Top

Published in:

01-03-2021 | Coronavirus | Epidemiology • Original Articlef

The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19

Authors: Haitham Jahrami, Ahmed S. BaHammam, Haifa AlGahtani, Ahmed Ebrahim, MoezAlIslam Faris, Kawthar AlEid, Zahra Saif, Eman Haji, Ali Dhahi, Hussain Marzooq, Suad Hubail, Zainab Hasan

Published in: Sleep and Breathing | Issue 1/2021

Abstract

Purpose

Few studies have addressed the sleep disturbances of healthcare workers during crisis events of public health. This study aimed to examine the sleep quality of frontline healthcare workers (FLHCW) in Bahrain during the COVID-19 pandemic, and compare it with the sleep quality of non-frontline healthcare workers (NFLHCW).

Methods

Healthcare workers (n = 280) from multiple facilities belonging to the Ministry of Health, Bahrain, were invited to participate in this cross-sectional study. An online questionnaire, including socio-demographics, the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS), was used to evaluate sleep disturbances and stress levels of healthcare workers. Poor sleep quality was defined as PSQI ≥ 5 and moderate-severe stress as PSS ≥ 14. Descriptive statistics were used to compare the scores of FLHCW and NFLHCW. Univariate and multivariate binary logistic regressions were used to identify predictors of poor sleep quality, moderate-severe stress, and the combined problem of poor sleep quality and moderate-severe stress.

Results

A total of 257 participants (129 FLHCW and 128 NFLHCW) provided usable responses. The overall PSQI and PSS scores were 7.0 ± 3.3 and 20.2 ± 7.1, respectively. The FLHCW scored higher in the PSQI and PSS compared with the NFLHCW; however, the differences in the PSQI and PSS scores were not statistically significant. For the FLHCW, 75% were poor sleepers, 85% had moderate-severe stress, and 61% had both poor sleep quality and moderate-severe stress. For the NFLHCW, 76% were poor sleepers, 84% had moderate-severe stress, and 62% had both poor sleep quality and moderate-severe stress. Female sex and professional background were the predictors of poor sleep quality and stress.

Conclusions

Poor sleep quality and stress are common during the COVID-19 crisis. Approximately, 60% of both FLHCW and NFLHCW have poor sleep quality combined with moderate-severe stress.

Chen C, Zhou Y, Wang DW (2020) SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz 45:1–3. https://doi.org/10.1007/s00059-020-04909-zCrossRef

Somily AM, BaHammam AS (2020) Coronavirus disease-19 (severe acute respiratory syndrome-coronavirus-2) is not just simple influenza: what have we learned so far? J Nat Sci Med 3(2):79–82. https://doi.org/10.4103/JNSM.JNSM_22_20CrossRef

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia Ja YT, Zhang X, Zhang L (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223):507–513. https://doi.org/10.1016/S0140-6736(20)30211-7CrossRefPubMedPubMedCentral

Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R (2020) COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 24:91–98. https://doi.org/10.1016/j.jare.2020.03.005CrossRefPubMedPubMedCentral

World Health Organization. Coronavirus disease (COVID-2019) situation reports, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it, https://www.who.int/emergencies/diseases/novelcoronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it

Tucci V, Moukaddam N, Meadows J, Shah S, Galwankar SC, Kapur GB (2017) The forgotten plague: psychiatric manifestations of ebola, zika, and emerging infectious diseases. J Global Infect Dis 9(4):151–156. https://doi.org/10.4103/jgid.jgid_66_17CrossRef

Stewart-Ibarra AM, Hargrave A, Diaz A, Kenneson A, Madden D, Romero MM, Molina JP, Macias Saltos D (2017) Psychological distress and zika, dengue and chikungunya symptoms following the 2016 earthquake in Bahía de Caráquez, Ecuador. Int J Environ Res Public Health 14(12). https://doi.org/10.3390/ijerph14121516

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC (2020) Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 17(5). https://doi.org/10.3390/ijerph17051729

10.

Levin J (2019) Mental health care for survivors and healthcare workers in the aftermath of an outbreak. Psychiatry Pandemics:127–141. https://doi.org/10.1007/978-3-030-15346-5_11

11.

