Anxiety and sleep quality in a sample of Lebanese healthcare workers during the COVID-19 outbreak

A cross-sectional, survey based study was conducted in order to assess mental health outcomes among healthcare workers in a private university hospital involved in the COVID-19 response in Lebanon. The main objective was to quantify symptoms of anxiety and sleep quality using self-rating scales (the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) respectively), while identifying factors that might affect those symptoms. A total of 628 healthcare workers completed the survey; 409 (66.2%) were younger than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered nurses, residents, women, and younger participants presented higher scores on both scales than other categories of participants. Among factors related with COVID-19, those associated with higher scores were having relatives affected by the virus (22.2%), being excessively exposed to media (12.9%), and increasing the consumption of substances/alcohol (31.2%) during this period. Factors associated with higher risk of anxiety symptoms after multivariable logistic regression analysis were: female sex, young age, poor sleep quality, and living with elderly. Our findings contribute to the understanding of the psychological wellbeing of health care workers involved in the acute COVID-19 outbreak in Lebanon.     

Sleep characteristics in health workers exposed to the COVID-19 pandemic

IntroductionThe development of sleep disorders, and specifically insomnia, has been linked to the exposure to different stressors. In this line, Coronavirus disease 2019 (COVID-19) outbreak caused by the new coronavirus SARS-CoV-2, has caused a huge impact on our environment, and has exposed healthcare workers to an unprecedented threat. In this study, we try to assess sleep quality and the development of sleep disorders in health personnel directly dedicated to the care of COVID-19 patients at the height of the pandemic, compared to the general population.Materials and methodsA cross-sectional, anonymized, self-reported questionnaire survey was carried out at the “12 de Octubre” Hospital, in Madrid, Spain, during the outbreak of COVID-19, from March 1st to April 30th 2020. We compared two groups, healthcare workers who have treated directly COVID-19 patients versus non-healthcare workers. The questionnaire included demographic data, sleep related aspects, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and 17-items Hamilton Rating Scale (HRS).ResultsIn total 170 participants completed the questionnaire successfully, 100 healthcare workers and 70 non-healthcare workers. Self-reported insomnia, nightmares, sleepwalking, sleep terrors and PSQI>6 were more frequent in the healthcare group (p < 0,05). Shift work was associated to greater risk when performing multiple logistic regression analysis.ConclusionsWe observed that, during the outbreak of COVID-19, healthcare workers on the front line developed more sleep disturbances than non-healthcare professionals, and they had worse quality of sleep. Special attention should be paid to shift workers. Concrete protection and prevention measures for particularly exposed population should be considered in pandemic situations.     

Prevalence and associated factors of poor sleep quality among Chinese returning workers during the COVID-19 pandemic

ObjectivesThe 2019 novel coronavirus (COVID-19) pandemic is a severe global crisis which has resulted in many public health problems. This study aimed to investigate the prevalence of poor sleep quality and its related factors among employees who returned to work during the COVID-19 pandemic.MethodsOur online cross-sectional study included 2,410 participants aged ≥17 years in Deqing and Taizhou, Zhejiang Province, China from 5th to 14th March 2020. The questionnaire covered information on demographic characteristics, health status, workplace, lifestyle, attitude towards COVID-19, assessment of anxiety, depression and sleep quality. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) was administered to measure the poor sleep quality. Poor sleep quality was defined as a global PSQI score>5. Factors associated with sleep quality were analyzed by logistic regression models.ResultsIn sum near half (49.2%) of 2,410 returning workers were females and the average year of subjects was 36.3 ± 9.1 years. The overall prevalence of poor sleep quality was 14.9% (95%CI: 13.5%–16.3%). The average score of PSQI was 3.0 ± 2.5 and average sleep duration was 7.6 ± 1.2 h. Independent related factors of poor sleep quality included age older than 24 years, higher education level, negative attitude towards COVID-19 control measures, anxiety and depression.ConclusionsPoor sleep quality was common and there was a shorter sleep duration among returning workers during the COVID-19 pandemic. Possible risk factors identified from this study may be of great importance in developing proper intervention for the targeted population to improve the sleep health during the COVID-19 public health emergency.     

