bluuebunny/crossref_metadata_2025_split huggingface dataset:
196 Sleeping Through a Pandemic: Sleep Health in Adults Around the World During the COVID-19 Lockdown
Authors: Yuksel Dilara , McKee Grace , Perrin Paul , Alzueta Elisabet , Caffarra Sendy , Ramos-Usuga Daniela , Arango-Lasprilla Juan-Carlos , Baker Fiona 
Published: May 2021

Abstract

Introduction
The novel COVID-19 disease rapidly escalated into a global pandemic affecting people around the world. While communities imposed mitigation measures to stop the spread of the disease, the mass (home) confinement in addition to the uncertainty of the pandemic led to drastic changes in all aspects of life, including sleep. Sleep health is strongly linked with mental and overall health and could play a protective role against the development of mental distress during the pandemic. Here, we investigated sleep health in a global multicultural sample of adults during the COVID-19 pandemic.

Methods
We surveyed 6,882 adults (18-94 years) across 59 countries about their sleep health (RU-SATED scale), sleep behaviors, demographics, pandemic-related factors, and mood between late April and early May 2020. A hierarchical stepwise multiple linear regression was performed to investigate correlates of sleep health.

Results
Compared with pre-pandemic times, more than one third of the sample reported an increase in sleep disturbances, and more than half of the sample shifted their sleep schedule towards later bed- and wake-up times. Better sleep health was associated with being partnered, older age and living in a higher-income country (p&lt;.001). Poorer sleep health was associated with a stricter level of quarantine, and other pandemic-related factors including being laid off from job, financial strain, or difficulties with transitioning to working from home (R2=.116, p&lt;.001). Domestic conflict emerged as the strongest correlate of poorer sleep health in the regression model. Greater depression and anxiety symptoms were associated with a poorer sleep health (p&lt;.001). In a global comparison, Latin Americans reported the lowest sleep health scores.

Conclusion
Our findings highlight how sleep behavior has changed during the international quarantine- and isolation measurements and show the association between pandemic-related factors and poor sleep health, which, in turn, is closely linked with poorer mental health. These results emphasize the importance of maintaining good sleep health during the pandemic, since poorer sleep health may trigger or exacerbate mental disorders. Maintenance of good sleep health should be incorporated into public health messages aimed at helping people maintain optimal mental and physical health during major stressful life events like the COVID-19 pandemic.
Support (if any):
199 COVID-19 Pandemic Sleep and Dreams at the US-Mexico Border
Authors: Isalva Luz , Valencia Dora , Ghani Sadia , Delgadillo Marcos , Bastien Célyne , Madhivanan Purnima , Krupp Karl , Ruiz John , Killgore William , Wills Chloe , Grandner Michael 
Published: May 2021

Abstract

Introduction
The impact of the COVID-19 pandemic in the border region is not well-described, including the impact of pandemic-related sleep disturbances on dream experiences, despite frequent reports of meaningful changes to dreams in the population.

Methods
Participants were 155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) Study and a COVID sub-study (95% Hispanic/Latino). Participants were asked whether, as a result of the pandemic, they have experienced more schedule regularity, improved/worsened sleep, more initial or middle-of-the-night insomnia, more sleepiness, and more napping. They were also asked whether they experienced more, fewer, or the same amount of dreams in general, positive dreams, and negative dreams. Multinomial logistic regressions were used to examine overall, positive, and negative dream recall (more or less vs same) as outcome and perceived change in sleep as independent variable, adjusted for age, sex, socioeconomics, and mental health symptoms (assessed with PHQ4).

