Sleep quality of inpatients with a positive diagnosis of COVID-19

Background: Low sleep quality and sleep disturbances are reported to be higher during the COVID-19 pandemic period. This study aimed to evaluate the sleep quality of hospitalized patients with COVID-19 and the factors that affect their sleep quality.

Materials and methods: Patients with COVID-19 who were hospitalized at the pandemic clinic of a University Training and Training Hospital between 15 May-15 September 2020 were included. The study included 150 patients who agreed to participate in the study, who were hospitalized in the COVID-19 clinics in a Training and Research Hospital. Adult patients over the age of 18 who had been accepted to participate in were enrolled in the study. The patients who had any diagnosed sleep-related disorders or neurological and psychiatric diseases were excluded. Data were collected using the Personal Information Form, Pittsburgh Sleep Quality Index.

Results: The patient’s PSQI score average was significantly higher in females, illiterate, married, and individuals with the first three days of diagnosis of disease. During their 75.2% hospitalization time, sleep patterns deteriorated and 90.0% of those patients also deteriorated 1-3 days after hospitalization. Given the conditions that caused sleep disorders during the time hospitalized, there were causes such as respiratory distress (41.3%), hospital environment (36.1%) and pain (32.0%). The requirements that patients need most to improve their sleep quality during the hospital period may be said to be good management of disease symptoms (36.4%), increased social support systems (33.3%), and communication with health staff (20.0%).

Conclusion: For sleep disorders in hospitalized patients with a positive (+) diagnosis of COVID-19, it can be said that 71.3% of the patients have poor sleep quality.

Introduction

Coronavirus disease - 2019 (COVID-19), first time in 2019 It appeared in Wuhan, China in December. Disease. It soon spread across the world on March 11, 2020. It has been declared a pandemic by the World Health Organization [1].

Millions of people have been affected by the Coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome-coronavirus-2. It has been shown that novel infectious diseases, such as severe acute respiratory syndrome affect sleep by increasing anxiety, depression and stress levels in the general population [2]. The negative impact of social life, the uncertainty of the duration and the departure of the epidemic, and the economic reasons that have occurred have led to increased levels of stress and anxiety in individuals [3]. Especially those who are in the risk group, have experienced a peak level of anxiety as they see the number of facts and deaths that occur in the country and the world, thinking that they may be sick and/or die. Stress and anxiety disorders have also brought sleep disorders [4].

Sleep impairment was reported to be frequent in patients with COVID-19 (10), which may be due to isolation, physical discomfort and psychological factors such as fear, anxiety, or depression [5]. Poor sleep quality during hospitalization in COVID-19 patients was reported as associated with a slow recovery from lymphopenia and an increased need for intensive care [6].

The SARS-CoV-2 virus affects the prefrontal cortex, basal ganglions, and hypothalamus in the brain, which are essential in regulating sleep. Therefore, the prevalence of sleep disorders seen in the pandemic COVID-19 is the prevalence of social and social lives of people in addition to emotional stressor factors, it develops due to asymptomatic viral infection [7].

COVID-Somnia (Coronasomnia) is a term used to identify sleep disorders seen during a pandemic. [8]. During the COVID-19 pandemic, several studies have been carried out to investigate sleep disorders. Sleep deprivation prevalence was between 2.3% and 76.6% in the study [9]. The factors associated with COVID-19-specific sleep are listed as concerns about the disease in patients with COVID-19, uncertainty due to the pandemic, lack of testing, and negative attitude toward control measures such as mask wear.

In a different study, 843 participants were surveyed; 69.4% of respondents had a change in sleep pattern, less than half (44.7%) had a relaxing sleep 45.6% of them reported that they were more sleepy than before the quarantine [10]. The frequently reported changes in sleep were found as sleep failure (divided sleep) (42.3%), involuntary sleep (35.2%), difficulty in falling asleep (30.9%) and late bedtime (30%) COVID-19-suspectedcted participants have indicated that they have had more nightmares [11].

In a meta-analysis of 54.231 participants from thirteen countries, Epworth Sleep structure was evaluated using scales such as “Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Athens Insomnia Scale”; the overall population of sleep disorder prevalence 32.3%; 36% for health workers; 74.8% for patients with COVID infection was found [12]. Concerns about the disease in patients with COVID-19 are listed as a negative attitude to control measures such as pandemic uncertainty, lack of testing, and mask wear [13].

COVID-19 positive (+) with the physical health of diagnosed patients identifying sleep problems in maintaining and developing spiritually good behavior will be a guide to the effective planning of nursing care. This study aimed to evaluate the sleep quality of hospitalized patients with COVID-19 and the factors that affect their sleep quality.

Materials and methods

Patients with COVID-19 who were hospitalized at the pandemic clinic of a University Training and Training Hospital between 15 May - 15 September 2020 were included. The study included 150 patients who agreed to participate and were hospitalized in the COVID-19 clinics in a Training and Research Hospital. Adult patients over the age of 18 who had been accepted to participate in were enrolled in the study. The patients who had any diagnosed sleep-related disorders or neurological and psychiatric diseases were excluded. Data were collected using the Personal Information Form, Pittsburgh Sleep Quality Index (PSQI).

