Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

Czeisler, Mark É; Capodilupo, Emily R; Weaver, Matthew D.; Czeisler, Charles A.; Rajaratnam, Shantha M W

doi:10.1016/j.sleh.2022.03.001

Cited by 17 publications

(13 citation statements)

References 58 publications

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“…This could lead to an underestimation of the impact of holidays as there were later bed times and wake times and longer sleep duration overall during this interval ( Robbins et al, 2021 ). Sleep consistency had also increased during the pandemic ( Czeisler et al, 2022 ) potentially leading to an overestimation in the changes in sleep consistency associated with holidays.…”

Section: Discussionmentioning

confidence: 99%

“…Sleep consistency was measure using a proprietary method adapted from the previously validated Sleep Regularity Index (SRI) ( Phillips et al, 2017 ), which is the percentage of concordance of individuals being in the same state (asleep versus awake) at different timepoints. Whereas the SRI compares two total timepoints 24 h apart, the WHOOP sleep consistency compares 24-h timepoints over a 4-day interval ( Czeisler et al, 2022 ). Additional timepoints were included to incorporate additional recent historical sleep-wake data into the WHOOP sleep consistency score, with the intervals assigned progressively lower weights as they become further apart.…”

Section: Methodsmentioning

confidence: 99%

“…The baselines were comprised of the same day of the week to account for population-level variance in sleep behaviors based on the day of the week ( Capodilupo and Miller, 2021 ). A local rather than a complete-year baseline was selected to avoid the confounding effect of seasonal variation in sleep and alcohol use patterns and the effect of fluctuating severity of the coronavirus disease 2019 (COVID-19) pandemic and its associated mitigation policies ( Capodilupo and Miller, 2021 ; Czeisler et al, 2022 ).…”

Section: Methodsmentioning

confidence: 99%

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Sleep and Alcohol Use Patterns During Federal Holidays and Daylight Saving Time Transitions in the United States

Heacock¹,

Capodilupo²,

Czeisler

et al. 2022

Front. Physiol.

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We conducted a retrospective observational study using remote wearable and mobile application data to evaluate whether US public holidays or Daylight Saving Time transitions were associated with significant changes in sleep behaviors, including sleep duration, sleep onset and offset, and the consistency of sleep timing, as well as changes in the point prevalence of alcohol use. These metrics were analyzed using objective, high resolution sleep-wake data (10,350,760 sleep episodes) and 5,777,008 survey responses of 24,250 US subscribers (74.5% male; mean age of 37.6 ± 9.8 years) to the wrist-worn biometric device platform, WHOOP (Boston, Massachusetts, United States), who were active users during 1 May 2020, through 1 May 2021. Compared to baseline, statistically significant differences in sleep and alcohol measures were found on most DST transitions, US public holidays, and their eves. For example, New Year’s Eve corresponded with a sleep consistency decrease of 13.8 ± 0.3%, a sleep onset delay of 88.9 ± 3.2 min (00:01 vs. 22:33 baseline) later, a sleep offset delay of 78.1 ± 3.1 min (07:56 vs. 06:39), and an increase in the prevalence of alcohol consumption, with more than twice as many participants having reported alcohol consumption [+138.0% ± 6.7 (74.2% vs. 31.2%)] compared to baseline. In this analysis of a non-random sample of mostly male subscribers conducted during the COVID-19 pandemic, the majority of US public holidays and holiday eves were associated with sample-level increases in sleep duration, decreases in sleep consistency, later sleep onset and offset, and increases in the prevalence of alcohol consumption. Future work would be warranted to explore the generalizability of these findings and their public health implications, including in more representative samples and over longer time intervals.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Sleep and Alcohol Use Patterns During Federal Holidays and Daylight Saving Time Transitions in the United States

Heacock¹,

Capodilupo²,

Czeisler

et al. 2022

Front. Physiol.

Self Cite

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“…The relationship between sleep deficiency and burnout symptoms is consistent with findings from a study of a US adult general population sample with objective wearable devices to measure sleep-wake data, in which persistently short sleep duration and sleep duration shortened during the pandemic were each associated with burnout, anxiety, and depression symptoms. 51 Additionally, untreated or potentially undiagnosed sleep or circadian disorders (ie, insomnia, obstructive sleep apnoea, shift work disorder) were associated with more severe burnout symptoms but treated diagnosed sleep and circadian disorders were not. Prepandemic research has reported similar relationships between untreated and undiagnosed sleep disorders and burnout symptoms in healthcare workers, 52 which, together with our findings, highlight the potential protective role that treatment of sleep and circadian disorders may have in reducing burnout symptoms.…”