Results
Those who reported more schedule regularity were less likely to report more negative dreams (Relative Risk Ratio [RRR]=0.40, p=0.010). Those who reported improved sleep were also more likely to report more positive dreams (RRR=3.97, p=0.004). Those with worsened sleep were more likely to report fewer dreams overall (RRR=2.23, p=0.037), fewer positive dreams (RRR=2.24, p=0.003) and more negative dreams (RRR=3.69, p&lt;0.0005). Those with more initial insomnia were more likely to report fewer positive dreams (RRR=2.43, p=0.002) and more negative dreams (RRR=4.12, p&lt;0.0005). Those with more middle-of-the-night insomnia reported fewer dreams overall (RRR=2.35, p=0.018), fewer positive dreams (RRR=2.55, p=0.001), and more negative dreams (RRR=5.01, p&lt;0.0005). Those with more daytime sleepiness were more likely to report fewer dreams overall (RRR=4.75, p&lt;0.0005), fewer positive dreams (RRR=1.92, p=0.019), and more negative dreams (RRR=3.91, p&lt;0.0005), and were less likely to report more positive dreams (RRR=0.26, p=0.018). Those who reported napping more were more likely to report fewer dreams overall (RRR=2.78, p=0.008), fewer positive dreams (RRR=2.10, P=0.008), and more negative dreams (RRR=2.83, p=0.003), and were less likely to report more positive dreams (RRR=0.16, p=0.004).

Conclusion
Those whose sleep worsened due to the pandemic reported less dream recall, and dream content that was more negative and less positive overall.

Support (if any)
R01MD011600, R01DA051321
201 COVID-19 Pandemic Sleep Disturbances Related to Stress Experiences at the US-Mexico Border
Authors: Begay Tommy , Valencia Dora , Ghani Sadia , Delgadillo Marcos , Madhivanan Purnima , Krupp Karl , Ruiz John , Seixas Azizi , Jean-Louis Giardin , Killgore William , Wills Chloe , Grandner Michael 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has impacted many individuals at the vulnerable US-Mexico border region in a variety of ways. Fear, worry, and stress have increased for many, as has poor sleep. The present study evaluated the degree to which worsened sleep due to the pandemic impacted stress experiences.

Methods
Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). They were asked the degree to which their sleep worsened due to the pandemic. They also reported the degree to which they agreed with statements regarding various pandemic-related stress experiences. These included infection-related stresses, stresses about community impact, personal psychosocial stresses, stresses about consequences of potential infection, media and society-related stresses, feelings of safety, and how the pandemic has impacted home life. Ordinal logistic regressions were used to determine whether changes in sleep were associated with agreement with statements about pandemic-related stress experiences, adjusted for age, sex, financial status, education, and mental health (PHQ4).

Results
Those who perceived that their sleep worsened were more likely to report greater endorsement of beliefs that they were infected (ordinal Odds Ratio [oOR]=2.82,p&lt;0.0005), they could possibly be infected (oOR=1.98,p=0.003), they feared testing (oOR=1.94,p=0.006), COVID-19 would impact their community (oOR=1.75,p=0.017) and would do so for a long time (oOR=1.90,p=0.006), they experience more general (oOR=4.10,p&lt;0.0005), financial (oOR=3.15,p&lt;0.0005), food-related (oOR=2.97,p&lt;0.0005), housing-related (oOR=2.14,p=0.002), family-related (oOR=2.53,p&lt;0.0005) and relationship (oOR=3.37,p&lt;0.0005) stress, their shopping was impacted by scarcity (oOR=1.76,p=0.014), and they are at high risk for COVID (oOR=1.87,p=0.008). Furthermore, media coverage of COVID-19 had increased their stress (oOR=2.46,p&lt;0.0005), there is too much panic about COVID-19 (oOR=1.67,p=0.032), and they themselves are scared of getting COVID-19 (oOR=1.95,p=0.005), worried about the future (oOR=1.71,p=0.022), feel less secure (oOR=0.59,p=0.028), are thriving less (oOR=0.40,p&lt;0.0005), and their mental health is not improving (oOR=0.46,p=0.002).

Conclusion
Worse sleep due to the COVID-19 pandemic was associated with increased reports of stresses across a wide range of domains. Perhaps sleep health interventions could improve social and emotional health in these domains and reduce stress experiences and better cope with the pandemic. Alternatively, mental health interventions should perhaps be targeted to this population.

Support (if any)
R01MD011600, R01DA051321
204 Changes in Physical Activity During the COVID-19 Pandemic Associated with Changes in Sleep
Authors: Abdi Harun , Killgore William , Wills Chloe , Kennedy Kathryn , Charest Jonathan , Knowlden Adam , Grandner Michael 
Published: May 2021

Abstract

Introduction
The COVID-19 global pandemic has likely led to changes in physical activity as behavioral patterns were disrupted. This is important because sleep and physical activity are interrelated and promote health, and well-being. This study examined whether changes to physical activity were related to changes to sleep health as a result of the COVID-19 pandemic.

