Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak.

Yi-Qi Lin,Zhao-Nan Zeng,Yong-Xi Wu,Xiao-Liang Xie,Lin Wang,Qiu-Yang Chen,Ze-Xin Lin,Shi-Chao Wei,Ling Wang

doi:10.3389/fnins.2020.631025

Abstract

ObjectivesNightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.MethodsA total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI.ResultsFrequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001).ConclusionThe present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.

Highlights

As coronavirus disease 2019 (COVID-19) broke out, medical workers were under great stress, and worldwide attention was focused on their sleep characteristics
Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan dealing with the COVID-19 pandemic
Compared with the score of the non-frequent nightmare group, the score of the frequent nightmare group was significantly higher in worry about being infected and family’s infection of COVID-19

Summary

Introduction

As coronavirus disease 2019 (COVID-19) broke out, medical workers were under great stress, and worldwide attention was focused on their sleep characteristics. During the COVID-19 pandemic, nightmares were found in 38–59% (Giardino et al, 2020; Herrero San Martin et al, 2020; Tu et al, 2020) of healthcare workers at the frontline, higher than those in non-healthcare workers (Herrero San Martin et al, 2020). Nightmares were found to be associated with mental and behavioral problems including depression and self-destructive behavior (Sateia, 2014) and were reported to predict PTSD symptoms dependent on mood and anxiety symptoms (van Liempt et al, 2013). Nightmares in frontline medical workers were worthy of attention during the COVID19 pandemic

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