Cates DS, Gomes PG, Krasilovsky AM (2018) Behavioral health support for patients, families, and healthcare workers. Bioemerg Plan:195–214. https://doi.org/10.1007/978-3-319-77032-1_16

12.

Lehmann M, Bruenahl CA, Löwe B, Addo MM, Schmiedel S, Lohse AW, Schramm C (2015) Ebola and psychological stress of health care professionals. Emerg Infect Dis 21(5):913–914. https://doi.org/10.3201/eid2105.141988CrossRefPubMedPubMedCentral

13.

Kline C (2013) Sleep quality. In: Gellman MD, Turner JR (eds) Encyclopedia of behavioral medicine. Springer, New York, NY, pp 1811–1813CrossRef

14.

Rosipal R, Lewandowski A, Dorffner G (2013) In search of objective components for sleep quality indexing in normal sleep. Biol Psychol 94(1):210–220. https://doi.org/10.1016/j.biopsycho.2013.05.014CrossRefPubMedPubMedCentral

15.

Madrid-Valero JJ, Martínez-Selva JM, Ribeiro do Couto B, Sánchez-Romera JF, Ordoñana JR (2017) Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac Sanit 31(1):18–22. https://doi.org/10.1016/j.gaceta.2016.05.013CrossRefPubMed

16.

Qiu D, Yu Y, Li R-Q, Li Y-L, Xiao S-Y (2020) Prevalence of sleep disturbances in Chinese healthcare professionals: a systematic review and meta-analysis. Sleep Med 67:258–266. https://doi.org/10.1016/j.sleep.2019.01.047CrossRefPubMed

17.

Zeng L-N, Yang Y, Wang C, Li X-H, Xiang Y-F, Hall BJ, Ungvari GS, Li C-Y, Chen C, Chen L-G, Cui X-L, An F-R, Xiang Y-T (2019) Prevalence of poor sleep quality in nursing staff: a meta-analysis of observational studies. Behav Sleep Med:1–14. https://doi.org/10.1080/15402002.2019.1677233

18.

AlSaif HI (2018) Prevalence of and risk factors for poor sleep quality among residents in training in KSA. J Taibah Univ Med Sci 14(1):52–59. https://doi.org/10.1016/j.jtumed.2018.11.007CrossRefPubMedPubMedCentral

19.

Ferri P, Guadi M, Marcheselli L, Balduzzi S, Magnani D, Di Lorenzo R (2016) The impact of shift work on the psychological and physical health of nurses in a general hospital: a comparison between rotating night shifts and day shifts. Risk Manag Healthc Policy 9:203–211. https://doi.org/10.2147/RMHP.S115326CrossRefPubMedPubMedCentral

20.

Caruso CC (2014) Negative impacts of shiftwork and long work hours. Rehab Nurs 39(1):16–25. https://doi.org/10.1002/rnj.107CrossRef

21.

Koinis A, Giannou V, Drantaki V, Angelaina S, Stratou E, Saridi M (2015) The impact of healthcare workers job environment on their mental-emotional health. Coping Strateg 3(1). https://doi.org/10.4081/hpr.2015.1984

22.

Kumar A, Bhat PS, Ryali S (2018) Study of quality of life among health workers and psychosocial factors influencing it. Ind Psychiatry J 27(1):96–102. https://doi.org/10.4103/ipj.ipj_41_18CrossRefPubMedPubMedCentral

23.

Mohanty A, Kabi A, Mohanty AP (2019) Health problems in healthcare workers: a review. J Fam Med Prim Care 8(8):2568–2572. https://doi.org/10.4103/jfmpc.jfmpc_431_19CrossRef

24.

Jahrami H, Dewald-Kaufmann J, Faris MA-I, AlAnsari AMS, Taha M, AlAnsari N (2019) Prevalence of sleep problems among medical students: a systematic review and meta-analysis. J Public Health. https://doi.org/10.1007/s10389-019-01064-6

25.

Medic G, Wille M, Hemels ME (2017) Short- and long-term health consequences of sleep disruption. Nat Sci Sleep 9:151–161. https://doi.org/10.2147/NSS.S134864CrossRefPubMedPubMedCentral

26.

Elm EV, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12(12):1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013CrossRef

27.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefPubMed

28.

Cohen S (1988) Perceived stress in a probability sample of the United States

29.

