Sleep (system call)

About: Sleep (system call) is a research topic. Over the lifetime, 2633 publications have been published within this topic receiving 27806 citations. The topic is also known as: Sleep() & sleep().

Mobile-terminal sleep wake-up method

Abstract: The invention proposes a mobile-terminal sleep wake-up method which includes: a terminal side: acquiring user sleep parameters configured by a base station in an access process; judging that a sleep mode needs to be entered under a standby state; according to the user sleep parameters, calculating a sleep time point and a monitoring time point; entering a sleep mode at the sleep time point and waking up and performing monitoring at the monitoring time point; waking up and initiating access if a sleep wake-up message is monitored; or continuing to sleep. A base-station side: monitoring the state of the terminal and judging that the terminal is in the sleep mode; according to the user sleep parameters configured for the terminal, calculating the monitoring time point; and sending the sleep wake-up message at the monitoring time point if the terminal needs to be woken up. Through adoption of the method, the terminal does not need to perform sleep consultation application to the base station for entrance of the sleep mode so that sleep failure resulted from occupancy of air-interface channel resources by message interaction and message loss is prevented and sleep preparation time is reduced and thus sleep efficiency is improved.

Non-intrusive sleep analyzer for real time detection of sleep anomalies

Abstract: Solutions for caring for the elderly both efficacious and cost-effective are given by Ambient Assisted Living (AAL) systems that combine the research fields of intelligent systems and communication technologies. These systems are promising for the improvement of the quality of life of elderly and disabled people. One important characteristic of health and well-being is sleep. While sleep quantity is directly measurable, its quality has traditionally been assessed with subjective methods such as questionnaires. In this paper, we propose a non-intrusive sleep analyzer for real time detection of sleep anomalies, part of an effective AAL system. The proposed solution is based on combination of non-invasive sensors and an algorithm for sleep analysis with two stages - low and high level reasoning. It also offers the opportunity to include third party devices. Using the analyzer we can monitor basic sleep behavior and to detect sleep anomalies, which can serve as an important indicator for both mental and physical health.

Sleep Information Gathering Protocol Using CoAP for Sleep Care

Abstract: There has been a growing interest in sleep management recently, and sleep care services using mobile or wearable devices are under development. However, devices with one sensor have limitations in analyzing various sleep states. If Internet of Things (IoT) technology, which collects information from multiple sensors and analyzes them in an integrated manner, can be used then various sleep states can be more accurately measured. Therefore, in this paper, we propose a Smart Model for Sleep Care to provide a service to measure and analyze the sleep state using various sensors. In this model, we designed and implemented a Sleep Information Gathering Protocol to transmit the information measured between physical sensors and sleep sensors. Experiments were conducted to compare the throughput and the consumed power of this new protocol with those of the protocols used in the existing service—we achieved the throughput of about two times and 20% reduction in power consumption, which has confirmed the effectiveness of the proposed protocol. We judge that this protocol is meaningful as it can be applied to a Smart Model for Sleep Care that incorporates IoT technology and allows expanded sleep care if used together with services for treating sleep disorders.

Insomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals

Abstract: Free AccessScientific InvestigationsInsomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals Luciano F. Drager, MD, PhD, Daniela V. Pachito, MD, PhD, Claudia R.C. Moreno, PhD, Almir R. Tavares, MD, PhD, Silvia G. Conway, PhD, Márcia Assis, MD, Danilo A. Sguillar, MD, PhD, Gustavo A. Moreira, MD, PhD, Andrea Bacelar, MD, Pedro R. Genta, MD, PhD Luciano F. Drager, MD, PhD Address correspondence to: Luciano F. Drager, MD, PhD, Associate Professor of Medicine, University of São Paulo Medical School, Brazil; Email: E-mail Address: [email protected] Unidade de Hipertensão, Departamento de Clinica Medica, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil Unidade de Hipertensão, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil Search for more papers by this author , Daniela V. Pachito, MD, PhD Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês, São Paulo, Brazil