Relationship between sleep quality and the psychological status of patients hospitalised with COVID-19

AimWe explored the sleep quality of patients who required mental health and clinical interventions in our hospital after being diagnosed with COVID-19.MethodWe enrolled 189 patients hospitalised with COVID-19 in April and May of 2020, of whom 78 were female and 111 male. We evaluated sleep quality and related factors in terms of demographic characteristics, the duration of hospitalisation, and Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety-Depression Scale scores.ResultsAll participants were divided into two groups according to PSQI score: n = 102 (54%) patients with PSQI scores ≥5 and n = 87 (46%) patients with PSQI scores <5. No significant between-group difference was evident in terms of age, gender, marital status, educational level, or chronic disease history. The duration of hospitalisation (p = 0.002) and the depression rate (p = 0.010) were higher in the group exhibiting poor sleep quality (PSQI score ≥5).ConclusionThe duration of hospitalisation was longer in patients experiencing poor sleep quality. Therefore, improvement in sleep quality will reduce the length of hospital and intensive care unit stays.     

Emotional intelligence and problem solving skills in individuals who attempted suicide

AimBased on our clinical observations, low emotional intelligence level and problem-solving skills may have play a role in suicide attempts. The present study is aimed to investigate the emotional intelligence levels and the correlation between problem solving skills and suicide attempts in individuals who already attempted suicide.Material and methodThe study was conducted on twenty-five individuals who attempted suicide and 25 healthy controls with similar sociodemographic characteristics. All participants were asked to fill in the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Problem-Solving Inventory (PSI) and Emotional Intelligence Scale (EIS).FindingsIt was determined that the patient group BAI scores and BDI scores were significantly higher when compared to the control group (p < 0.01, p < 0.01). The total EIS and emotional awareness, emotion management, self-motivation, empathy and relationship control subscale scores of the patient group were significantly lower when compared to the control group (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p = 0.047).PSI scores were significantly higher in the patient group when compared to the control group (p < 0.01). There was a negative correlation between PSI total score and EIS subscale scores.ConclusionIt was observed that these individuals experienced more difficulty in solving problems when compared to healthy individuals, however as their emotional intelligence levels increased, their problem-solving skills increased as well.     

Subjective sleep quality in sarcoidosis

BackgroundPoor sleep is common among patients with medical disorders. Sleep disturbances can be a cause of fatigue and poor quality of life for patients suffering from sarcoidosis. Studies on subjective sleep quality or prevalence of insomnia have not been reported so far.ObjectivesThe aim of this study was to investigate the subjectively reported sleep quality and its relation to psychological and physical factors in sarcoidosis patients.Methods1197 patients from Germany diagnosed with sarcoidosis were examined using the Pittsburgh Sleep Quality Index (PSQI), the Medical Research Council (MRC) dyspnea scale, the Hospital Anxiety and Depression Scale (HADS) and the Multidimensional Fatigue Inventory (MFI).Results802 patients (67%) had PSQI global scores >5, indicating subjectively poor quality of sleep. The mean PSQI score was 7.79 ± 4.00. Women reported a significantly inferior individual quality of sleep than men. The subjective quality of sleep was lowered significantly with increasing dyspnea for men and women. 294 patients (25%) had PSQI global scores >10 usually found in patients with clinically relevant insomnia. In this group 86% had high values for fatigue, 69% for anxiety, and 59% for depression. The prevalence of known sleep apnea was 8.7% and 15.7% for restless legs.ConclusionPoor subjective sleep quality in sarcoidosis patients is about twice as common as in the general population and is associated with fatigue, anxiety, depression and dyspnea. Questions about sleep complaints should therefore be included in the management of sarcoidosis.     

Poor sleep quality diminishes cognitive functioning independent of depression and anxiety in healthy young adults

