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).