Fundação Getúlio Vargas, São Paulo, Brazil Search for more papers by this author , Claudia R.C. Moreno, PhD School of Public Health, University of São Paulo, São Paulo, Brazil Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden Search for more papers by this author , Almir R. Tavares, MD, PhD Neurosciences Postgraduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil Search for more papers by this author , Silvia G. Conway, PhD Akasa—Formação e Conhecimento, São Paulo, Brazil Psychiatry Department, University of São Paulo Medical School, São Paulo, Brazil Search for more papers by this author , Márcia Assis, MD Clínica do Sono de Curitiba, Hospital São Lucas, Curitiba Paraná, Brazil Search for more papers by this author , Danilo A. Sguillar, MD, PhD ENT Department of Universidade Federal de Sao Paulo, São Paulo, Brazil Search for more papers by this author , Gustavo A. Moreira, MD, PhD Department of Pediatrics and Psychobiology, Universidade Federal de Sao Paulo, São Paulo, Brazil Search for more papers by this author , Andrea Bacelar, MD Carlos Bacelar Clinica, Rio de Janeiro, Brazil Search for more papers by this author , Pedro R. Genta, MD, PhD Laboratório do Sono, LIM 63, Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil Search for more papers by this author Published Online:February 1, 2022https://doi.org/10.5664/jcsm.9570Cited by:5SectionsAbstractEpubPDFSupplemental Material ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTStudy Objectives:To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on insomnia and other sleep disturbances in health care professionals.Methods:A survey was distributed using social media and organizational emails to Brazilian active health care professionals during the COVID-19 outbreak. We explored potential associated factors including age, sex, occupation, workplace, work hours, income, previous infection with COVID-19, recent/current contact with COVID-19 patients, regional number of incident deaths, anxiety, and burnout. We evaluated new-onset/previous insomnia worsening episodes (primary outcome), new pharmacological treatments, sleep quality, duration, nightmares, and snoring (secondary outcomes).Results:A total of 4,384 health professionals from all regions of the country were included in the analysis (44 ± 12 years, 76% females, 53.8% physicians). Overall, 55.7% were assisting patients with COVID-19, and 9.2% had a previous COVID-19 infection. The primary outcome occurred in 32.9% of respondents in parallel to 13% new pharmacological treatments for insomnia. The sleep quality worsened for 61.4%, while 43.5% and 22.8% reported ≥ 1-hour sleep duration reduction and worsening or new-onset nightmares, respectively. Multivariate analyses showed that age (odds ratio [OR]: 1.008; 95% confidence interval [CI] 1.001–1.015), females (OR: 1.590; 95% CI 1.335–1.900), weight change (decrease: OR: 1.772; 95% CI 1.453–2.161; increase: OR: 1.468; 95% CI 1.249–1.728), prevalent anxiety (OR: 3.414; 95% CI 2.954–3.948), new-onset burnout (OR: 1.761; 95% CI 1.489–2.083), family income reduction > 30% (OR: 1.288; 95% CI 1.069–1.553), and assisting patients with COVID-19 (OR: 1.275; 95% CI 1.081–1.506) were independently associated with new-onset or worsening of previous insomnia episodes.Conclusions:We observed a huge burden of insomnia episodes and other sleep disturbances in health care professionals during the COVID-19 pandemic.Citation:Drager LF, Pachito DV, Moreno CRC, et al. Insomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals. J Clin Sleep Med. 2022;18(2):373–382.BRIEF SUMMARYCurrent Knowledge/Study Rationale: The stressful routine and risk of infection by COVID-19 may predispose health care professionals to sleep disturbances. This nationwide cross-sectional study comprising several occupational categories explored the burden of several sleep disturbances, new-onset pharmacological treatments for insomnia, and their related independent predictors.Study Impact: We observed a worrisome scenario of new-onset/worsening preexisting insomnia episodes (which contributed to new pharmacological treatments for insomnia), impaired sleep quality, duration, nightmare, and snoring. Age, females, weight change, anxiety, burnout, income reduction, and assisting patients with COVID-19 were independently associated with the primary outcome. Considering the impact of sleep disorders on work performance/health care decisions, this study underscores the need for dedicated sleep and mental health programs for health care professionals.INTRODUCTIONThe adverse impact of the coronavirus disease 2019 (COVID-19) pandemic on sleep quality and anxiety levels in the global population reinforces the need for urgent attention to sleep disorders and mental health globally.1–4 The lack of effective pharmacological treatments, low availability of vaccines, the rapid dissemination of the virus, social