Sufficient sleep is essential for optimum cognitive and psychological functioning. Diminished sleep quality is associated with depression and anxiety, but the extent to which poor sleep quality uniquely impacts attention and executive functions independent of the effects of the common underlying features of depression and anxiety requires further exploration. Here 67 healthy young adults were given the Minnesota Multiphasic Personality Inventory, second edition (MMPI-2), the Pittsburgh Sleep Quality Index (PSQI), and tests of attention and executive functions. Similar to findings from a previous study with healthy community-based older adults (Nebes, Buysse, Halligan, Houck, & Monk, 2009), participants who reported poor sleep quality on the PSQI endorsed significantly greater scores on MMPI-2 Restructured Clinical scales related to depression and anxiety (Cohen's d?=?0.77-1.05). In addition, PSQI component scores indexing poor sleep quality, duration, and medication use were associated with diminished attention and executive functions, even after controlling for emotional reactivity or demoralization (rs?=?0.21-0.27). These results add to the concurrent validity of the PSQI, and provide further evidence for subtle cognitive decrements related to insufficient sleep even in healthy young adults. Future extension of these findings is necessary with larger samples and clinical comparison groups, and using objective indices of sleep dysfunction such as polysomnography.     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco

BackgroundThe lockdown of COVID-19 (Coronavirus Disease 2019) is associated with several stressful factors that can negatively affect peoples' sleep quality and mental health. Objectives: We conducted this study to evaluate sleep disorders and psychological impact associated with the spread of the COVID-19 and the lockdown on the Moroccan population. We also aimed to study the effects of respondents' beliefs and attitudes about sleep on sleep disorders, anxiety-related symptoms, and depressive symptoms.Material and MethodsWe used a questionnaire enclosing respondents' sociodemographic information, five psychological and behavioral tests including Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), Hamilton Anxiety Rating Scale (HARS) and Beck Depression Inventory (BDI) test.ResultsOur results highlighted widespread false beliefs about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms within the Moroccan population. Nearly 82.3% of respondents revealed false beliefs about sleep. Furthermore, we confirmed a strong positive correlation between knowledge and attitudes about sleep and the prevalence of sleep disorders, anxiety, and depression-related symptoms. However, we found no significant difference in the prevalence of sleep and psychological disorders, between healthcare workers and other professions workers.ConclusionOur study revealed a high prevalence of sleep disorders, anxiety, and depressive symptoms in the Moroccan population during the COVID-19 lockdown period. Moreover, false beliefs on sleep understanding were prevalent and were presenting a risk factor leading to sleep disorders, anxiety, and depressive symptoms.     

The endless quarantine: the impact of the COVID-19 outbreak on healthcare workers after three months of mandatory social isolation in Argentina

ObjectivesAt the end of 2019 the SARS-CoV-2 outbreak spread around the globe with a late arrival to South America. The objective of this study was to evaluate the impact of the long period of mandatory social isolation that took place in Argentina on the general psychological well-being of healthcare workers due to the COVID-19 pandemic.MethodsA survey was conducted during June 2020, in healthcare workers. Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleepiness-Wakefulness Inability and Fatigue Test, and Goldberg depression and anxiety scale, were used to analyze the effects of the SARS-Cov 2 outbreak after three months of mandatory social isolation. Analyses were performed by logistic regression and a clustering algorithm in order to classify subjects in the function of their outcome's severity.ResultsFrom 1059 surveys, the majority reported symptoms of depression (81.0%), anxiety (76.5%), poor sleep quality (84.7%), and insomnia (73.7%) with 58.9% suffering from nightmares. Logistic regression showed that being in contact with COVID-19 patients, age, gender and the consumption of sleep medication during the mandatory social isolation were relevant predictors for insomnia, anxiety, and depression. Clustering analysis classified healthcare workers in three groups with healthy/mild, moderate, and severe outcomes. The most vulnerable group was composed mainly of younger people, female, non-medical staff, or physicians in training.ConclusionAn extremely high proportion of Argentinian healthcare workers suffered from sleep problems, anxiety, and depression symptoms. The clustering algorithm successfully separates vulnerable from non-vulnerable populations suggesting the need to carry out future studies involving resilience and vulnerability factors.     

