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Background: The aim of this study was to describe the sleep quality and its influencing factors among medical workers of different working statuses and staff types during the coronavirus disease COVID epidemic. Results: A total of 4, respondents completed the survey. Among them, Anxiety, depression, and coping style were associated with sleep disturbance. Conclusion: The sleep quality of the medical staffs has been impaired during the epidemic period, especially among nurses, doctors, and administrators who are working on the front line. Medical institutions should strengthen psychological services and coping strategies for medical staffs. In the past decade, there have been several virus outbreaks: the H1N1 influenza pandemic around the globe, the Middle East respiratory syndrome-associated coronavirus MERS-CoV spreading throughout the Arabian Peninsula, the Ebola virus sweeping across West African, and the Zika virus endemic in the Americas 1. Recently, a pneumonia outbreak caused by a novel coronavirus that was detected in Wuhan, Hubei Province has spread across China and beyond since December 2. As of March 22, , a total of , laboratory-confirmed COVID cases and 14, deaths were reported by countries or regions around the world, with 40, confirmed new cases and 1, new deaths in the preceding 24 h 4. As the outbreak continues, health workers have been persistently confronted with heavy workloads and a high risk of infection. In this large-scale public health emergency, medical staffs are facing unprecedented physical and psychological pressures. Some studies have reported that mental and sleep problems have been prevalent among medical workers in Wuhan and other areas during the period. Zaki et al. Wu et al. Chen et al. It is relatively well-known that sleep affects both physical and mental health 9 — As a result, good sleep quality is the premise of the physical and mental health of the medical staffs. During the epidemic period, there have been few domestic articles on sleep considering all sectors of the hospital staffs. The samples for this study were selected from representative hospitals in Hunan Province to study the sleep and related factors of medical staffs in various occupations. A series of prompt actions, such as the lockdown of Wuhan and even the entire Hubei Province, follow-up supervision, and timely reporting of information on the epidemic situation, early detection, strict quarantine, and provision of treatment with no personal charge for confirmed patients, was imposed by the Chinese government with the purpose of containing the outbreak. Furthermore, over 8, doctors and nurses from other provinces and cities, merging into 68 voluntary medical teams, converged in Hubei, the hardest-hit province in China, to combat the novel coronavirus in collaboration with the local medical workers Hunan is the neighboring province of Hubei, with a total of 1, confirmed cases being reported. As the largest top-class tertiary hospital in Hunan Province, Xiangya Hospital of Central South University has screened a significant number of suspicious cases at the local level by setting up two h fever clinics and four screening wards, one for patients with respiratory disease, two for suspected patients with mild symptoms, and one for severely affected patients. In response to this disease, the medical staffs from the department of infectious disease, as well as the volunteers from other departments, such as the department of intensive care, respiratory medicine, and emergency medicine, were all summoned to join in the battle against the virus. To describe their sleep quality and identify related factors, we investigated all staffs of Xiangya Hospital through an online survey. The study aimed to provide evidence for designing and implementing interventional strategies for those who reported impaired quality of sleep. This was a single-centered cross-sectional study that investigated all medical staffs in Xiangya Hospital through an online WeChat-based survey. The questionnaire was distributed by the administrative department of the hospital from February 13, to February 15, A post-hoc estimation of the sample size was performed. Assuming a significance level of 0. The questionnaire included the following sections: general information, sleep quality, symptoms of stress, anxiety, and depression, social support, and coping strategies. Sociodemographic characteristics included gender, age, marital status, educational level, years of working, staff type doctor, nurse, technician, pharmacist, administrator, researcher, logistician, other , professional title, working status working in the non-epidemic area of the hospital, working in the epidemic area of the hospital, assigned to the ICU of Union Hospital in Wuhan, working at home, resting at home, quarantined , disease history, living situation living alone or not , exposure to confirmed or suspected COVID cases, average monthly income, personal economic impact from the outbreak, recognition of the effectiveness of protection, and concerns about insufficient supplies of protective materials. It has been widely used in studies of the Chinese population, with validated psychometric properties and an established normative range, and the Cronbach's alpha was 0. Total scores can therefore range from 10 to Symptoms of stress, anxiety, and depression were measured by the Chinese version of the short-form Depression, Anxiety and Stress