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Partinen M, Holzinger B, Morin CM, et al. 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. BMJ Open. 2021;11(12):e050672doi: 10.1136/bmjopen-2021-050672.
Partinen, M., Holzinger, B., Morin, C. M., Espie, C., Chung, F., Penzel, T., Benedict, C., Bolstad, C. J., Cedernaes, J., Chan, R. N. Y., Dauvilliers, Y., De Gennaro, L., Han, F., Inoue, Y., Matsui, K., Leger, D., Cunha, A. S., Merikanto, I., Mota-Rolim, S., Nadorff, M., Plazzi, G., Schneider, J., Sieminski, M., Wing, Y. K., & Bjorvatn, B. (2021). 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. BMJ open, 11(12), e050672. https://doi.org/10.1136/bmjopen-2021-050672
Partinen, Markku, et al. "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." BMJ open vol. 11,12 (2021): e050672. doi: https://doi.org/10.1136/bmjopen-2021-050672
Partinen M, Holzinger B, Morin CM, Espie C, Chung F, Penzel T, Benedict C, Bolstad CJ, Cedernaes J, Chan RNY, Dauvilliers Y, De Gennaro L, Han F, Inoue Y, Matsui K, Leger D, Cunha AS, Merikanto I, Mota-Rolim S, Nadorff M, Plazzi G, Schneider J, Sieminski M, Wing YK, Bjorvatn B. 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. BMJ Open. 2021 Dec 13;11(12):e050672. doi: 10.1136/bmjopen-2021-050672. PMID: 34903540; PMCID: PMC8671846.
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BMJ Open. 2021 Dec 13;11(12):e050672. doi: 10.1136/bmjopen-2021-050672.

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.

BMJ open

Markku Partinen, Brigitte Holzinger, Charles M Morin, Colin Espie, Frances Chung, Thomas Penzel, Christian Benedict, Courtney J Bolstad, Jonathan Cedernaes, Rachel Ngan Yin Chan, Yves Dauvilliers, Luigi De Gennaro, Fang Han, Yuichi Inoue, Kentaro Matsui, Damien Leger, Ana Suely Cunha, Ilona Merikanto, Sergio Mota-Rolim, Michael Nadorff, Giuseppe Plazzi, Jules Schneider, Mariusz Sieminski, Yun-Kwok Wing, Bjørn Bjorvatn

Affiliations

  1. Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland [email protected].
  2. Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
  3. Institute for Dream and Consciousness Research, Medical University of Vienna, Wien, Austria.
  4. Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval École de psychologie, Quebec, Quebec, Canada.
  5. Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
  6. Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada.
  7. Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
  8. Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden.
  9. Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
  10. Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  11. Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  12. Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
  13. National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Centre Montpellier, Montpellier, France.
  14. Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
  15. IRCCS Fondazione Santa Lucia, Roma, Italy.
  16. Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China.
  17. Department of Somnology, Tokyo Medical University, Shinjuku-ku, Japan.
  18. Neuropsychiatric Research Institute, Japan Somnology Center, Tokyo, Japan.
  19. Department of Clinical Laboratory and Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry National Institute of Mental Health, Kodaira, Japan.
  20. Department of Psychiatry, Tokyo Women's Medical University, Shinjuku-ku, Japan.
  21. Sleep and Vigilance Center, Hopital Hotel-Dieu de Paris, Paris, France.
  22. VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Universite de Paris, Paris, France.
  23. Production Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil.
  24. Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
  25. Brain Institute, Onofre Lopes University Hospital, Petropolis, Brazil.
  26. Physiology and Behavior Department, Federal University of Rio Grande do Norte, Natal, Brazil.
  27. IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
  28. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
  29. Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
  30. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
  31. Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.

PMID: 34903540 PMCID: PMC8671846 DOI: 10.1136/bmjopen-2021-050672

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.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: COVID-19; anxiety disorders; epidemiology; neurology; sleep medicine; social medicine

Conflict of interest statement

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 submi

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