ABSTRACT
Objective:
This study was conducted to compare sleep disturbances between women with and without a history of Coronavirus disease-2019 (COVID-19) infection.
Materials and Methods:
In this descriptive study, the “Pittsburgh Sleep Quality Index” was used to evaluate sleep problems. The research sample was calculated as 120: 1. group 60 (with a history of COVID-19) and 2. group 60 (without a history of COVID-19) using the G*Power 3.1 method. A total of 141 women were interviewed in case of data loss. Due to the ongoing pandemic, the forms were filled in via google form in the social media environment. The data were analyzed with Statistical Package for Social Sciences for the Windows 22.0 program.
Results:
The mean age of the women involved in the study was 22.241±6.593 (min: 18, max: 58). Women with a history of COVID-19 experience occasional sleep problems several times a week and have difficulty falling asleep. Statistically significant differences were found between the sleep quality of women with and without a history of COVID-19. Subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, daytime dysfunction, and total sleep quality scores were found to be higher in women with a history of COVID-19.
Conclusion:
Sleep quality is lower in women with a history of COVID-19. During the COVID-19 pandemic, sleep quality should be evaluated, and sleep problems should be identified and treated within a short period. It is recommended to develop methods of coping with anxiety and stress experienced, especially during the COVID-19 pandemic and to raise awareness on this issue among people with a COVID-19 history.
Introduction
Sleep is defined as the state of temporary, partial, and periodic loss of the organism’s communication with the environment (1). People spend an average of 1/3 of their life sleeping. It would not be a correct assessment to consider sleep only as a time outside of daily life because it is a vital necessity that forms the basis of a healthy and long life (1-3). Considering the average life expectancy, this ratio is equivalent to the significant years of human life. Recent studies have reported that the average life expectancy in our country is 78.6 (4). This means that a person spends an average of 26.2 years sleeping, which corresponds to a significant period.
Sleep quality is the individual’s feeling rested, fit, and ready for a new day after waking up. Sleep quality includes both quantitative aspects of sleep like sleep latency, sleep duration, frequency of waking up at night, and subjective aspects like sleep depth and restfulness (3). In determining sleep quality, there are important criteria such as environmental factors, occupational conditions, stress, presence of disease, and sleep routine of the person. Studies have reported that sleep disorders are more common in people with chronic diseases and occupational groups working on shifts (3,5).
It is suggested that sleep problems may have developed in women after the Coronavirus disease-2019 (COVID-19) pandemic that emerged in Wuhan, China. The reasons for this can be listed as the increase in the workload, uncertainties, worrying about the family, barriers to accessing health facilities, and the increase in the household burden of non-working women due to family members staying at home (6). This increasing workload, social, and health concerns in women turn into a stress factor and eventually lead to sleep disturbances.
The study aims to examine sleep disturbances and affecting factors in women during the COVID-19 pandemic.
Materials and Methods
Research Design and Sampling
The study is in descriptive design. The research sample was determined as 120 people: 1. group 60 (those with a history of COVID-19) and 2. group 60 (those without a history of COVID-19) using the G*Power 3.1 method [ratio var1/var 0: 0.3647827, α=0.03, power (1-β err prob) = 0.95]. The variance rate was determined by calculating the variance analysis values in the reference study (7). The data were collected online due to the ongoing pandemic and high case numbers. Due to the unknown population, the non-probability and easy sampling method was used thanks to being fast and easy. The research was conducted with volunteer participants who approved the information text at the top of the form in accordance with the Helsinki Declaration criteria. Considering the possibility of data loss, 143 people who met the inclusion criteria of the research were reached. Due to the incomplete form, 2 women were excluded from the study, and thus the sample consisted of 141 participants.
Inclusion Criteria
Inclusion criteria for the study were being female between the ages of 20 and 65, speaking and understanding Turkish, having a history of COVID-19 (group 1), not having a history of COVID-19 (group 2), having no sleep problems before the COVID-19 pandemic, not having been diagnosed with any psychiatric disorder before the pandemic, and being a volunteer. In addition, women included in the 1. Group were required to have been infected with COVID-19 a minimum of three and a maximum of 6 months ago.
