Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis

Yun Li; Baixin Chen; Zhuoting Hong; Qimeng Sun; Yanyuan Dai; Maria Basta; Xiangdong Tang; Qingsong Qin

doi:10.1016/j.sleep.2021.09.014

Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis

Sleep Med. 2022 Mar:91:262-272. doi: 10.1016/j.sleep.2021.09.014. Epub 2021 Sep 28.

Authors

Yun Li¹, Baixin Chen², Zhuoting Hong², Qimeng Sun², Yanyuan Dai², Maria Basta³, Xiangdong Tang⁴, Qingsong Qin⁵

Affiliations

¹ Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China. Electronic address: s_liyun@stu.edu.cn.
² Department of Sleep Medicine, Mental Health Center of Shantou University, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China.
³ Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece.
⁴ Sleep Medicine Center, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.
⁵ Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, China.

Abstract

Background: Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic.

Methods: We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020.

Results: A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1% (95% CI 36.2-42.0%); the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1-39.9%) and 41.8% (95% CI 33.6-50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression.

Conclusions: Over one third of our sample present insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustains high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.

Keywords: COVID-19; China; Insomnia; Sleep.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / epidemiology
COVID-19* / epidemiology
China / epidemiology
Chronic Disease
Depression / epidemiology
Humans
Pandemics
Prevalence
Sleep Initiation and Maintenance Disorders* / epidemiology