Sleep Reactivity and Sleep Efforts in Shift Workers

ObjectiveThe current study aimed to investigate the differences in sleep reactivity and sleep effort differs among late night shift workers (LSWs) and non-late night shift workers (non-LSWs), and non-shift workers (non-SWs). MethodsIn total, 6,023 participants (1,613 non-SWs, 3,339 LSWs, and 1,071 non-LSWs) were recruited. Non-SWs was defined as those who works at fixed schedules during standard daylight. LSWs was defined as who work late night hours (10 _PM–6 _AM), while non-LSWs was SWs who did not work during late night. All completed the Ford Insomnia Response to Stress Test (FIRST), the Glasgow Sleep Effort Scale (GSES), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), and the short-term Center for Epidemiologic Studies-Depression scale (CES-D) through online survey. ResultsLSWs and non-LSWs reported higher FIRST, GSES scores than non-SWs. In addition, LSWs reported higher FIRST, GSES scores than non-LSWs. FIRST scores were correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. GSES scores were also correlated with CES-D, PSQI, ISI, and ESS for LSWs, non-LSWs, and non-SWs alike. ConclusionSWs showed higher sleep reactivity and sleep effort than non-SWs. LSWs had higher sleep reactivity and sleep effort than non-LSWs, and these variables are associated with insomnia, daytime sleepiness, and depressive symptoms. Our findings suggests that late night schedule, may increase sleep reactivity and sleep effort, which are associated with sleep and mood disturbances.     

Relationship between Obsessive-Compulsive Symptoms and Anxiety Levels during the COVID-19 Pandemic in Healthcare Professionals <i>vs.</i> Non-Healthcare Professionals

The present study investigated the effect of the COVID-19 pandemic on anxiety levels, contamination and responsibility/control obsessions and associated OC behaviors in healthcare versus non-healthcare professionals. The study also aimed to examine the relationship between anxiety levels and obsessive-compulsive (OC) symptom levels, gender, age, educational level, and personal and family history of chronic diseases. The 664 participants included 395 (59.5%) men and 269 (40.5%) women and comprised 180 (27.1%) healthcare professionals and 484 (72.9%) non-healthcare professionals. The survey included three data collection tools: (i) Sociodemographic data form, (ii) Beck Anxiety Inventory (BAI), and (iii) the Dimensional Obsessive-Compulsive Scale Abriged (DOCS-A) pre- and post-pandemic forms. The BAI scores established a moderate positive correlation with post-pandemic DOCS-A total scores and a weak positive correlation with pre-pandemic DOCS-A total scores (p < 0.001 for both). Pre- and post-pandemic DOCS-A total and subdimension scores were significantly higher in women than in men (p < 0.05). Participants with a personal history of chronic diseases had higher BAI and DOCS-A scores compared to participants with no such history (p < 0.001 and p < 0.001, respectively). The results indicated a significant increase in OC symptoms during the pandemic period compared to the pre-pandemic period and a moderate correlation between the anxiety levels and OC symptom severity. It was also revealed that female gender and personal or family history of chronic diseases posed a higher risk for the increase in anxiety and OC symptoms and healthcare professionals had a higher risk of developing anxiety symptoms compared to non-healthcare professionals.     

Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index,derived from a German community sample of 9284 people

BackgroundThe Pittsburgh Sleep Quality Index (PSQI) is frequently used to assess sleep problems in patients. The aim of this study was to provide reference values for this questionnaire, to test psychometric properties, and to analyze associations with psychological, sociodemographic, and behavioral factors.MethodsA German community sample comprising 9284 adult residents (aged 18–80 years) was surveyed using the PSQI and several other questionnaires.ResultsAccording to the generally accepted cut-off (PSQI > 5), 36% of the general population slept badly. Females reported significantly more sleep problems than males (mean scores: M = 5.5 vs. M = 4.4, respectively; effect size d = 0.35), but there was no linear association between age and sleep quality. Sleep problems were correlated with fatigue, quality of life (physical as well as mental), physical complaints, anxiety, and lack of optimism. Sleep quality was also strongly associated with socioeconomic status, professional situation (poorest sleep quality in unemployed people), and obesity. In addition to the results of the PSQI total score, mean scores of specific components of sleep quality were presented (sleep latency, sleep duration, and use of sleep medication).ConclusionThe PSQI proved to be a suitable instrument for measuring sleep quality. Gender differences, psychological factors, and obesity should be taken into account when groups of patients are compared with respect to sleep problems.     