Section: Discussionmentioning

confidence: 99%

Association between burnout and adherence with mask usage and additional COVID-19 prevention behaviours: findings from a large-scale, demographically representative survey of US adults

et al. 2023

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ObjectivesStudies have found associations between occupational burnout symptoms and reduced engagement with healthy behaviours. We sought to characterise demographic, employment and sleep characteristics associated with occupational burnout symptoms, and to evaluate their relationships with adherence to COVID-19 prevention behaviours (mask usage, hand hygiene, avoiding gatherings, physical distancing, obtaining COVID-19 tests if potentially infected).MethodsDuring December 2020, surveys were administered cross-sectionally to 5208 US adults (response rate=65.8%). Quota sampling and survey weighting were employed to improve sample representativeness of sex, age and race and ethnicity. Among 3026 employed respondents, logistic regression models examined associations between burnout symptoms and demographic, employment and sleep characteristics. Similar models were conducted to estimate associations between burnout and non-adherence with COVID-19 prevention behaviours.ResultsWomen, younger adults, unpaid caregivers, those working more on-site versus remotely and those with insufficient or impaired sleep had higher odds of occupational burnout symptoms. Burnout symptoms were associated with less frequent mask usage (adjusted odds ratio (aOR)=1.7, 95% CI 1.3–2.1), hand hygiene (aOR=2.1, 95% CI 1.7–2.7), physical distancing (aOR=1.3, 95% CI 1.1–1.6), avoiding gatherings (aOR=1.4, 95% CI 1.1–1.7) and obtaining COVID-19 tests (aOR=1.4, 95% CI 1.1–1.8).ConclusionsDisparities in occupational burnout symptoms exist by gender, age, caregiving, employment and sleep health. Employees experiencing occupational burnout symptoms might exhibit reduced adherence with COVID-19 prevention behaviours. Employers can support employee health by addressing the psychological syndrome of occupational burnout.

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“…Heart rate variability (HRV) is a noninvasive measure of the autonomic nervous system. The WHOOP Strap (Whoop, Inc., Boston, MA, USA) is a commercially available wearable device that provides continuous physiological data including HRV for a range of applications, including predicting COVID-19 (Miller et al, 2020) and risk of adverse mental health outcomes (Czeisler et al, 2022)). Rowan et al (2022) utilized the WHOOP Strap to describe decreases in maternal HRV during term pregnancies until approximately 33 weeks when the trend reversed and increased through delivery.…”

Section: Introductionmentioning

confidence: 99%

Wearable-Derived Maternal Heart Rate Variability As A Novel Digital Biomarker of Preterm Birth

Jasinski¹,

Rowan

Presby³

et al. 2022

Preprint

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Despite considerable health consequences from preterm births, their incidence remains unchanged over recent decades, due partially to limited screening methods and limited use of extant methods. Wearable technology offers a novel, noninvasive, and acceptable way to track vital signs, such as maternal heart rate variability (mHRV). Previous research observed that mHRV declines throughout the first 33 weeks of gestation in term, singleton pregnancies, after which it improves. The aim of this study was to explore whether mHRV inflection is a feature of gestational age or an indication of time to delivery. This retrospective case-control study considered term and preterm deliveries. Remote data collection via non-invasive wearable technology enabled diverse participation with subjects representing 42 US states and 16 countries. Participants (N=241) were recruited from the WHOOP (Whoop, Inc.) userbase and wore WHOOP straps during singleton pregnancies between March 2021 and October 2022. Mixed effect spline models by gestational age and time until birth were fit for within-person mHRV, grouped into preterm and term births. For term pregnancies, gestational age (AIC = 26627.6, R2m = 0.0109 , R2c= 0.8571) and weeks until birth (AIC =26616.3, R2m = 0.0112 , R2c = 0.8576) were representative of mHRV trends, with significantly stronger fit for weeks until birth (relative log-likelihood ratio = 279.5). For preterm pregnancies, gestational age (AIC =1861.9, R2m = 0.0016, R2c = 0.8582) and time until birth ( AIC = 1848.0, R2m = 0.0100, R2c = 0.8676) were representative of mHRV trends, with significantly stronger fit for weeks until birth (relative log-likelihood ratio= 859.4). This study suggests that wearable technology, such as the WHOOP strap, may provide a digital biomarker for preterm delivery by screening for changes in nighttime mHRV throughout pregnancy that could in turn alert to the need for further evaluation and intervention.

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Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

Cited by 17 publications

References 58 publications

Sleep and Alcohol Use Patterns During Federal Holidays and Daylight Saving Time Transitions in the United States

Sleep and Alcohol Use Patterns During Federal Holidays and Daylight Saving Time Transitions in the United States

Association between burnout and adherence with mask usage and additional COVID-19 prevention behaviours: findings from a large-scale, demographically representative survey of US adults

Wearable-Derived Maternal Heart Rate Variability As A Novel Digital Biomarker of Preterm Birth

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