The patients completed the Pittsburgh sleep quality index (PSQI) after the first night of admission to minimalizing the hospital factors (e.g., light exposure, sound exposure and disturbance by staff) that could be the reason for poor sleep quality during hospitalization. The questionnaires were performed face-to-face in patients’ rooms. Clinicians wore personal protective equipment and the patients wore surgical masks during the survey which took a maximum of 15 minutes.

Developed by Buysse and his friends (1991), PUKI is the self-notification scale that evaluates sleep quality and deformity over the past month [14]. The PSQI questionnaire which consisted of seven parts a total of 18 items, including sleep quality, sleep duration, sleep latency, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction was used to measure the sleep quality of the patients. Each part was scored from 0 - 3 and the total score ranged from 0 - 21. A high score is accepted as indicating poor sleep quality. The Turkish validity and reliability of the measurement tool were carried out by Agargun and his friends [15].

Data analysis

The data has been analyzed by transferring it to IBM SPSS Statistics 25 in a computer environment. When evaluating data, the frequency distribution for categorical variables, the identifier statistics for numerical variables (mean, standard deviation, median, IQR), “ In groups-to-group comparisons, the independent sample t-test was used for two-group comparisons, and ANOVA was used for more than two group comparisons. Dunnet test was used for the groups with a difference to understand from which group the difference originated.

Ethical consideration

This study was performed by the Declaration of Helsinki and was approved by the University Human Research Ethics Committee (protocol number: 2022 - 112). Permission from the COVID-19 Scientific Research Assessment Commission of the Turkish Ministry of Health has been obtained. All patients provided signed informed consent to participate in the study.

Results

63.0% of patients are female, age averages are 54.32±12.44, 50.0% are primary school graduates, 83.3% are married, 28.6% have 1 child and 55.3% represent their economic status as a medium. 42.0% of patients were admitted to the hospital in the first three days after receiving a COVID-19-positive diagnosis. The PSQI score average was significantly higher in females, illiterate, married and individuals with the first three days of diagnosis of disease (p < 0.05) (Table 1).

During their 75.2% hospitalization time, sleep patterns deteriorated and 90.0% of those patients also deteriorated 1-3 days after hospitalization. 95% of the patients reported that they slept during the night and day hours, and 38.6% reported that they were traveling on social media during periods of insomnia (Table 2). Given the conditions that caused sleep disorders during the time hospitalized, there were causes such as respiratory distress (41.3%), hospital environment (36.1%), and pain (32.0%). The requirements that patients need most to improve their sleep quality during the hospital period may be said to be good management of disease symptoms (36.4%), increased social support systems (33.3%) and communication with health staff (20.0%), respectively (Table 2).

When Table 3 is examined, the average of the total score of PSQI of patients is 7.84 ± 0.64 (min: 0.00; max: 15.00) and 71.3% of the patients are found to be poor sleep quality (Table 3).

Discussion

The COVID-19 pandemic had a negative effect on adult sleep quality. Sleep is an essential physiological activity for maintaining physical and mental health and good quality of life. Degradation in the normal sleep cycle leads to inadequate sleep and long-term awakening, resulting in insomnia, nightmares, daytime instability, and fatigue [16].

During the COVID-19 pandemic, many studies have been carried out to examine sleep disorders [17]. In the studies, age, gender, education level, physical and mental health, COVID-19, associated stressor factors, and profession (especially being a health worker) were identified as factors related to a sleep disorder. In our study, sleep quality was determined as bad in females, illiterate, married, and individuals with the first three days of disease diagnosis. A study from Brazil reported that monthly income, occupation, gender, age, and marital status had effects on sleep quality [18].

Hospitalized patients are trying to adapt to changes due to the new situation they are in while dealing with the effects of their illness. These changes may also affect the quality of patients’ sleep [19]. A study conducted on 7236 participants in China during the pandemic concluded that 18% of the general population experienced poor sleep quality. In addition, patients with COVID-19 are expected to have reduced sleep quality due to symptoms associated with contracting the disease [20].

In our study, factors that cause insomnia during the time hospitalized in the hospital outlook causes such as respiratory distress, hospital environment, and pain. According to the findings of our study and the literature, it can be said that this may be related to the uncertainty, social isolation, and the more intense symptoms experienced in the patient’s illness during the time spent in the hospital. In this context, patients can be given orientation from their initial hospitalization to the hospital, reduced anxiety by providing information about the general process, and exposure to the clinical and treatment team in which they are treated.

Sleep hygiene is defined as policies and practices that improve sleep quality. Sleep hygiene training is also frequently used to deal with sleep disorders. In this context, watching TV or reading books in bed makes it difficult to fall asleep using technology [21]. In our study, the majority of patients were found to sleep during the night and day hours, and to be able to sleep; they were able to navigate social media and watch television during periods of insomnia.

In addition, the requirements that patients need most to improve their sleep quality during their stay in the hospital are, in order, the management of disease symptoms, communication with healthcare staff, and social support.

Conclusion

Patients with COVID-19 positive (+) diagnosis show that their sleep deterioration occurs after the first three days; about three-quarters of them have poor sleep quality, and cases that cause sleep disorders are caused by complaints such as symptoms, hospital environment, and pain. Hospitalized patients are trying to adapt to changes due to the new situation they are in while dealing with the effects of their illness. Patients should be trained, informed, and provided hospital orientation and sleep hygiene training with effective communication methods from patient hospitalization to stool.

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