Effects of COVID-19 Outbreak on Children’s Mental Health: A Comparative Study with Children Diagnosed and Isolated from Their Parents

Objective The COVID-19 outbreak has negatively affected children in many ways. This study aimed to compare the psychological responses of children exposed to different levels of stress during the COVID-19 outbreak. Methods The anxiety levels, negative thoughts, and quality of life of COVID-19-positive children with COVID-19-positive parents (Child+ group, n=17), COVID-19-negative children who are separated from COVID-19-positive parents (Parent+ group, n=59), and a control group (n=64) were compared. The participants completed the Screen for Child Anxiety and Related Disorders (SCARED), Children’s Negative Cognitive Errors Questionnaire (CNCEQ), and Pediatric Quality of Life Inventory (PedsQL). Results The statistical analysis revealed that the Parent+ group recorded higher SCARED and CNCEQ scores and lower PedsQL scores in comparison with the control group. No statistically significant difference was found between the scores of the Child+ and control groups. Furthermore, high CNCEQ scores and low PedsQL scores in the Parent+ group predicted an increase in their SCARED scores. Conclusion Our study indicates that separating children from their parents during the COVID-19 outbreak negatively influences their mental health and increases their anxiety levels.     

Job-related factors associated with changes in sleep quality among healthcare workers screening for 2019 novel coronavirus infection: a longitudinal study

BackgroundSleep disorders may exacerbate many physical and mental health conditions, causing difficulty function in a healthcare setting. Workers screening for the 2019 novel coronavirus (2019-nCoV) infection have a high risk of not only occupational exposure to the virus but also sleep disorders. However, the job-related factors associated with reduced sleep quality remain unclear.MethodsAll healthcare workers temporarily scheduled to screen the 2019-nCoV patients were asked to complete a self-administered questionnaire that included questions on demographics, job-related factors, and sleep quality as assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep quality was assessed over a one-month follow-up period.ResultsA total of 116 doctors and 99 nurses were recruited for this study. The total scheduled work time was 14.78 ± 6.69 days during follow-up. Some job-related factors, such as number of work days, years of work experience, and subjective psychological stress, were associated with changes in the PSQI score. During the study, some workers tried out cognitive behavioral therapy (CBT) for sleep disorders using methods that were available online and easily accessible. Adopting online CBT was shown to be associated with scores of components of sleep quality, sleep latency, and sleep disturbance (β = −0.152, P = 0.01; β = −0.175, P = 0.008; and β = −0.158, P = 0.011, respectively).ConclusionsHealthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality, and a reasonable work schedule may help with maintaining sleep quality. In addition, interventions for healthcare workers should target self-help sleep assistance.     

Subjective sleep quality in adult patients affected by Duchenne muscular dystrophy. Beyond nocturnal hypoventilation

ObjectiveIn stable neuromuscular patients under long-term non-invasive ventilation (NIV), subjective sleep quality may be predicted by chronic hypoventilation, as assessed by base excess (BE), and %N3 sleep stage duration. In this study, we explored how other variables, closely associated with self-reported health complaints, contributed to subjective sleep quality in adult patients with Duchenne muscular dystrophy (DMD).MethodsThis is a secondary analysis of a quality of life study in 48 adult DMD patients under NIV therapy, with little evidence of residual hypoventilation. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). A PSQI score >5 was considered indicative of poor sleep quality. Several other symptoms were evaluated: sleepiness, by the Epworth Sleepiness Scale (ESS); depression and anxiety, by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); autonomic symptoms, by the Composite Autonomic Symptom Score 31; pain, by the Numeric Pain Rating Scale (NPRS); and fatigue, by the Fatigue Severity Scale (FSS).ResultsMean PSQI was 6.1 ± 2.9. Abnormal scores were found for NPRS in 40, for HADS-A in 10 and for FSS in 24 subjects. The NPRS, HADS-A and FSS scores and the N3 sleep stage, independently predicted PSQI (R² = 0.47, p < 0.0001).ConclusionsIn adult DMD patients, pain, fatigue and anxiety may have a prominent influence on subjective sleep quality. Improvement of sleep quality may be of utmost importance in DMD, as it may ameliorate quality of life and extend its benefits to cardiovascular morbidity and life expectancy.     