Manzar MD, BaHammam AS, Hameed UA, Spence DW, Pandi-Perumal SR, Moscovitch A, Streiner DL (2018) Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health Qual Life Outcomes 16(1):89. https://doi.org/10.1186/s12955-018-0915-xCrossRefPubMedPubMedCentral

30.

Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A (2016) The Pittsburgh Sleep Quality Index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev 25:52–73. https://doi.org/10.1016/j.smrv.2015.01.009CrossRefPubMed

31.

Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, Reis SE, Matthews KA (2008) Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 4(6):563–571CrossRefPubMedPubMedCentral

32.

Jiang JM, Seng EK, Zimmerman ME, Kim M, Lipton RB (2017) Positively worded subscale score of the Perceived Stress Scale is associated with cognitive domain function. J Behav Brain Sci 7(7):311–324. https://doi.org/10.4236/jbbs.2017.77023CrossRefPubMedPubMedCentral

33.

Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396CrossRefPubMed

34.

Lee E-H (2012) Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res 6(4):121–127. https://doi.org/10.1016/j.anr.2012.08.004CrossRef

35.

Stata MPtE (2019) 16.0. College Station, TX: StataCorp

36.

Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, Patterson PD, Hostler D (2012) The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med 19(1):85–91. https://doi.org/10.1111/j.1553-2712.2011.01254.xCrossRefPubMed

37.

Surani AA, Surani A, Zahid S, Ali S, Farhan R, Surani S (2015) To assess sleep quality among Pakistani junior physicians (house officers): a cross-sectional study. Ann Med Health Sci Res 5(5):329–333. https://doi.org/10.4103/2141-9248.165246CrossRefPubMedPubMedCentral

38.

Alhifzi S, Al-Ghonimy A, Al Aboudi M, Al Abdullah R, Olaish A, BaHammam AS (2018) Assessment of sleep quality, daytime sleepiness, and depression among emergency physicians working in shifts. J Nat Sci Med 1:17–21. https://doi.org/10.4103/JNSM.JNSM_8_18CrossRef

39.

Xiao H, Zhang Y, Kong D, Li S, Yang N (2020) The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 26:e923549. https://doi.org/10.12659/MSM.923549CrossRefPubMedPubMedCentral

40.

Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, Du H, Li R, Kang L, Su M, Zhang J, Liu Z, Zhang B (2020) Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry 11:306. https://doi.org/10.3389/fpsyt.2020.00306CrossRefPubMedPubMedCentral

41.

Merga H, Fufa T (2019) Impacts of working environment and benefits packages on the health professionals’ job satisfaction in selected public health facilities in eastern Ethiopia: using principal component analysis. BMC Health Serv Res 19(1):494. https://doi.org/10.1186/s12913-019-4317-5CrossRefPubMedPubMedCentral

42.

Brooks SK, Dunn R, Amlot R, Rubin GJ, Greenberg N (2018) A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 60(3):248–257. https://doi.org/10.1097/JOM.0000000000001235CrossRefPubMed

43.

Thompson MR, Schwartz Barcott D (2017) The concept of exposure in environmental health for nursing. J Adv Nurs 73(6):1315–1330. https://doi.org/10.1111/jan.13246CrossRefPubMedPubMedCentral

44.

Matud MP, Bethencourt JM, Ibanez I (2015) Gender differences in psychological distress in Spain. Int J Soc Psychiatry 61(6):560–568. https://doi.org/10.1177/0020764014564801CrossRefPubMed

45.

Maunder RG, Lancee WJ, Rourke S, Hunter JJ, Goldbloom D, Balderson K, Petryshen P, Steinberg R, Wasylenki D, Koh D, Fones CS (2004) Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Psychosom Med 66(6):938–942. https://doi.org/10.1097/01.psy.0000145673.84698.18CrossRefPubMed

46.

Ter Horst JP, de Kloet ER, Schächinger H, Oitzl MJC, neurobiology m (2012) Relevance of stress and female sex hormones for emotion and cognition. 32(5):725–735

47.

Barsky AJ, Peekna HM, Borus JF (2001) Somatic symptom reporting in women and men. J Gen Intern Med 16(4):266–275CrossRefPubMedPubMedCentral

48.

Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, Chew-Graham C, Peters D, Hodkinson A, Riley R, Esmail A (2018) Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med 178(10):1317–1330. https://doi.org/10.1001/jamainternmed.2018.3713CrossRefPubMedPubMedCentral

49.