distancing, decreased physical activity, the negative economic impact, and even the alarming fake news are contributing to this scenario.5–7Health care professionals are particularly exposed to higher levels of stress and work demand.8 In addition, health care professionals have a higher risk of contamination when compared to the general population.9 Several reports10–18 have discussed the potential impact of COVID-19 pandemic on sleep in health care professionals. Limitations of previous studies include one or more factors including small sample sizes, analysis of specific health care occupations, the lack of comparisons with the period before COVID-19, and lack of assessment of several variables associated with insomnia.In this large survey we aimed to explore the potential impact of the COVID-19 pandemic on sleep, anxiety levels, and burnout symptoms in a large sample of health care professionals from Brazil. Our country has continental dimensions and is experiencing a high overall incidence of COVID-19, but with significant differences among each region. We assessed independent predictors of new-onset or worsening of preexisting insomnia (primary outcome) as well as new-onset pharmacological treatments for insomnia, sleep quality, sleep duration, nightmares, and snoring (secondary outcomes) among these professionals. We made the hypothesis that insomnia among health care professionals will worsen during the pandemic as compared to the prepandemic period. As a consequence, health care professionals will report increased use of hypnotics during the pandemic as compared to the prepandemic period.METHODSThis study is a joint initiative effort from the Brazilian Association of Sleep (ABS) and the Brazilian Association of Sleep Medicine (ABMS). This cross-sectional study was reviewed and approved by the Hospital das Clínicas Institutional Review Board (CAAE: 31750920.9.0000.0068) and was exempted from a consent form. No participant identifier was required or recorded, preserving the anonymity of responders. The study report aimed at covering all items of the Strobe checklist for cross-sectional studies).19Sample populationHealth care professionals (including physicians, nurses, nurse technicians, physical therapists, psychologists, nutritionists, occupational therapists, pharmacists, physical educators, dentists, biologists, and administrative officers) were invited to participate through the WhatsApp digital platform. Invitations were also sent by email using organizational mailing lists of health care professional associations. The survey was distributed and managed using REDCap electronic data capture tools hosted at the Hospital das Clínicas.20 The survey remained active from May 28, 2020 to June 28, 2020. Participants had to be active health care professionals. Subjects were excluded if their answers to the main outcome questions (insomnia) were left blank. No further exclusion criteria were applied.The survey was developed by sleep medicine specialists and included information on occupation, age, sex, and workplace environment (intensive care unit, ward, operating room, pharmacy, administrative area, outpatient clinic, etc.) and the postal code of the home address (supplemental material). Participants were also asked to describe current and previous weekly work hours, whether they were involved in the care of COVID-19 patients, and whether they had been diagnosed with COVID-19. Three domains addressing anxiety levels, sleep characteristics, and burnout symptoms were included. The anxiety domain included generalized anxiety disorder 2-item21 to assess the presence of anxiety symptoms and a question asking the participant to compare his (her) current anxiety symptoms to those before the COVID-19 pandemic. The domain related to sleep characteristics included questions regarding current and previous sleep quality, sleep duration, sleepiness assessed by the Stanford Sleepiness Scale,22 insomnia symptoms, nightmares, and snoring. Participants were asked if they had insomnia and whether insomnia worsened during the pandemic. In addition, participants were asked the frequency of insomnia episodes and if they used to take or started taking medications for insomnia. New-onset insomnia was considered when difficult in initiating or maintaining sleep that occurred at least twice a week during the pandemic. Worsening of preexisting insomnia was considered when the participant had a previous insomnia history but it was impaired by at least two additional episodes per week during the pandemic. The burnout domain included questions addressing current and previous burnout symptoms.23 The burnout questionnaire was scored from 1 (no burnout symptoms) to 5 (severe burnout symptoms). New-onset burnout was considered when participants scored 1 or 2 before the pandemic and 3–5 during the pandemic. In addition, participants were asked to declare changes in weight