Methods
A sample of N=419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked to estimate the number of minutes per day they engaged in physical activity during the pandemic, as well as before. These were subtracted from each other, and a difference score was computed. Then, responses were categorized as no change (&lt;=15 mins difference), 16-45 minutes more or less activity, or 46+ minutes more or less activity (5 categories total). Outcome variables included the degree to which participants believed that due to the pandemic, they experienced (1) more schedule regularity, (2) better sleep, (3) worse sleep, (4) more difficulty falling asleep, (5) more difficulty maintaining sleep, (6) more sleepiness, and (7) more napping. Ordinal regressions were adjusted for age, and sex.

Results
Those who increased their activity by over 45 minutes per day reported that they were less likely to experience more daytime sleepiness (oOR=0.28, p&lt;0.02). Those who decreased their activity by over 45 minutes per day reported that they were more likely to experience worse sleep (oOR=2.38, p&lt;0.01) and less likely to experience a more regular schedule (oOR=0.37, p&lt;0.003) than prior to the pandemic.

Conclusion
Overall, those who increased their physical activity since the beginning of the pandemic reported less daytime sleepiness; and those who decreased their physical activity reported worse sleep experiences and a more irregular schedule. The relationship between physical activity and sleep during the pandemic may be bidirectional.

Support (if any)
R01MD011600, R01DA051321
208 Sleep Disturbances During the COVID-19 Pandemic Associated with Worries and Fears About Possible Infection
Authors: Lujan Matthew , Kennedy Kathryn , Killgore William , Wills Chloe , Grandner Michael 
Published: May 2021

Abstract

Introduction
The sudden COVID-19 pandemic and the uncertainty surrounding the virus has led to increased worry and fear. How this fear is associated with sleep remains unknown.

Methods
419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked about agreement with statements endorsing beliefs that they were currently infected, that they would someday be infected, that they fear testing, and that they are worried about a family member becoming infected. They were asked to rate agreement with statements regarding changes to sleep during the pandemic. Ordinal logistic regressions with degree of agreement with statements about sleep changes were outcomes, agreement with statements about COVID infection beliefs as predictor, and age, sex, and race/ethnicity as covariates were examined.

Results
Those who believed they were infected were 65% less likely to be keeping a regular schedule (p=0.001), 61% less likely to report improved sleep (p=0.009), 2.9 times as likely to report worse sleep (p=0.001), 2.7 times as likely to report difficulty falling asleep (p=0.002), 2.1 times as likely to report sleep maintenance problems (p=0.03), 2.9 times as likely to report sleepiness (p=0.001). Those who believed they would be infected in the future were 83% less likely to report improved sleep (p=0.005), 7.49 times as likely to report worse sleep (p=0.001), 5.3 times as likely to report difficulty falling asleep (p=0.003), 4.1 times as likely to report sleep maintenance problems (p=0.01), and 5.7 times as likely to report sleepiness (0.003). Those that feared testing were 5.7 times as likely to report more sleepiness (p=0.03). Those that worried about family were 80% less likely to be keeping a regular schedule (p=0.01), 75% less likely to report improved sleep (p=0.02), 4.5 times as likely to report worse sleep (p=0.02), 4.5 times as likely to report sleep maintenance problems (p=0.01), and 8.3 times as likely to report sleepiness (p=0.001).

Conclusion
Those who believed they were infected reported worsening sleep, though the degree was even greater among those who anticipated infection for themselves or a family member. Worries about COVID-19 may result in more adverse impact on sleep than potential infection itself.
Support (if any):
213 Eating Patterns Associated with Sleep Duration, Insomnia, Daytime Sleepiness and Overall Sleep Quality at the US-Mexico Border
Authors: Ghani Sadia , Delgadillo Marcos , Granados Karla , Okuagu Ashley , Wills Chloe , Alfonso-Miller Pamela , Buxton Orfeu , Patel Sanjay , Parthasarathy Sairam , Haynes Patricia , Molina Patricia , Seixas Azizi , Knowlden Adam , Jean-Louis Giardin , Grandner Michael 
Published: May 2021

Abstract

Introduction
Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep for health among this group.

