The impact of COVID-19 pandemic in the quality of sleep by Pittsburgh Sleep Quality Index: A systematic review

Souza, Luiz Felipe Ferreira de; Paineiras-Domingos, Laisa Liane; Melo-Oliveira, Maria Eduarda de Souza; Pessanha-Freitas, Juliana; Moreira-Marconi, Eloá; Lacerda, Ana Cristina Rodrigues; Mendonça, Vanessa Amaral; Sá-Caputo, Danubia da Cunha; Bernardo-Filho, Mario

doi:10.1590/1413-81232021264.45952020

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FREE THEMES • Ciênc. saúde coletiva 26 (4) • Apr 2021 • https://doi.org/10.1590/1413-81232021264.45952020 copy

The impact of COVID-19 pandemic in the quality of sleep by Pittsburgh Sleep Quality Index: A systematic review

O impacto da pandemia COVID-19 na qualidade do sono pelo Índice de Qualidade do Sono de Pittsburgh: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to evaluate the sleep quality in individuals during the COVID-19 pandemic by Pittsburgh Sleep Quality Index (PSQI). Searches were conducted in the PubMed, Embase, Web of Science, and PEDro databases, on May 22, 2020. In the publications, 208 articles were found and, considering the eligibility criteria, 10 articles were included at the end, showing the effects on sleep quality during the pandemic, in populations hospitalized, quarantined, and in frontline health professionals. The PSQI measured sleep disorders and a higher score indicated poor sleep quality. Nine articles were classified with evidence level IV and one as level III-2. Eight studies present a “serious” risk of bias and two in “moderate”. The studies investigated different populations and described the results as “poor” sleep quality, considering the PSQI on quarantined individuals and frontline health professionals as the most committed. A poor sleep quality was found in the populations evaluated in the selected publications, probably, due to the COVID-19 to contribute as a risk factor for mental health. Psychological interventions must be made to minimize the consequences through social support and social capital.

Key words
Sleep; Self-assessment; Social isolation; COVID-19

Authors/Year	Items^* * Items: (1) Bias Due to Confounding; (2) Bias in Selection of Participants; (3) Bias in Measurement of Interventions; (4) Bias Due to Departures from Intended Interventions; (5) Bias Due to Missing Data; (6) Bias in Measurement of Outcomes; (7) Bias in Selection of Reported Results; (8) Overall RoB Judgment.								LE^ LE - level of evidence according National Health and Medical Research Council (NHMRC).
Authors/Year	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
1. Cellini et al. (2020)²⁴24 Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020; 29(4):e13074.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
2. Wu and Wei (2020)⁴4 Wu K, Wei X. Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China. Med Sci Monit Basic Res. 2020; 26:e924085.	moderate	moderate	low	moderate	low	low	low	moderate	III-2
3. Huang and Zhao (2020)²⁵25 Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms, and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
4. Yuan et al. (2020)¹⁰10 Yuan S, Liao Z, Huang H, Jiang B, Zhang X, Wang Y, Zhao M. Comparison of the indicators of psychological stress in the population of Hubei province and non-endemic provinces in China during two weeks during the coronavirus disease 2019 (COVID-19) outbreak in February 2020. Med Sci Monit. 2020; 26:e923767	moderate	low	low	moderate	low	low	low	moderate	IV
5. Xiao et al. (2020)⁷7 Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit 2020; 26:e923921.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
6. Xiao et al. (2020)¹⁷17 Xiao H, Zhang Y, Kong D, Li S, Yang N. 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. 2020; 26:e923549.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
7. Casagrande et al. (2020)⁵5 Casagrande M, Favieri F, Tambelli R, Forte G. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med. 2020; 75:12-20.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
8. Wang et al. (2020)²⁶26 Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med. 2020; 70(5):364-369.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
9. Yin et al. (2020)²⁷27 Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, Shang Z, Zhou Y, Liu W. Posttraumatic stress symptoms of health care workers during the coronavirus disease 2019. Clin Psychol Psychother. 2020; 27(3):384-395.	moderate	moderate	low	moderate	moderate	low	low	serious	IV
10. Liu et al. (2020)²⁸28 Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Zhou Y, Wang Y, Liu W. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020; 287:112921.	moderate	moderate	low	moderate	moderate	low	low	serious	IV