and family income compared to the prepandemic period.Data on the regional incidence of death due to COVID-19 (per 10,000 inhabitants) was collected from the Brazilian Ministry of Health website in the same period of this survey.24 Since the goal of the present study was to obtain the highest number of responses possible, the sample size calculation was not conducted. A post hoc power calculation based on our main findings is presented in the Results section.Statistical analysisAll analyses were conducted using the software R 3.6.0. Graphs were built with the ggplot2 package. For comparisons of categorical variables, the χ2 test was performed. Normally distributed continuous variables were compared by using unpaired Student’s t test or one-way analysis of variance and presented as the means and standard deviation. Kruskal-Wallis tests were used to compare skewed variables and are presented as medians and interquartile ranges. We performed a logistic regression analysis to assess the influence of independent variables on the combination of new onset of insomnia and worsening of preexisting insomnia episodes. Logistic regression was also used to determine the independent predictors of new-onset pharmacological treatments, sleep quality, and sleep duration. Adjusted estimates (odds ratio) and their precision (95% confidence interval) are presented. The following variables were entered in the model: age, sex, health category, workplace, previous diagnosis of COVID-19, previous or current care of patients with COVID-19, regional death incidence of COVID-19 according to the epidemiological week in the individual’s municipality, change in working hours, change in weight (no change, decrease, or increase), the proportion of change in family income (no change, increase, decrease > 0 but < 30%, and decrease > 30%), prevalent anxiety, and change in burnout severity. For the secondary outcomes, insomnia was included in the regression model. For all statistical tests, a significance level of 5% was adopted. Incomplete responses were excluded preventing the need for imputation of missing values.RESULTSAfter the completion of study recruitment we obtained 4,939 responses, of which 4,384 were completed for the outcomes of interest (88.8% of the total). Methods applied for disseminating the link to the survey precluded the calculation of response rates.The distribution of responders across the Brazilian territory is shown on a heat map ( Figure S1 in the supplemental material), representing all geographic regions. Around half of the responders were physicians, followed by physiotherapists and nurses ( Figure S2 in the supplemental material).The characteristics of the studied population are shown in Table 1. Overall, our sample comprised middle-aged women. On average, participants reported a reduction of weekly working hours during the pandemic compared to the prepandemic period. Figure S3 in the supplemental material reports work hours changes (per week) by health professional category. A significant proportion of participants reported they were predominantly working from home. More than half of the interviewed professionals were assisting or had previously assisted patients with COVID-19. Almost 10% had a previous COVID-19 infection. The frequencies of professional groups by occupation that were assisting patients with COVID-19 or had a previous diagnosis of COVID-19 are reported in Figure S4 and Figure S5 in the supplemental material, respectively. We observed a substantial proportion of health care professionals with prevalent anxiety ( Figure S6 in the supplemental material), burnout ( Figure S7 in the supplemental material), reporting worsening sleep quality and duration during the pandemic (Table 1), or reporting family income reduction ( Figure S8 in the supplemental material).Table 1 Characteristics of the studied population of health care professionals in Brazil.VariableValuesAge, mean ± SD, y44 ± 12Females, n (%)3333 (76.0%)Weekly work hours (before), mean ± SD41.4 ± 15.2Weekly work hours (current), mean ± SD34.6 ± 18.5Home office, n (%)1,742/4,379 (39.8%)Recent or current care of patients with COVID-19, n (%)2,442 (55.7%)Previous diagnosis of COVID-19, n (%)403 (9.2%)Prevalent anxiety, n (%)1,939 (44.2%)New-onset burnout, n (%)882 (20.1%)Stanford Sleepiness Scale2.5 ± 1.4Current sleep quality (in comparison to prepandemic) Worse2,691/4,381 (61.4%) Similar1,492/4,381 (34.1%) Better198/4,381 (4.5%)Current sleep duration (in comparison to prepandemic) Decreased2,135/4,377 (48.8%) Similar1,552/4,377 (35.5%) Increased690/4,377 (15.8%)Prepandemic subjective sleep duration, h6.8 ± 1.2 (n = 4,325)Current subjective sleep duration, h6.4 ± 1.6 (n = 4,328)COVID-19 = coronavirus disease 2019, SD = standard deviation.Main outcome: insomnia episodesOur survey showed that 1,444 out of 4,384 (32.9%) health care professionals presented new-onset insomnia during