Methods
Data were collected from N=100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for “cognitive restraint,” “uncontrolled eating, “and “emotional eating.” Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included: age, sex, Body Mass Index (BMI), education and immigrant status.

Results
When adjusted for age, sex and immigrant status (model-1), eating patterns were associated with greater insomnia (95%CI:[0.066,1.095];p=0.027), poorer sleep quality (95%CI:[0.170,1.456];p=0.014), sleepiness (95%CI[0.032,1.026];p=0.037), and weekend (but not weekday) sleep duration (95%CI:[-0.031,0.003];p=0.015). Further adjustment for education (model-2) revealed similar significant associations. Additional adjustment for BMI (model-3) revealed a change in daytime sleepiness, where no association was seen (95%CI:[-0.202,0.805];p=0.238). Regarding subscale scores, relationships were generally seen between sleep and both emotional eating and uncontrolled eating, but not cognitive restraint. However, after adjustment for BMI, there was a significant association between cognitive restraint and weekend sleep duration (95%CI:[-0.015,-0.001];p=0.030).

Conclusion
Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US Mexico border, particularly in terms of uncontrolled eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Support (if any)
Supported by T32HL007249, R01MD011600, R01DA051321
215 Sleep duration, quality and timing during confinement amid the COVID-19 Pandemic
Authors: Kaizi-Lutu Marc , Dinges David , Cordoza Makayla , Jones Christopher , Mange Ami 
Published: May 2021

Abstract

Introduction
As of March 2020, most U.S. states and territories issued statements advising people “stay at home” to avoid spreading the novel Coronavirus (COVID-19). This resulted in an unprecedented number of people practicing physical confinement and social distancing. This study examined self-reported changes in sleep duration, quality and timing in response to confinement and isolation.

Methods
We developed the “Anonymous Survey on Confinement during the COVID-19 Pandemic” to collect information on the American population practicing social distancing and some level of confinement. The survey collected information on demographics, duration and degree of confinement, and sleep-wake dynamics. The online survey was available for completion by any individual ≥18 years of age through the Penn Medicine Clinical Research page from May 16th to November 11th 2020. Descriptive statistics characterized the nature of confinement and non-parametric correlations evaluated the relationships between confinement and sleep-wake dynamics.

Results
N=226 participants completed the survey (n=176 female [77.8%]; n=47 male [20.8%]). The average age was 44.9±17.4 years. N=215[95.1%] reported confinement since March 2020 for an average of 89.3±41.7 days in confinement. Surveyed participants in confinement reported sleeping more than before confinement [40.0%], taking the same amount of time to fall asleep [56.6%], and felt that they were getting enough sleep [66.3%]. However, 36.3% of participants reported going to bed earlier and waking up earlier. Participants that engaged in naps prior to confinement reported taking more naps in confinement [50.8%]. Participants reported more daytime sleepiness [42.9%] and more disturbed sleep quality during confinement relative to before confinement [42.5%]. There were no significant correlations between time in confinement and sleep outcomes.

Conclusion
During the confinement amid the COVID-19 pandemic, participants responded by sleeping more and at different times, which could reflect circadian disruption of sleep. Changes in sleep amount and sleeping timing were accompanied by increased daytime sleepiness and a reduction in sleep quality. These changes may have been due to age, stressors experienced during the pandemic, social isolation, and/or a change in behavioral routines in response to changing demands and schedules. Our findings suggest that attention to changes in sleep-wake dynamics due to prolonged confinement is likely important to maintain healthy behaviors.
Support (if any):
216 Resilience, sleep difficulties, and subjective sleep quality during COVID-19
Authors: Socarras Laura Ramos , Potvin Jérémie , Forest Geneviève 
Published: May 2021

Abstract

Introduction
We have shown in a previous study that despite significant improvements in sleep patterns and sleep duration during COVID-19 in teens and young adults, only teens reported better sleep quality and satisfaction. Moreover, sleep difficulties seem to be more prominent in the older group during the pandemic, suggesting that there could be additional risk factors involved. The current study aimed to investigate the role of resilience in the association between changes in sleep and the subjective sleep quality (SSQ) in teens and young adults during COVID-19.

