Impact of the COVID-19 pandemic on stress and sleep in emergency room professionals

Abstract

Aims and objectives: To analyze stress levels, sleep quality, sleepiness and chronotypes on emergency room (ER) professionals before and during the COVID-19.

Background: ER healthcare professionals are exposed to high stress levels, and they often present with poor sleep quality.

Design: Observational study conducted into two different phases (before the COVID-19 and during the first wave of the COVID-19).

Method: Physicians, nurses and nursing assistants working in the ER were included. Stress, sleep quality, daytime sleepiness and chronotypes were assessed by the Stress Factors and Manifestations Scale (SFMS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Horne and Österberg Morningness-Eveningness questionnaire, respectively. The first phase of the study was performed between December 2019 and February 2020, and the second between April and June 2020. The STROBE checklist was used to report the present study.

Results: In total, 189 ER professionals in the pre-COVID-19 phase and 171 (of the initial 189) during COVID-19 were included. The proportion of workers with a morning circadian rhythm increased during the COVID-19, and stress levels were significantly higher during COVID-19 compared to the previous phase (38.34 ± 10.74 vs. 49.97 ± 15.81). ER professionals with poor sleep quality presented higher stress in the pre-COVID-19 phase (40.60 ± 10.71 vs. 32.22 ± 8.19) and during COVID-19 (55.27 ± 15.75 vs. 39.66 ± 9.75). Similarly, workers with excessive sleepiness had higher stress in the pre-COVID-19 phase (42.06 ± 10.95 vs. 36.64 ± 10.24) and during COVID-19 (54.67 ± 18.10 vs. 48.44 ± 14.75). Positive associations were also found between the SFMS and the PSQI, as well as with the ESS in both phases of the study.

Conclusions: Emergency room professionals had increased stress levels during the COVID-19 pandemic. Stress was particularly higher in those with poor sleep quality or with excessive daytime sleepiness.

Relevance to clinical practice: These results should aim to impulse the implementation of measures to improve the working conditions of ER professionals.

Keywords: COVID-19; chronotype; emergencies; nurses; nursing assistants; physicians; sleep quality; sleepiness; stress.