the pandemic or worsening of preexisting insomnia episodes. Considering the proportion of the main outcome, this sample size allowed 95% significance level with a margin of error of just 1.46%. The characteristics of health care professionals with no insomnia, no change in previous insomnia, and new insomnia/insomnia impairment during the pandemic of COVID-19 are shown in Table 2. Figure S9 in the supplemental material details the rate of new-onset or worsening insomnia episodes according to the occupation category. In the logistic regression analysis, age (each 1-year increase), female sex, significant weight change (decrease or increase), prevalent anxiety, new-onset burnout, family income reduction > 30%, and previous/current care of patients with COVID-19 were independently associated with new onset of insomnia or worsening of preexisting insomnia episodes (Figure 1). In contrast, physicians, psychologists, physiotherapists, and dentists (administrative officers as the reference group), increased family income, working in the outpatient clinic, and (unexpectedly) increased work hours were associated with a lower chance of new-onset or worsening of preexisting insomnia episodes (Figure 1). Detailed data on insomnia episodes outcomes are presented in Table S1 in the supplemental material.Table 2 Characteristics of health care professionals who do not have insomnia episodes, no change in previous insomnia, and new-onset/worsening insomnia episodes during the pandemic of COVID-19.InsomniaPNo(n = 1,683)Yes, but No Significant Change(n = 1,244)New Onset/Worsening of Insomnia Episodes (n = 1,444)Age, mean ± SD, y43.6 ± 11.9(n = 1,683)45.9 ± 11.9(n = 1,224)43.1 ± 11.1(n = 1,444).001Female, n (%)1,209/1,683 (71.8%)898/1,224 (73.4%)1,195/1,444 (82.8%)<.001Health professional categories, n (%)<.001 Administrative officers98/1,683 (5.8%)84/1,224 (6.9%)131/1,444 (9.1%) Dentists114/1,683 (6.8%)116/1,224 (9.5%)91/1,444 (6.3%) Nurses101/1,683 (6.0%)94/1,224 (7.7%)139/1,444 (9.6%) Nursing assistants41/1,683 (2.4%)46/1,224 (3.8%)62/1,444 (4.3%) Physicians965/1,683 (57.3%)650/1,224 (53.1%)740/1,444 (51.2%) Physiotherapists155/1,683 (9.2%)70/1,224 (5.7%)122/1,444 (8.4%) Speech therapists36/1,683 (2.1%)24/1,224 (2.0%)43/1,444 (3.0%) Psychologists95/1,683 (5.6%)74/1,224 (6.0%)40/1,444 (2.8%) Others78/1,683 (4.6%)66/1,224 (5.4%)76/1,444 (5.3%)Worksite, n (%) Administrative area246/1,683 (14.6%)190/1,224 (15.5%)249/1,444 (17.2%).128 Emergency room/ intensive care unit/semi-intensive care unit331/1,683 (19.7%)222/1,224 (18.1%)339/1,444 (23.5%).002 Outpatient clinic1079/1,683 (64.1%)754/1,224 (61.6%)766/1,444 (53.0%)<.001 Pharmacy17/1,683 (1.0%)21/1,224 (1.7%)19/1,444 (1.3%).255 Sleep laboratory41/1,683 (2.4%)35/1,224 (2.9%)29/1,444 (2.0%).360 Operating room226/1,683 (13.4%)147/1,224 (12.0%)158/1,444 (10.9%).103 Ward361/1,683 (21.4%)233/1,224 (19.0%)375/1,444 (26.0%)<.001Previous diagnosis of COVID-19, n (%)148/1,683 (8.8%)109/1,224 (8.9%)142/1,444 (9.8%).562Recent/current care of patients with COVID-19, n (%)907/1,683 (53.9%)629/1,224 (51.4%)884/1,444 (61.2%)<.001Death rate (per 10,000 inhabitants in the epidemiological week, mean ± SD2.9 ± 2.4(n = 1,683)2.8 ± 2.3(n = 1,224)3.0 ± 2.3(n = 1,444).011Change in weekly working hours, mean ± SD−7.5 ± 15.4(n = 1,683)−6.5 ± 14.5(n = 1,224)−6.4 ± 15.2(n = 1,444).001Body weight<.001 Decreased296/1,683 (17.6%)232/1,224 (19.0%)334/1,444 (23.1%) Increased735/1,683 (43.7%)562/1,224 (45.9%)763/1,444 (52.8%) No change652/1,683 (38.7%)430/1,224 (35.1%)347/1,444 (24.0%)Income, n (%)<.001 Decreased < 30%554/1,683 (32.9%)353/1,224 (28.8%)391/1,444 (27.1%) Decreased > 30%573/1,683 (34.0%)433/1,224 (35.4%)564/1,444 (39.1%) Increased,88/1,683 (5.2%)44/1,224 (3.6%)51/1,444 (3.5%) No change468/1,683 (27.8%)394/1,224 (32.2%)438/1,444 (30.3%)Prevalent anxiety, n (%)470/1,683 (27.9%)477/1,224 (39.0%)965/1,444 (66.8%)<.001New-onset burnout, n (%)237/1,683 (14.1%)183/1,224 (15.0%)457/1,444 (31.6%)<.001COVID-19 = coronavirus disease 2019, SD = standard deviation.Figure 1: Independent predictors of new-onset and worsening insomnia frequency.Data are presented as OR and 95% CI. Variables reported in blue and red mean significant lower and higher association with new-onset and worsening insomnia frequency, respectively. CI = confidence interval, COVID-19 = coronavirus disease 2019, E.R. = emergency room, ICU = intensive care unit, OR = odds ratio.Download FigureSecondary outcomes: new-onset pharmacological treatments for insomnia, sleep quality, sleep duration, nightmares, and snoringPrevious hypnotic use was reported by 9% and new use was reported by 13% of the participants (n = 572) during the pandemic. Nursing technicians and physicians were the most prevalent health care professionals reporting the need for new pharmacological treatment for insomnia ( Figure S10 in the supplemental material). The independent predictors of new-onset