Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

Zainab Alimoradi; Anders Broström; Hector W H Tsang; Mark D Griffiths; Shahab Haghayegh; Maurice M Ohayon; Chung-Ying Lin; Amir H Pakpour

doi:10.1016/j.eclinm.2021.100916

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

EClinicalMedicine. 2021 Jun:36:100916. doi: 10.1016/j.eclinm.2021.100916. Epub 2021 Jun 10.

Authors

Zainab Alimoradi¹, Anders Broström^{2

3}, Hector W H Tsang⁴, Mark D Griffiths⁵, Shahab Haghayegh⁶, Maurice M Ohayon⁷, Chung-Ying Lin^{8

9

10}, Amir H Pakpour^{1

2}

Affiliations

¹ Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
² Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
³ Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
⁴ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
⁵ International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
⁶ Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁷ Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA.
⁸ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁹ Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ Department of Occupational Therapy, College of Medicine, National Cheng Kung University.

Abstract

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

Methods: Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

Funding: The present study received no funding.

Keywords: COVID-19; COVID-19 patients; General population; Healthcare workers; Meta-analysis; Sleep problems.