Scale DASS , which was first proposed by Lovibond and Lovibond 14 and later reduced to 21 items by Antony et al. Studies by domestic scholars have found that the DASS has high reliability and validity. When applied to college students, the Cronbach's alpha coefficients for the three subscales of the DASS were 0. There are seven items in each of the three subscales, with scores ranging from 0 to The SSRS was utilized to assess the level of social support over the past year, including subjective support four items , objective support three items , and support available three items. This scale was compiled by Xie 19 and includes two dimensions: active coping 12 items and passive coping 8 items. The instrument has been commonly used in China and shows good reliability and validity The Cronbach's alpha coefficient of the CSQ was 0. In this study, the Cronbach's alpha coefficient of the CSQ was 0. Group differences were examined by chi-square test for categorical data and analysis of variance ANOVA for continuous data with normal distribution. Multiple comparison of means was performed using the SNK-q test. To reduce bias for group comparisons, propensity score matching PSM was applied. Logistic regression was used to investigate factors associated with sleep quality. All statistical analyses were performed using SPSS. The significance level was 0. Xiangya Hospital has a total of 5, employees. As shown in Table 1 , there were doctors With respect to working status, 2, As shown in Table 2 , the prevalence of sleep disturbance among medical staffs was Table 2. The prevalence rates of sleep disturbance and SRSS scores compared with the norm. Subgroup analysis was conducted for the staffs who were assigned to the ICU of Union Hospital in Wuhan exposure group and the staffs who were working in the epidemic area of Xiangya Hospital control group. Six demographic variables, including gender, age, marital status, educational level, years of working, and staff type, were matched by PSM for the purpose of comparison. Before matching, educational level, years of working, and staff type were different between the two groups, whereas after matching, no differences were identified Supplementary Table 1. There was no statistically significant difference in the mean SRSS scores between the exposure The prevalence of sleep disturbance of the two groups was Due to the lack of significant difference, we further combined the two aforementioned groups as the battlefront staffs exposure group and made a comparison with the staffs who were working in the non-epidemic area control group. After matching, the mean SRSS scores were The prevalence of sleep disturbance in the two groups was The results show that the mean SRSS score was the highest among nurses, followed by doctors and administrators Table 4. In contrast, technicians and logisticians reported the lowest mean scores. Table 5. We constructed a logistic model with a step-back method for all first-line staffs to investigate the factors influencing sleep disturbance. Table 6. Logistic regression on factors for sleep disturbance among battlefront staffs. Medical practitioners around the world are facing a lasting epidemic event, and ensuring sleep quality is one of the prerequisites for medical workers' physical and mental health. To understand the sleep quality and its influencing factors in medical workers during the epidemic, we immediately implemented an online survey and found that Among the staff types, the sleep quality of nurses was the worst, followed by doctors and administrators. Professional title, anxiety, depression, and coping style were identified to be associated with sleep disturbance. Among frontline nurses, anxiety and coping style were the associated factors identified. Among frontline doctors, recognition of the effectiveness of protection, concerns about insufficient supplies of protective materials, and anxiety were the associated factors identified. The overall prevalence of sleep disturbance among medical staffs in this study was The sleep quality of the frontline group, which included the staffs assigned to the ICU of Union Hospital in Wuhan and the staffs working in the epidemic area of the hospital, was worse than that of the staffs working in the non-epidemic area of the hospital; this was consistent with findings of a previous study 8. The prevalence rate of sleep disturbance among quarantined staffs was lower than that of the staffs working on the front line, which may have been because the quarantined staffs had taken protective measures before contacting confirmed or suspected cases, none of them manifested clinical symptoms, and most were quarantined at home except for two staffs in the isolation ward. As reported previously, the frontline staffs at a high risk of infection in the severe acute respiratory syndrome SARS epidemic not only had chronic stress but also suffered from depression and anxiety to a greater extent Similarly, through the investigation of medical workers fighting against COVID in China, the medical workers who had close and direct contact with infected patients exhibited higher anxiety scores than those who had not Therefore, we should attach great importance to the sleep quality of frontline medical workers, and interventional measures should be taken for them. A review of SARS research recommended that employers should make every endeavor to provide a supportive environment in the workplace and promise to ensure overall support for workers