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CC BY-NC-ND 4.0 · Sleep Sci 2022; 15(01): 8-16
DOI: 10.5935/1984-0063.20210020
ORIGINAL ARTICLE

Sleep quality and anxiety among Egyptian population during covid-19 pandemic

Samar Abd ElHafeez
1   High Institute of Public Health, Alexandria University, Epidemioloy Department - Alexandria - Egypt.
,
Miguel Meira e Cruz 
2   Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Sleep Unit - Lisbon - Portugal.
3   Escola Bahiana de Medicina e Saúde Pública, Clinical Cronobiology and Sleep Medicine Group - Bahia - Brazil.
4   Faculdade São Leopoldo Mandic, Neuroimune Pain Interface Lab - Campinas - São Paulo - Brazil.
5   Centro Europeu do Sono, R&D Lab - Lisboa - Portugal.
,
Salma Gouda
6   School of Medicine, Badr University - Cairo - Egypt.
,
Marwa Nofal
7   Helwan Mental Health Hospital, Sleep - Cairo - Egypt.
,
Abdalrahman Fayed
8   High Institute of Public Health, Alexandria University, Health Administration and Behavioral Science Department - Alexandria - Egypt.
,
Ramy Mohamed Ghazy
9   High Institute of Public Health, Alexandria University, Tropical Health Department - Alexandria - Egypt.
,
Jaidaa Mekky
10   Faculty of Medicine, Alexandria University, Neuropsychiatry Department - Alexandria - Egypt.
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ABSTRACT

Objectives: COVID-19 pandemic imposed a relevant number of stressful factors potentially impacting either daytime function or sleep quality. This study aimed to assess the sleep quality and anxiety among the general population living in Egypt.

Material and Methods: A cross-sectional survey was conducted among 1,000 individuals who have been recruited via a convenience sample. A predesigned questionnaire was distributed online to collect data on sleep quality using the validated Arabic version of the Pittsburgh sleep quality index, anxiety disorders by the generalized anxiety disorder (GAD-7) scale, demographic characteristics, and clinical history.

Results: Among the study participants (33.8% males, 46.2% healthcare workers, 25% had chronic diseases, 30.1% were physically active during lockdown, and 70.3% reported work termination due to COVID-19 infection, 68.4% complained of bad sleep and 70.3% showed clinically significant levels of anxiety). In multiple logistic regression analysis, bad sleep quality was significantly associated with moderate anxiety (OR: 1.88; [95% CI: 1.37-2.60]), severe anxiety (OR: 3.15; [95% CI: 2.18-4.55]), being physically active (OR: 0.53; [95% CI: 0.39-0.71]), received higher education as being postgraduate (OR: 0.56; [95% CI: 0.35-0.92]), or living with family (OR: 0.74; [95% CI :0.56-0.98]).The GAD-7 scale added 8% discrimination power for prediction of bad sleep quality compared to the model based on demographic and clinical data [with GAD: AUC=0.70, p<0.001; without GAD: AUC=0.62, p<0.001].

Conclusion: COVID-19 had a significant impact on sleep quality and anxiety among Egyptians. Since both the conditions may overlap and potentiate each other leading to chronic dysfunctional outcomes, an accurate assessment and clinical approach may favor a better prognosis.

Keywords:

COVID-19 - Sleep Quality - Anxiety - Egyptians


Publication History

Article published online:
01 December 2023

© 2022. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 World Health Organization (WHO). Coronavirus disease 2019 (COVID-19): situation report - 51. Geneva: WHO; 2020.
  • 2 Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb;395(10223):470-3.
  • 3 United Nations Development Programme (UNDP). COVID-19 pandemic humanity needs leadership and solidarity to defeat COVID-19 Egypt [Internet]. Cairo: UNDP; 2020. Available from: https://www.eg.undp.org/content/egypt/en/home/coronavirus.html
  • 4 Ministry of Health and Population (EGY). Egypt implements strong measures to fight COVID-19 [Internet]. Cairo: Egyptian Government/Ministry of Health and Population; 2020. Available from: https://www.care.gov.eg/EgyptCare/Index.aspx
  • 5 Altena E, Baglioni C, Espie CA, Ellis J, Gavriloff D, Holzinger B, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. J Sleep Res. 2020 Aug;29(4):e13052.
  • 6 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 Jun;288:112954.
  • 7 Li DJ, Ko NY, Chen YL, Wang PW, Chang YP, Yen CF, et al. COVID-19-related factors associated with sleep disturbance and suicidal thoughts among the Taiwanese public: a facebook survey. Int J Environ Res Public Health. 2020 Jun;17(12):4479.
  • 8 Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020 Jul;289:113076.
  • 9 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 May;e13074.
  • 10 Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Front Public Health. 2018;6:288.
  • 11 Suleiman KH, Yates BC, Berger AM, Pozehl B, Meza J. Translating the Pittsburgh sleep quality index into Arabic. West J Nurs Res. 2010 Mar;32(2):250-68.
  • 12 Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
  • 13 Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the patient health questionnaire - 9 (PHQ-9) and the Generalized anxiety disorder - 7 questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016 May;239:245-52.
  • 14 Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May;166(10):1092-7.
  • 15 Rose S. International ethical guidelines for epidemiological studies. Geneva: Council for International Organizations of Medical Sciences (CIOMS)/World Health Organization (WHO); 2009.
  • 16 Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17.
  • 17 Jager DJ, Mutsert R, Jager KJ, Zoccali C, Dekker FW. Reporting of interaction. Nephron Clin Pract. 2011;119(2):c158-61.
  • 18 Tripepi G, Jager KJ, Dekker FW, Zoccali C. Statistical methods for the assessment of prognostic biomarkers (Part I): discrimination. Nephrol Dial Transplant. 2010 May;25(5):1399-401.
  • 19 Fu W, Wang C, Zou L, Guo Y, Lu Z, Yan S, et al. Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China. Transl Psychiatry. 2020;10(1):225.
  • 20 Marelli S, Castelnuovo A, Somma A, Castronovo V, Mombelli S, Bottoni D, et al. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2020 Jan;268(1):8-15.
  • 21 Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020 Aug;16(8):1417-8.
  • 22 Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020 Jul;289:113076.
  • 23 Pinto J, Van Zeller M, Amorim P, Pimentel A, Dantas P, Eusébio E, et al. Sleep quality in times of Covid-19 pandemic. Sleep Med. 2020;74:81-5.
  • 24 Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res. 2020;293:113382.
  • 25 Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021 Feb;17(2):299-313.
  • 26 Idrissi AJ, Lamkaddem A, Benouajjit A, El Bouaazzaoui MB, El Houari F, Alami M, et al. Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco. Sleep Med. 2020 Aug;74:248-53.
  • 27 Saadeh H, Saadeh M, Almobaideen W, Al Refaei A, Shewaikani N, Al Fayez RQ, et al. Effect of COVID-19 quarantine on the sleep quality and the depressive symptom levels of University Students in Jordan during the spring of 2020. Front Psychiatry. 2021 Feb;12:605676.
  • 28 Arafa A, Mohamed A, Saleh L, Senosy S. Psychological impacts of the COVID-19 pandemic on the public in Egypt. Community Ment Health J. 2020 Aug;1-6.
  • 29 Lin Y, Liu S, Li S, Zuo H, Zhang B. Relationships between the changes in sleep patterns and sleep quality among Chinese people during the 2019 coronavirus disease outbreak. Sleep Med. 2021 Jan 18; [Epub ahead of print]. DOI: https://doi.org/10.1016/j.sleep.2021.01.021
  • 30 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 Nov;75:12-20.
  • 31 Hinz A, Glaesmer H, Brähler E, Löffler M, Engel C, Enzenbach C, et al. Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people. Sleep Med. 2017 Feb;30:57-63.
  • 32 LeGates TA, Fernandez DC, Hattar S. Light as a central modulator of circadian rhythms, sleep and affect. Nat Rev Neurosci. 2014 Jul;15(7):443-54.
  • 33 Van Maanen A, Meijer AM, Van Der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016 Oct;29:52-62.
  • 34 Dijk DJ, Czeisler CA. Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. J Neurosci. 1995 May;15(5 Pt 1):3526-38.
  • 35 Scheiermann C, Kunisaki Y, Frenette PS. Circadian control of the immune system. Nat Rev Immunol. 2013 Mar;13(3):190-8.
  • 36 Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health. 2020;16(1):57.
  • 37 Arora T, Grey I, Östlundh L, Lam KBH, Omar OM, Arnone D. The prevalence of psychological consequences of COVID-19: a systematic review and meta-analysis of observational studies. J Health Psychol. 2020 Oct 29; [Epub ahead of print]. DOI: https://doi.org/10.1177/1359105320966639
  • 38 Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020 Dec;277:55-64.
  • 39 Alamrawy RG, Fadl N, Khaled A. Psychiatric morbidity and dietary habits during COVID-19 pandemic: a cross-sectional study among Egyptian Youth (14-24 years). Middle East Curr Psychiatry. 2021;28(1):6.
  • 40 Ghanem M, Gadallah M, Meky FA, Mourad S, El-Kholy G. National survey of prevalence of mental disorders in Egypt: preliminary survey. East Mediterr Health J. 2009 Jan/Feb;15(1):65-75.
  • 41 Mellman TA. Sleep and anxiety disorders. Psychiatr Clin North Am. 2006 Dec;29(4):1047-58.
  • 42 Papadimitriou GN, Linkowski P. Sleep disturbance in anxiety disorders. Int Rev Psychiatry. 2005 Aug;17(4):229-36.
  • 43 Kondo M, Nakamura Y, Ishida Y, Shimada S. The 5-HT3 receptor is essential for exercise-induced hippocampal neurogenesis and antidepressant effects. Mol Psychiatry. 2015;20(1):1428-37.
  • 44 Bortz WM, Angwin P, Mefford IN, Boarder MR, Noyce N, Barchas JD. Catecholamines, dopamine, and endorphin levels during extreme exercise. N Engl J Med. 1981 Aug;305(8):466-7.
  • 45 Woodgate RL, Tailor K, Tennent P, Wener P, Altman G. The experience of the self in Canadian youth living with anxiety: a qualitative study. PLoS One. 2020;15(1):e0228193.
  • 46 Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934.
  • 47 Kemp S. DIGITAL 2020: EGYPT [Internet]. Cairo: DATAREPORTAL; 2020; [access in 2020 Nov 25]. Available from: https://datareportal.com/reports/digital-2020-egypt
  • 48 El-Tantawy A, Al-Yahya A, Raya Y, Mohamed S. Sleep disorders and sleep quality among patients with anxiety or depressive disorders in relation to their quality of life. Egypt J Psychiatry. 2014;35(1):56-64.
  • 49 Morin CM, Carrier J. The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Med. 2020 Jan;77:346-7.