et al, 2021 ) and poor sleep quality in seven studies using Pittsburgh sleep quality index (PSQI) and the Patient-Reported Outcomes Information System (PROIS) ( Amicucci, Salfi, D'Atri, Viselli, & Ferrara, 2021 ; Bhat, Mir, Hussain, & Shah, 2020 ; Garcia Carlini et al, 2023 ; Kantor, Kantor, Fortgang, & Pace-Schott, 2022 ; Kim et al, 2022 ; Udeh-Momoh et al, 2021 ; Wang et al, 2021 ); 2) short sleep duration <7 h (three studies) ( Amerio et al, 2023 ; Mistry et al, 2021 ; Rodríguez-Gómez et al, 2022 ) and long sleep duration ≥9 h (two studies) ( Mistry et al, 2021 ; Rodríguez-Gómez et al, 2022 ); 3) insomnia symptoms (three studies using self-constructed items ( Savci et al, 2021 ; Schou-Bredal et al, 2021 ; Xu, Li, Zhu, & Zhong, 2022 ) and 11 studies using the insomnia severity index (ISI) or the Athens insomnia scale (AIS) ( Al-Mutawa & Al-Mutairi, 2021 ; Amicucci et al, 2021 ; Christodoulou et al, 2023 ; Dale, Budimir, Probst, Stippl, & Pieh, 2021 ; Humer, Schaffler, Jesser, Probst, & Pieh, 2022 ; Li et al, 2022 ; Parlapani et al, 2020 ; Philip et al, 2020 ; Pieh et al, 2021 ; …”