LeBlanc VR (2009) The effects of acute stress on performance: implications for health professions education. Acad Med 84(10 Suppl):S25–S33. https://doi.org/10.1097/ACM.0b013e3181b37b8fCrossRefPubMed

50.

Mulfinger N, Sander A, Stuber F, Brinster R, Junne F, Limprecht R, Jarczok MN, Seifried-Dubon T, Rieger MA, Zipfel S, Peters M, Stiawa M, Maatouk I, Helass M, Nikendei C, Rothermund E, Hander N, Ziegenhain U, Gulde M, Genrich M, Worringer B, Kullenberg J, Blum K, Suss S, Gesang E, Ruhle S, Contributors of the Sc, Muller A, Schweitzer-Rothers J, Angerer P, Gundel H (2019) Cluster-randomised trial evaluating a complex intervention to improve mental health and well-being of employees working in hospital - a protocol for the SEEGEN trial. BMC Public Health 19(1):1694. https://doi.org/10.1186/s12889-019-7909-4CrossRefPubMedPubMedCentral

51.

Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, Cheung T, Xiang YT Progression of mental health services during the COVID-19 outbreak in China. (1449–2288 (Electronic))

52.

Lemma S, Gelaye B, Berhane Y, Worku A, Williams MA (2012) Sleep quality and its psychological correlates among university students in Ethiopia: a cross-sectional study. BMC Psychiatry 12:237–237. https://doi.org/10.1186/1471-244X-12-237CrossRefPubMedPubMedCentral

53.

Rebello CR, Kallingappa PB, Hegde PG (2018) Assessment of perceived stress and association with sleep quality and attributed stressors among 1(st)-year medical students: a cross-sectional study from Karwar, Karnataka, India. Ci Ji Yi Xue Za Zhi 30(4):221–226. https://doi.org/10.4103/tcmj.tcmj_85_17CrossRefPubMed

54.

Sano A, Phillips AJ, Yu AZ, McHill AW, Taylor S, Jaques N, Czeisler CA, Klerman EB, Picard RW (2015) Recognizing academic performance, sleep quality, stress level, and mental health using personality traits, wearable sensors and mobile phones. Int Conf Wearable Implant Body Sens Netw. https://doi.org/10.1109/BSN.2015.7299420

55.

Bihlmaier I, Schlarb AA (2016) Self-efficacy and sleep problems. Somnologie 20(4):275–280CrossRef

56.

Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG (2020) COVID-19 pandemic: stress experience of healthcare workers - a short current review. Psychiatr Prax 47(4):190–197. https://doi.org/10.1055/a-1159-5551CrossRefPubMedPubMedCentral

57.

Taylor AM, Holscher HD (2020) A review of dietary and microbial connections to depression, anxiety, and stress. Nutr Neurosci. 23(3):237–250CrossRefPubMed

58.

Ismaeel A, Weems S, Ellor JW, Crow J, Myers D, Dolan S, Whitacre J, Morissette SBJMBH (2018) Association between negative emotional states and unhealthy nutritional behaviors in soldiers. 6(1):66–74

Title: The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19
Authors: Haitham Jahrami
Ahmed S. BaHammam
Haifa AlGahtani
Ahmed Ebrahim
MoezAlIslam Faris
Kawthar AlEid
Zahra Saif
Eman Haji
Ali Dhahi
Hussain Marzooq
Suad Hubail
Zainab Hasan
Publication date: 01-03-2021
Publisher: Springer International Publishing
Keywords: Coronavirus
SARS-CoV-2
COVID-19
Published in: Sleep and Breathing / Issue 1/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-020-02135-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Hypoxemic features of obstructive sleep apnea and the risk of mortality: a cluster analysis

Longer duration electroencephalogram arousals have a better relationship with impaired vigilance and health status in obstructive sleep apnoea

Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review

Dysfunction of processing task-irrelevant emotional faces in primary insomnia patients: an evidence from expression-related visual MMN

Serum adropin level is associated with endothelial dysfunction in patients with obstructive sleep apnea and hypopnea syndrome

Sea level nocturnal minimal oxygen saturation can accurately detect the presence of obstructive sleep apnea in a population with high pretest probability

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage