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  • 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

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Epidemiology
Original research
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
  1. Markku Partinen1,2,
  2. Brigitte Holzinger3,
  3. Charles M Morin4,
  4. Colin Espie5,
  5. Frances Chung6,
  6. Thomas Penzel7,
  7. Christian Benedict8,
  8. Courtney J Bolstad9,
  9. Jonathan Cedernaes10,11,
  10. Rachel Ngan Yin Chan12,
  11. Yves Dauvilliers13,
  12. Luigi De Gennaro14,15,
  13. Fang Han16,
  14. Yuichi Inoue17,18,
  15. Kentaro Matsui19,20,
  16. Damien Leger21,22,
  17. Ana Suely Cunha23,
  18. Ilona Merikanto24,
  19. Sergio Mota-Rolim25,26,
  20. Michael Nadorff9,
  21. Giuseppe Plazzi27,28,
  22. Jules Schneider5,
  23. Mariusz Sieminski29,
  24. Yun-Kwok Wing12,
  25. Bjørn Bjorvatn30,31
  1. 1Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland
  2. 2Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
  3. 3Institute for Dream and Consciousness Research, Medical University of Vienna, Wien, Austria
  4. 4Centre d’étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada
  5. 5Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  6. 6Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada
  7. 7Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
  8. 8Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden
  9. 9Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
  10. 10Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  11. 11Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  12. 12Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  13. 13National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Centre Montpellier, Montpellier, France
  14. 14Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy
  15. 15IRCCS Fondazione Santa Lucia, Roma, Italy
  16. 16Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
  17. 17Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan
  18. 18Neuropsychiatric Research Institute, Japan Somnology Center, Tokyo, Japan
  19. 19Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan
  20. 20Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Japan
  21. 21Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France
  22. 22VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Universite de Paris, Paris, France
  23. 23Production Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil
  24. 24Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  25. 25Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil
  26. 26Physiology and Behavior Department, Federal University of Rio Grande do Norte, Natal, Brazil
  27. 27IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
  28. 28Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
  29. 29Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
  30. 30Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  31. 31Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
  1. Correspondence to Dr Markku Partinen; markku.partinen{at}helsinki.fi

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.

  • COVID-19
  • epidemiology
  • neurology
  • anxiety disorders
  • sleep medicine
  • social medicine

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-050672

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @MarkkuPartinen

    • Contributors Members of the core group (BB, FC, CE, BH, CMM, MP and TP) contributed in all phases of the study (conception and design, data collection, data analysis and interpretation, drafting the article, critical revision of the article and final approval of the version to be published). YD and IM contributed in the design of the survey, data collection, data analysis and interpretation, critical revision of the article and final approval of the version to be published. CB, CJB, JC, RNYC, LDG, FH, YI, KM, DL, ASC, SM-R, MN, GP, JS, MS and Y-KW contributed in data collection, critical revision of the article and final approval of the version to be published. MP is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.