Exclusion Criteria
Exclusion criteria were withdrawing from the study at any time and filling in the survey forms incompletely.
Data Collection Tools
In this descriptive study, data were collected in two stages using a 30-item “Participant Information Form” and a 24-item “Pittsburgh Sleep Quality Index (PSQI)”, which were created by the researchers scanning the literature and consulting experts.
Participant Information Form: The form consists of a total of 33 questions prepared by making use of the literature. Some of the questions are multiple choice and some are open-ended. This form includes: questions to inquire about his sociodemographic history, his status of passing COVID-19, his thoughts on the COVID-19 pandemic, sleep patterns and sleep problems.
The Pittsburgh Sleep Quality Index: PSQI was developed by Buysse et al. (8) and adapted into Turkish by Yücel Ağargün et al. (9). PSQI is a 19-item self-report scale that evaluates sleep quality and disturbance over one month. On the scale consisting of 24 questions, 19 questions are self-report questions, and 5 questions are answered by the spouse or roommate. The 18 questions scored consist of 7 components: Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medication, daytime dysfunction. Each component is evaluated over 0-3 points, and the total score yields the scale score. The total score ranges from 0 to 21, and a total score greater than 5 indicates “poor sleep quality”. The Cronbach’s alpha reliability of the scale is 0.875. The Cronbach’s alpha reliability of this study was found to be 0.777.
Statistical Analysis
The data form created by the researchers was converted online via Google Forms due to the pandemic. The online form link was forwarded to women via WhatsApp and e-mail. The data were evaluated with the Statistical Package for the Social Sciences (SPSS)-22 program, error controls, tables, and statistical analyzes were made. In statistical evaluations, numbers and percentage values were given, and normality analyzes were made. Normality control of continuous variables was evaluated with the Shapiro-Wilk test. Student’s t-test was used to compare the mean of the groups according to the variables conforming to the normal distribution. The Mann-Whitney U test was used to compare the groups in the variables that did not conform to the normal distribution. The statistical significance level was taken as 0.05 in all analyzes.
Ethical Aspect of Research
Prior to the research, ethics committee approval (number: E-46418926-050.01.04--47573 date: 12.07.2021) was obtained from the Non-Interventional Ethics Committee of the University of Health Sciences, and forms were sent to women who volunteered to participate in the study. Thus, the Helsinki Declaration Principles and Publication Ethics were complied with at all stages of the research.
Results
The mean age of the women in the study was found to be 22.24±6.59 (min: 18, max: 58). The descriptive characteristics of the women in the study are given in Table 1.
According to Table 1, While there was no significant relationship between women’s occupation, marital status, education level, perceived income level, alcohol use, presence of chronic diseases, use of medication, and the status of getting infected with COVID-19, a significant relationship was found between smoking and the status of getting infected with COVID-19 (Table 1). The rate of smoking is higher in the group without a history of COVID-19.
According to Table 2, no significant relationship was found between the state of having sleep problems, the frequency of sleep problems, the effect of sleep problems on physical activities, waking up at night, and the status of having a history of COVID-19. However, having sleep problems, the frequency of sleep problems, and the frequency of waking up at night are more common in the group with a history of COVID-19. There is a statistically significant relationship between having difficulty falling asleep and having a history of COVID-19 (p<0.05). Difficulty falling asleep is more common among the group with a history of COVID-19.
According to Table 3, evaluation of sleep quality of women according to their status of having a history of COVID-19 revealed significant differences between subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, daytime dysfunction, and total sleep quality scores. Sleep problems were found to be more common among women who had COVID-19, and their sleep quality decreased (p<0.05).
Discussion
COVID-19 infection was declared a Public Health Emergency by the World Health Organization on January 30, 2020 (10). The crisis experienced in the early stages of the pandemic, the uncertainties about the process, and the lack of a vaccine and a proven treatment caused serious concerns. The ongoing pandemic causes the emergence of many diseases after being infected. The aim of this study is to determine the effects of getting COVID-19 on sleep quality.