Perceived stress and sleep quality among the non-diseased general public in China during the 2019 coronavirus disease: a moderated mediation model

BackgroundThe 2019 coronavirus disease (COVID-19) has spread worldwide, and its associated stressors have resulted in decreased sleep quality among front-line workers. However, in China, the general public displayed more psychological problems than the front-line workers during the pandemic. Therefore, we investigated the influence of perceived stress on the sleep quality of the non-diseased general public and developed a moderated mediation model to explain said relationship.MethodsQuestionnaire-based surveys were conducted online from February 18–25, 2020 with 1630 Chinese participants (aged 18–68 years).ResultsAround one-third (36.38%) of participants were poor sleepers during the COVID-19 pandemic. Moreover, higher perceived stress was significantly associated with higher anxiety levels, which, in turn, was associated with lower sleep quality. Self-esteem moderated the indirect effect of perceived stress on sleep quality through its moderation of the effect of perceived stress on anxiety. This indicated that the mediation effect of anxiety was stronger in those with low levels of self-esteem than in those with high levels of self-esteem.ConclusionsThese findings suggest that both the sleep quality and perceived stress levels of the non-diseased general public required attention during the COVID-19 pandemic. Our findings also identify personality characteristics related to better sleep quality, demonstrating the important role of self-esteem in environmental adaptation.     

The association between sleep quality and quality of life: a population-based study

ObjectivesThis study aimed to evaluate the association between sleep quality and quality of life (QoL).MethodsThis cross-sectional study included 225,541 adults (101,133 men, 124,408 women) who participated in the 2018 Korean Community Health Survey. Multiple sociodemographic and psychosocial variables were evaluated and compared between participants with poor (n = 67,619) and good sleep quality (n = 157,922); sleep quality was subjectively determined using the Pittsburgh Sleep Quality Index (PSQI). The EuroQol five-dimension (EQ-5D) index scores were adjusted for multiple confounding factors and compared between the good and poor sleep quality groups. A logistic regression analysis was used to identify determinants of the lowest quartile of QoL.ResultsThe mean EQ-5D index scores were significantly lower in the poor sleep quality group (score 0.85) than in the good sleep quality group (score 0.92; p < 0.001). The multivariate odds ratio (OR) for the lowest quartile of the EQ-5D index scores in the poor sleep quality group versus that in the good sleep quality group was 1.95 (95% confidence interval [CI], 1.89–2.00). Participants with poor sleep quality were more likely than those with good sleep quality to have some or severe problems with physical activity (OR, 1.46; 95% CI, 1.41–1.51), self-control (OR, 1.35; 95% CI, 1.29–1.42), daily activity (OR, 1.44; 95% CI, 1.39–1.50), pain (OR, 1.81; 95% CI, 1.77–1.86), and anxiety/depression (OR, 2.24; 95% CI, 2.17–2.31).ConclusionPoor sleep quality is associated with impaired QoL, particularly if some or severe problems with anxiety/depression are present.     

The effects of repeated transcranial direct current stimulation on sleep quality and depression symptoms in patients with major depression and insomnia

ImportanceAlthough several strategies using transcranial direct current stimulation (tDCS) have been investigated to treat major depressive disorder (MDD), the efficacy of this treatment for patients with MDD who also have insomnia is unclear.ObjectiveTo observe the effects of tDCS on sleep quality and depressive symptoms in patients with MDD who have insomnia.MethodsWe conducted a randomized, double-blinded study involving adults with major depression and insomnia. We randomly assigned patients to either add tDCS or to sham tDCS to their regular treatment. After randomization, we treated a total of 90 patients at the Kangning Hospital, Ningbo, China. We allocated 47 patients to the tDCS group and 43 to the sham tDCS group. The tDCS treatment procedure included 20 sessions of 2-mA stimulation of the dorsolateral prefrontal cortex (DLPFC) for 30 min, which was followed by four weekly treatments. The anode and cathode electrodes were placed on the left and right DLPFC, respectively. We recorded the Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Inventory (PSQI), and Polysomnography (PSG) at Day 1 and Day 28.ResultsCompared with the sham tDCS group, the active tDCS group showed improved total scores of SAS and SDS. PSQI total score and all PSQI sub-divisions, except for “sleep duration and sleep efficiency,” significantly improved after treatment. We also observed that tDCS affected sleep architecture, by increasing total sleep time and improving sleep efficiency through PSG.ConclusionsOur study demonstrated the effect of tDCS on sleep quality and depressive symptoms in patients with MDD and insomnia. These results suggested that tDCS stimulation not only improved symptoms of depression and anxiety but also had a positive effect on sleep quality in patients with MDD. For patients with depression and insomnia, tDCS stimulation could be a good supplement to drugs.