Authors/Year	Population size/ Country	Age (M_age ±SD) or year	Gender (Male/ Female)	Tool for Evaluation (sleep quality)
Cellini et al. (2020)²⁴24 Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020; 29(4):e13074.	1310 (Italy)	23.9±3.6	430/880	PSQI^(b) (b) Global PSQI >5; (Italy version)
Wu and Wei (2020)⁴4 Wu K, Wei X. Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China. Med Sci Monit Basic Res. 2020; 26:e924085.	120 (China)	33.5±12.4	31/89	PSQI^(c) (c) Chine PSQI >7; (China version)
Huang and Zhao (2020)²⁵25 Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms, and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954.	7236 (China)	35.3±5.6	3284/3952	PSQI^(c) (c) Chine PSQI >7; (China version)
Yuan et al. (2020)¹⁰10 Yuan S, Liao Z, Huang H, Jiang B, Zhang X, Wang Y, Zhao M. Comparison of the indicators of psychological stress in the population of Hubei province and non-endemic provinces in China during two weeks during the coronavirus disease 2019 (COVID-19) outbreak in February 2020. Med Sci Monit. 2020; 26:e923767	939 (China)	from 18 to 60 years or greater	357/582	PSQI^(e) (e) Using 3 items PSQI.
Xiao et al. (2020)⁷7 Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit 2020; 26:e923921.	170 (China)	37.8±4.1	101/69	PSQI
Xiao et al. (2020)¹⁷17 Xiao H, Zhang Y, Kong D, Li S, Yang N. 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. 2020; 26:e923549.	180 (China)	32.3±4.8	51/129	PSQI (China version)
Casagrande et al. (2020)⁵5 Casagrande M, Favieri F, Tambelli R, Forte G. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med. 2020; 75:12-20.	2291 (Italy)	30.0±11.5	580/1708^(a) (a) Other not identified (03);	PSQI^(b) (b) Global PSQI >5;
Wang et al. (2020)²⁶26 Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med. 2020; 70(5):364-369.	123 (China)	33.7±8.4	12/111	PSQI (China version)
Yin et al. (2020)²⁷27 Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, Shang Z, Zhou Y, Liu W. Posttraumatic stress symptoms of health care workers during the coronavirus disease 2019. Clin Psychol Psychother. 2020; 27(3):384-395.	371 (China)	35.3±9.5	143/228	PSQI^(d) (d) Using 4 items PSQI; (China version)
Liu et al. (2020)²⁸28 Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Zhou Y, Wang Y, Liu W. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020; 287:112921.	285 (China)	>18 years	130/155	PSQI^(c) (c) Chine PSQI >7; ,^(d) (d) Using 4 items PSQI; (China version)

Authors/Year	Studied population	M±SD PSQI Score or n (%)	Sleep quality	Specific condition
Cellini et al. (2020)²⁴24 Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020; 29(4):e13074.	Individuals Non- hospitalized	686 (52.4)	poor	Residents in lockdown
Wu and Wei (2020)⁴ (a) Other not identified (03);	Front-line medical staff	16.07±3.76^* * Cut-off point (score >7).	poor	Designated and non-designated hospital with infection
Huang and Zhao (2020)²⁵25 Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms, and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954.	Individuals with different occupation	1.317 (18.2)^* * Cut-off point (score >7).	poor	During the COVID-19 outbreak
Yuan et al. (2020)¹⁰ * Cut-off point (score >7).	Individuals with different occupation	192 (36.4)	poor	In endemic and non-endemic provinces
Xiao et al. (2020)⁷ (d) Using 4 items PSQI;	Individuals self-isolated at home	8.482±4.65^* * Cut-off point (score >7).	poor	During the COVID-19 outbreak
Xiao et al. (2020)¹⁷17 Xiao H, Zhang Y, Kong D, Li S, Yang N. 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. 2020; 26:e923549.	Medical staff	8.58±4.57^* * Cut-off point (score >7).	poor	Treating patients with COVID-19
Casagrande et al. (2020)⁵ (b) Global PSQI >5;	Individuals self-isolated	5.69±3.40^ Cut-off point (score >5).	poor	In three different areas in Italy
Wang et al. (2020)²⁶26 Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med. 2020; 70(5):364-369.	Front-line healthcare workers	9.87±1.98^* * Cut-off point (score >7).	poor	At healthcare hospital
Yin et al. (2020)²⁷27 Yin Q, Sun Z, Liu T, Ni X, Deng X, Jia Y, Shang Z, Zhou Y, Liu W. Posttraumatic stress symptoms of health care workers during the coronavirus disease 2019. Clin Psychol Psychother. 2020; 27(3):384-395.	Front-line healthcare workers	10.60	poor	In different provinces of China
Liu et al. (2020)²⁸28 Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Zhou Y, Wang Y, Liu W. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020; 287:112921.	Individuals self-isolated	59 (20.7)	poor	During the COVID-19 outbreak

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[1] Collaborations

LFF Souza: conceptualization, data curation and writing-original draft. LL Paineiras-Domingos: formal analysis and writing-review and editing. MES Melo-Oliveira: data curation and validation. J Pessanha-Freitas: software and visualization. E Moreira-Marconi: methodology and writing-review and editing. ACR Lacerda: methodology and writing-review and editing. VA Mendonça: methodology and writing-review and editing. DC Sá-Caputo: visualization and writing-review and editing. M Bernardo-Filho: investigation, supervision and writing-review and editing.