Insomnia symptoms during the covid-19 pandemic: a case-control study

Bacelar, Andrea; Conway, Silvia Gonçalves; Assis, Márcia; Silva, Victor Menezes; Genta, Pedro Rodrigues; Pachito, Daniela Vianna; Tavares Júnior, Almir Ribeiro; Sguillar, Danilo Anunciatto; Moreira, Gustavo Antonio; Drager, Luciano Ferreira; Moreno, Claudia Roberta de Castro

doi:10.11606/s1518-8787.2023057004801

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Original Article • Rev. Saúde Pública 57 (suppl 1) • 2023 • https://doi.org/10.11606/s1518-8787.2023057004801 linkcopy

Insomnia symptoms during the covid-19 pandemic: a case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic.

METHODS A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems.

RESULTS The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50–6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69–5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04–2.84), being 40 years or older (OR = 1.93; 95%CI 1.22–3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22–3.69) were predictors for symptoms of insomnia disorder during the pandemic.

CONCLUSIONS In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed.

Sleep Initiation and Maintenance Disorders, epidemiology; Risk Factors; Socioeconomic Factors; Case-Control Studies; COVID-19

Variable	Symptoms of insomnia				p^a

	No		Yes

	n	%	n	%
Gender identity
Female	361	74	127	26	0.24
Male	115	78.8	31	21.2
Age Group
18 to 30	90	82.6	19	17.4	0.013
30 to 39	133	81.1	31	18.9
40 to 49	95	66.9	47	33.1
50 to 59	95	73.1	35	26.9
60 to 79	63	70.8	26	29.2
Having children
No	211	75.1	70	24.9	0.996
Yes	265	75.1	88	24.9
Education
High school complete or less	78	67.2	38	32.8	0.03
Incomplete higher education	56	70	24	30
Higher education complete	129	74.6	44	25.4
Postgraduate	213	80.4	52	19.6
Occupation
Retired	47	66.2	24	33.8	< 0.001
Unemployed	47	58	34	42
Employed	192	80.7	46	19.3
Entrepreneur/employer	31	86.1	5	13.9
Student	42	65.6	22	34.4
Liberal professional	117	81.3	27	18.8
State (place of residence)
São Paulo	149	81.4	34	18.6	0.019
Rio de Janeiro	97	67.8	46	32.2
Other	230	74.7	78	25.3
Nutritional status^b
Underweight or eutrophic	207	77.5	60	22.5	0.365
Overweight	151	71.9	59	28.1
Obesity	118	75.6	38	24.4

Total	476	75.1	158	24.9

Variable	Symptoms of insomnia				p^a

	No		Yes

	n	%	n	%
Self-perception of chronotype
Definitely active in the morning	224	77.2	66	22.8	0.508
Somewhat active in the morning	77	76.2	24	23.8
Definitely active at night	108	73.5	39	26.5
Somewhat active at night	65	70.7	27	29.3
No information	2	50	2	50
Total sleep time during the pandemic^b
6 hours or more	394	84	75	16	< 0.001
Less than 6 hours	75	50	75	50
Satisfaction with sleep duration (≥ 6 hours)^b
Had enough sleep before and during	372	85.1	65	14.9	< 0.001
Had insufficient sleep before and got better during	20	66.7	10	33.3
Had enough sleep before and got worse during	63	52.1	58	47.9
Had insufficient sleep before and during	12	41.4	17	58.6
Satisfaction with sleep quality (before and during the pandemic)^b
Good quality before and after	320	88.9	40	11.1	< 0.001
Poor quality before and good quality after	31	88.6	4	11.4
Good quality before and bad quality after	92	56.8	70	43.2
Poor quality before and after	25	37.9	41	62.1
Snoring
No	342	76.2	107	23.8	0.323
Yes	134	72.4	51	27.6
Excessive daytime sleepiness
No	339	77.8	97	22.2	0.021
Yes	137	69.2	61	30.8
Sleep Apnea
No	432	76.6	132	23.4	0.012
Yes	44	62.9	26	37.1
Grinding or clenching of teeth during sleep
No	334	75.7	107	24.3	0.563
Yes	142	73.6	51	26.4
Waking up with a headache
No	304	79.6	78	20.4	0.001
Yes	172	68.3	80	31.7
Nightmares
No	376	77.5	109	22.5	0.01
Yes	100	67.1	49	32.9
Leg discomfort or the need to move legs at bedtime
No	393	80.7	94	19.3	< 0.001
Yes	83	56.5	64	43.5
Waking up feeling tired
No	235	87.4	34	12.6	< 0.001
Yes	241	66	124	34
Sleepwalking
No	470	92.2	40	154	0.266
Yes	6	13	40	4
No problem
No	475	75	158	25	0.564
Yes	1	100	0	0

Total	476	75.1	158	24.9

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E-mail: revsp@usp.br

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[TFN1] ^a Chi-square test.

[TFN2] ^b Total less than 634 due to no response.