Discussion
There are several studies evaluating the burden of mental health issues
(stress, anxiety and depression) and sleep disturbance among healthcare
providers during COVID-19. The prevalence of sleep problems is high and
affects approximately 40% of people from general and health care
populations. No systematic review or meta-analysis has yet been
conducted to examine the impact of the pandemic on the prevalence of
sleep problems among the general population, healthcare professionals,
or COVID-19 patients (1-3). A recent systematic review evaluated the
impact and prevalence of sleep problems among the general population,
healthcare workers, or COVID-19 patients of the pandemic. They found
that health care workers and the general population had comparative
rates of sleep problems with rates of 36.0% (95% CI, 21.1–54.2%) and
32.3% (95% CI, 25.3–40.2%), respectively (11). The prevalence and
severity of sleep problems in different populations remains unknown. We
evaluated how sleep behaviors changed in a large population of
healthcare workers during the COVID-19 pandemic in Turkey, the presence
of excessive daytime sleepiness, and their sleep quality with the JSS,
which is an easily applicable scale.
Healthcare workers who participated in our survey reported that they
started to go to bed later, fell asleep later (mean:41.75±35.35minutes),
their total sleep time (mean:6.67±1.88 hours) was shortened, and they
needed medication to sleep more (%5.7) after the COVID-19 pandemic.
During the COVID-19 pandemic, bedtime behavior after 24:00 decreased
from 80.1% to 43.9% of those who previously went to bed before 24:00.
For those who went to bed after 24:00 before, it increased from 19.9%
to 56.1%.In addition, sleep quality as assessed by subjective and JSS
significantly deteriorated after theCOVID-19 pandemic. Excessive daytime
sleepiness increased. Those with ESS>10 before COVID-19
were 3.9%, post-COVID-19 ESS>10 14.1%
(p<0.001).
Mental health status of healthcare workers worldwide during the COVID-19
pandemic; It has been shown to be affected by high levels of psychiatric
symptoms, including anxiety, depression, acute stress, PTDS, and sleep
disturbances. Sleep problems may be associated with other disorders such
as: PTSD, depression, anxiety. Two factors can contribute to sleep
problems among healthcare workers: high workload (including night work
that alters circadian rhythms) and stress-induced sleep problems
(1,12,13). Global prevalence reports of 20-45% for insomnia symptoms
during the COVID-19 pandemic (3). Sleep deprivation leads to cognitive
impairment and reduces cognitive processing affecting everything from
memory to reflexes. This is an important risk factor for health workers
to make wrong decisions and for important mistakes and work accidents.
Moreover, inadequate and poor sleep affects the immune system and mental
health, impairs the immune response, facilitates the spread of
infectious diseases, and worsens mental health and quality of life
(1,11,14). The sleep behaviors and sleep quality of our participants
were adversely affected by the COVID-19 pandemic. The deterioration in
sleep quality was independent of active work in the pandemic. This
suggested that even if all healthcare professionals do not care for
COVID-19 patients, working in a high-risk area may be sufficient to
disrupt their sleep patterns.
The Pittsburgh Sleep Quality Index (PSQI) captures a very broad range of
sleep-related issues (eg, nightmares, snoring, sleep medication use),
which may explain the higher prevalence rates compared with the Athens
Insomnia Scale, Insomnia Severity Index, or researcher developed
measure. Findings on sleep problems were obtained using the PSQI,
suggesting that health care providers and the general population were
affected comparatively with rates of 39.7% (95% CI, 21.2–61.6%) and
37.9% (95% CI, 25.2–52.4%), respectively (1). We preferred JSS to
assess sleep quality, as PSQI is more difficult to applicability and
computation in large population studies. We also asked about the
subjective sleep quality as poor, moderate, high. In the COVID 19
pandemic, very few studies have used the JSS (15,16), and there is no
study conducted in healthcare workers. It is very significant and
practical to use in large population studies to evaluate the effects of
the pandemic on sleep quality.
Also, ESS is often used in large studies. We found that daytime
sleepiness increased during the pandemic in healthcare workers who
participated in our study. Healthcare workers are particularly at risk
of sleepiness affecting their jobs as they tend to work long shifts or
work at night. This was accompanied by depression, anxiety and working
under stress. Excessive sleepiness and fatigue can lead to deterioration
in cognitive functions, leading to serious errors and accidents in the
workplace (17-20). Therefore, training on sleep hygiene and coping with
fatigue should be given to healthcare professionals. It is necessary to
try to control various behavioral and environmental factors that may
adversely affect sleep quality and duration (21,22).