Methods
289 teens (12-17 years old) and 294 young adults (18-25 years old) completed the Connor-Davidson Resilience Scale-10 and an adapted version of the Pittsburgh Sleep Quality Index online. Teens and young adults were each divided into a resilient and less resilient group. Hierarchical regression models were conducted to examine the unique contribution of weekdays sleep duration, sleep difficulties, and resilience to SSQ. Sleep duration, sleep difficulties and SSQ before COVID-19, and gender were entered as controls.

Results
Results show that in less resilient teens, changes in sleep onset difficulties (β=-.285, p=.003), nocturnal and early awakenings (β=-.218, p=.019), and weekdays sleep duration (β=.282, p=.001) significantly predicted SSQ and explained 36.5% of the variance. In less resilient young adults, changes in nightmares (β=-.309, p=.027) and sleep onset difficulties (β=-.263, p=.012) significantly predicted SSQ and explained 24.1% of the variance. In resilient teens, changes in weekdays sleep duration (β=.296, p=.007) significantly predicted SSQ and explained 20.1% of the variance. In resilient adults, changes in sleep onset difficulties (β=-.325, p=.001), nocturnal and early awakenings (β=-.374, p=.000), and weekdays sleep duration (β=.192, p=.009) significantly predicted SSQ and explained 46.0% of the variance.

Conclusion
Our results suggest that resilience appears to be a protecting factor in the impacts of sleep difficulties on sleep quality, but only in adolescents. Indeed, in young adults, sleep difficulties seem to be a more important factor modulating sleep quality than changes in sleep duration. These results underline the importance of focusing on the intrinsic characteristics of each population to better target interventions.
Support (if any):
231 COVID-19 Lockdown Policies Across 20 Countries Modulate Sleep and Resting Heart Rate Measures
Authors: Ong Ju Lynn , Lau Teyang , Karsikas Mari , Kinnunen Hannu , Chee Michael 
Published: May 2021

Abstract

Introduction
Lockdowns imposed to stem the spread of COVID-19 have disrupted the lifestyles of many worldwide, but studies to date are mostly confined to observations within a limited number of countries, based on subjective reports and survey from a narrow time window. In the present study, we investigate associations between the severity of lockdown policies and objective sleep and resting-heart rate measures.

Methods
Data from 113,000 users of a consumer sleep tracker across 20 countries were gathered between Jan–Jul 2020 and compared with an equivalent period in 2019 as a control for naturally occurring seasonal fluctuations. Lockdown stringency was derived using scores from the Oxford Government Response Tracker. Multilevel growth curve models were used to quantify the effect of lockdown stringency on changes to sleep patterns (midsleep time and midsleep variability) and resting heart rate changes, and to predict changes in resting heart rate from changes to sleep patterns.

Results
Lockdown severity modulated the size of shifts in sleep midpoint and regularity during this period. Midsleep times were delayed in all countries during strict lockdowns, particularly on weekdays, while midsleep variability reduced. The largest shifts in midsleep time (+0.09 to +0.58 hours), midsleep variability (–0.12 to –0.26 hours) and resting heart rate (–0.35 to –2.08 bpm) occurred in April and May - when most countries imposed their strictest lockdown measures. In addition, multilevel modelling revealed that for each unit increase in stringency index, midsleep time was delayed by 0.96 min, midsleep variability decreased by 0.46 min and resting heart rate decreased by 0.06 bpm. Finally, in models predicting changes in resting heart rate from changes to sleep patterns, midsleep variability was shown to be the strongest predictor of resting heart rate, wherein an hour increase in the standard deviation of midsleep variability predicted a 5.12 increase in bpm, while an hour increase in midsleep time only predicted a 1.25 decrease in bpm.

Conclusion
Our findings demonstrate the utility of large-scale data from consumer wearables in providing population-level insights into how lockdown severity directly impacts sleep health during this pandemic period.

Support (if any)
Work conducted at NUS is supported by a grant awarded to Michael Chee (NMRC/STAR19may-0001).