who carry the greatest burden of risk, such as those who have the most contact with patients and the most prolonged exposure to virus Psychological disturbances among frontline staffs during the epidemic have also been linked to workloads 23 , so the working hours of frontline staffs should be reasonably arranged. Occupational roles often have an impact on psychological effects. Our study found the worst sleep quality among staff types to be for nurses, whereas the sleep quality for technicians and logisticians was better. Anxiety and coping style were also identified as significant factors in this study. Nurses not only provide treatment, nursing, and health education but also participate in patients' rehabilitation and provide support for patients and their families. During the COVID epidemic, nurses are still the main medical practitioners in the treatment of confirmed or suspected cases. During the epidemic, the public and patients were prone to psychological pressure 24 , 25 , and the nursing work of nurse—patient communication and spiritual care became more difficult than before. A study of nurses in South Korea showed that poor sleep quality might lead to lower nurse productivity As this study shows, the higher the professional title, the better the sleep quality. Therefore, nurse leaders and managers should consider taking measures to improve nurses' sleep quality and work efficiency. According to national policies, the administrative departments of hospitals should implement public management measures in place, such as public information dissemination, infection prevention and control training, and psychological assistance, etc. Compared with frontline nurses, hospital managers should strengthen epidemic prevention and control knowledge training for doctors and ensure sufficient supplies of protective materials. Frontline staffs with anxiety and depression were more likely to develop sleep disturbance, which is consistent with many studies during the outbreak 7 , 8. Studies of other populations have also shown that poor sleep quality was directly associated with anxiety and depressive symptoms 28 , Systematic epidemic prevention programs, such as in-service training, human resources allocation, gathering sufficient protective equipment, and establishing a mental health team, could improve anxiety, depression levels, and sleep quality among battlefront staffs Progressive muscle relaxation training could alleviate anxiety and improve sleep quality, and this training can be performed remotely and multiple times after one training session During the outbreak, we advocate that medical institutions adopt systematic prevention programs and psychological interventions to alleviate anxiety and depression and improve sleep quality. Many studies have shown that social support is a protective factor for sleep quality. Social support was significant for self-reported sleep in a study of American adults In light of the study conducted by Xiao using the structural equation analysis, the levels of anxiety, stress, and self-efficacy of Chinese medical workers who had been treating patients infected by COVID between January and February depended on their sleep quality and the social support they had received Liu holds the opinion that the mental health, general health, physical pain, and vitality of medical workers who fought against SARS-CoV-2 pneumonia in China showed a close connection with support from family members, friends, and society as a whole Therefore, medical institutions should protect their medical staffs with protective materials and provide psychological support and train them to seek help and support from their families, colleagues, and friends. This study shows that battlefront staffs with better coping skills suffered a lower risk of sleep disturbance. In the H1N1 epidemic in Japan, staff members with close ties to psychiatric services in hospitals felt less significant psychological impact, whereas those provided with less information about the pandemic felt an overwhelming sense of insecurity regarding exposure without protection Therefore, support for medical staffs during the epidemic should also include knowledge dissemination and infection control training, which might also be beneficial to their coping strategies. In this study, we found that the psychophysiological response following insomnia was the most prevalent symptom of sleep disruption, and that insufficient sleep time, poor sleep quality, and disrupted sleep accounted for the largest proportions of high score sleep factors among medical staffs. Since the rest time of medical staffs was limited during the epidemic period, we can provide some feasible psychological treatment methods to improve sleep quality. By tapping into the power of music, Lestarini discovered that soft and soothing music could be used as an intervention therapy to alleviate symptoms of depression and improve sleep quality for senior citizens According to a meta-analysis, through online communication, cognitive behavioral therapy was able to relieve insomnia, improve sleep efficiency and subjective sleep quality, and reduce the number of wake-ups after sleep onset and nighttime awakenings following treatment, thereby reducing latency to sleep and increase total sleep time Ong et al. Therefore, medical institutions can provide relaxation therapy audio, mindfulness audio, network cognitive behavioral therapy, etc. There are several limitations in this study. First, the generalizability might be limited in a single-centered study. Second, the sample size of the staffs assigned to Wuhan was relatively small. Third, we did not conduct face-to-face interviews, but rather an online questionnaire survey was used instead for safety and feasibility. Item response might be biased by extreme response style. Sleep disturbance is prevalent among medical staffs during the COVID outbreak, especially in high-risk staffs who directly contact patients on the battlefront, as well as nurses, doctors, and administrative groups. Anxiety and depression are associated with sleep problems, whereas coping ability is a protective factor for sleep. Medical institutions should use practical psychotherapeutic methods to improve employees' psychological and sleep status. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. SL and FG were responsible for collecting data. FJ was involved in the manuscript preparation and drafting the paper. HD and ZG were involved in editing and revising the manuscript. All authors have contributed to and have approved the final manuscript. The funder had no influence in the design, analysis, or interpretation of data or in the writing of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We would like to show our great gratitude to all my colleagues who have offered invaluable support. We would like also to show our great gratitude to all of the participants who have contributed to this project. Opportunities and challenges in modeling emerging infectious diseases. A novel coronavirus outbreak of global health concern. World Health Organization Coronavirus Disease Google Scholar. Zhonghua liuxingbingxue zazhi. J Nat Sci Med. Investigation on sleep quality of first-line nurses in fighting against novel coronavirus pneumonia and its influencing factors. Chinese Nurs Res. A composite measure of sleep health predicts concurrent mental and physical health outcomes in adolescents prone to eveningness. Sleep Health. Prather AA. Sleep, stress, and immunity. Does sleep partially mediate the effect of everyday discrimination on future mental and physical health?. Soc Sci Med. Wang FS, Zhang C. What to do next to control the nCoV epidemic?. Li JM. Chinese J Health Psychol. Behav Res Ther. Psychometric properties of the item and item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. J Clin Psychol. Xiao SY. Social support rating scale. Chinese Mental Health J. Study on the reliability and validity of social support rating scale. J Xinjiang Med Univ. Xie Y. Reliability and validity of the simplified Coping Style Questionnaire. Chinese J Clin Psychol. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Canad J Psychiatry. The prevalence and influencing factors for anxiety in medical workers fighting COVID in China: a cross-sectional survey. Epidemiol Infect. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occupat Environ Med. The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID epidemic: workload should be concerned. J Affective Disord. A nationwide survey of psychological distress among Chinese people in the COVID epidemic: implications and policy recommendations. Gen Psychiatr. Psychological responses, behavioral changes and public perceptions during the early phase of the COVID outbreak in China: a population based cross-sectional survey. Association between sleep quality and nurse productivity among Korean clinical nurses. J Nurs Manage. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease epidemic. World J Clin Cases. Sleep Med. The synergic relationship between social anxiety, depressive symptoms, poor sleep quality and body fatness in adolescents. J Affect Disord. Effects of a SARS prevention programme in Taiwan on nursing staff 's anxiety, depression and sleep quality: a longitudinal survey. Int J Nurs Stud. Complem Therap Clin Practice. Chung J. Social support, social strain, sleep quality, and actigraphic sleep characteristics: evidence from a national survey of US adults. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease Med Sci Monitor. Perceived social support and its impact on psychological status and quality of life of medical staffs after outbreak of SARS-CoV-2 pneumonia: a cross-sectional study. Psychological impact of the pandemic H1N1 on general hospital workers in Kobe. Psychiatry Clin Neurosci. Music therapy on sleep quality in elderly. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia—a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. A randomized controlled trial of mindfulness meditation for chronic insomnia: effects on daytime symptoms and cognitive-emotional arousal. Psychiatry The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Psychiatry , 09 June Background In the past decade, there have been several virus outbreaks: the H1N1 influenza pandemic around the globe, the Middle East respiratory syndrome-associated coronavirus MERS-CoV spreading throughout the Arabian Peninsula, the Ebola virus sweeping across West African, and the Zika virus endemic in the Americas 1. Methods Study Design and Participants This was a single-centered cross-sectional study that investigated all medical staffs in Xiangya Hospital through an online WeChat-based survey. Sample Size Estimation A post-hoc estimation of the sample size was performed. Table 1. Demographics and characteristics of the study sample. Table 3. Table 4. The SRSS scores of different staff types and multiple comparison. Edited by: Ahmed S.

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