The mean age of the women involved in the study was 22.24. Since the number of students participating in the study was high (77.3%), the age group of women was low, most of them were single, and their education level was high. The rate of smoking was higher in those without a history of COVID-19. Studies have revealed a relationship between smoking and respiratory tract infections, hypertension, diabetes, obesity, and chronic obstructive pulmonary disease (11-13). Especially in studies conducted during the COVID-19 period, it is recommended to quit smoking due to the risk of disease (14). In our study, the reason for the high rate of smoking among women without a history of COVID-19 may be due to the low age scale of the participant group and therefore the low incidence of chronic diseases.
Uncertainties in the COVID-19 period, anxiety, isolation, depression, panic attacks, sleep disorders, fear of death, and illness cause many diseases in individuals. Sleep is a biological function and an active behavior and is vital for the brain and body health of individuals of all ages. Quality sleep increases the health, quality of life, bodily functions, autonomy, and safety of individuals (15,16). Sleep problems were reported to cause insomnia, mood disorder, cognitive dysfunction, depression, anxiety, attention deficit, and memory problems (17). In this study, the effects of COVID-19 on sleep problems were evaluated. The women included in the study did not have any sleep problems prior to COVID-19. Although the examination of the sleep problems experienced by women during the COVID-19 period did not reveal significant differences between the groups, sleep problems were more common among women with a history of COVID-19. It was determined that the group with a history of COVID-19 occasionally experienced sleep problems several times a week and had difficulty falling asleep. There was no significant difference between the groups in terms of perceived subjective sleep difficulties (Table 2).
Literature has citations that curfew and isolation process to reduce the spread of infection in the COVID-19 pandemic, uncertainties, fear of being infected, anxiety, boredom, and feelings of uncertainty affect daily living standards and sleep quality (18-20). Some studies have shown a bidirectional relationship between sleep problems and mood changes in terms of anxiety and depression (17,21,22). Although mood fluctuations in the COVID-19, called a public health crisis, are considered normal, they can be the precursors of various clinical conditions such as psychological distress, anxiety characterized by somatization forms, and major depressive disorders (23). During the COVID-19 period, post-traumatic stress disorder is seen at a rate of 7% in women, the sleep quality of women with stress disorders has increased, and night-waking problems have increased (24). The results of our study, which evaluated the sleep quality between groups with and without a history of COVID-19, showed statistically significant differences between the groups. Subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleeping medication, daytime dysfunction, and total sleep quality scores were found to be higher in women with a history of COVID-19. It is important to detect and treat the complaints seen in individuals after COVID-19 in the early period. Long-term sleep problems reduce the quality of life of individuals and trigger many disorders. It is thought that controlling stress and anxiety, supporting methods of coping with stress, and eliminating sleep problems in the early period will be a significant step in the COVID-19 period.
Conclusion
The study showed that women with COVID-19 had lower sleep quality. COVID-19 infection disrupts sleep quality, and sleep problems trigger many diseases. It is pivotal to evaluate the sleep quality of individuals with a history of COVID-19 and to identify and treat sleep problems in a short time. It is recommended to develop methods of coping with anxiety and stress experienced especially during the COVID-19 pandemic and to raise awareness on this issue among those with a history of COVID-19.
Ethics
Ethics Committee Approval: Ethics committee approval (number: E-46418926-050.01.04--47573 date: 12.07.2021) was obtained from the University of Health Sciences, Hamidiye Scientific Research Ethics Committee.
Informed Consent: Forms were sent to women who volunteered to participate in the study.
Peer-review: Internally peer-reviewed.
Authorship Contributions
Design: S.D., H.Ö., Data Collection or Processing: S.D., H.Ö., Analysis or Interpretation: S.D., H.Ö., Literature Search: S.D., H.Ö., Writing: S.D., H.Ö.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.