pharmacological treatments for insomnia included females, previous/current care of patients with COVID-19, reduced weight, prevalent anxiety, new-onset burnout, family income reduction > 30%, and (expected to be the most important factor) insomnia episodes (Figure 2). Detailed data on pharmacological treatment outcome are presented in Table S2 in the supplemental material.Figure 2: Independent predictors of new-onset pharmacological treatments for insomnia.Data are presented as ORs and 95% CIs. Variables reported in red mean significant higher association with new-onset pharmacological treatments for insomnia. CI = confidence interval, COVID-19 = coronavirus disease 2019, E.R. = emergency room, ICU = intensive care unit, OR = odds ratio.Download FigureThe majority of participants (61.4%) described that their sleep quality worsened during the pandemic. In the logistic regression analysis, females, working in emergency room/intensive care, recent/current care of patients with COVID-19, COVID-19 regional cumulative number of deaths per 10,000 inhabitants, increase in weekly work hours, change in weight (gain or loss), prevalent anxiety, new onset of burnout, and new-onset/worsening preexisting insomnia episodes were independent predictors of impaired sleep quality during the pandemic. In contrast, age, nurse technicians (administrative group as a reference), and increased family income were independently associated with sleep quality improvement (Figure 3). Detailed data on sleep quality outcomes are presented in Table S3 in the supplemental material.Figure 3: Independent predictors of sleep quality impairment.Data are presented as ORs and 95% CIs. Variables reported in blue and red mean significant lower and higher association with sleep quality impairment, respectively. CI = confidence interval, COVID-19 = coronavirus disease 2019, E.R. = emergency room, ICU = intensive care unit, OR = odds ratio.Download FigureThe reduction of at least 1 hour of sleep was reported by 43.5% of the participants. In the logistic regression analysis, age, working at pharmacy, increase in weekly work hours, change in weight (increase or decrease), prevalent anxiety, new-onset burnout, and new-onset/worsening of insomnia episodes were independently associated with an increased chance for reduction at least 1 hour of self-reported sleep duration. In contrast, specific occupational categories (physicians, nurses, physiotherapists, and psychologists) and working in the operating room were independently associated with less chance of having a reduction at least 1 hour in the self-reported sleep duration (Figure 4). Detailed data on sleep quantity outcomes are presented in Table S4 in the supplemental material.Figure 4: Independent predictors of self-reported sleep duration reduction.Data are presented as ORs and 95% CIs. Variables reported in blue and red mean significant lower and higher association with self-reported sleep duration reduction, respectively. CI = confidence interval, COVID-19 = coronavirus disease 2019, E.R. = emergency room, ICU = intensive care unit, OR = odds ratio.Download FigureRegarding nightmares, 1,001 participants (22.8%) reported worsening or new-onset nightmares. Compared to participants with no nightmares or those with previous nightmare but no change during the pandemic, new onset or worsening of preexisting nightmares episodes were younger, had a higher frequency of females, higher frequency of recent/current contact with patients with COVID-19, had more impact on the income, gained more weight, and had a frequency of anxiety, burnout, and insomnia. In the logistic regression analysis ( Figure S11 in the supplemental material), females, recent/current contact with patients with COVID-19, income reduction, weight gain, anxiety, burnout, and insomnia were independently associated with new onset or worsening of preexisting nightmares episodes in health professionals.New-onset or worsening snoring were reported by 390 participants (8.9%). Independent factors associated with the snoring outcome included being nursing technician, recent/current contact with patients with COVID-19, increased working hours, increased weight, significant reduction in income, anxiety, and insomnia ( Figure S12 in the supplemental material).DISCUSSIONTo our knowledge, this is one of the largest investigations addressing sleep disturbances and their predictors among health care professionals during the COVID-19 pandemic. This nationwide cross-sectional study comprising several occupational categories and multiple related factors revealed the following results. Supporting our hypothesis, 32.9% of the health care professionals developed new-onset or worsening preexisting insomnia episodes, which contributed to the initiation of pharmacological treatment for insomnia in 13% of the responders. Sleep quality, duration, nightmare, and snoring were also severely impaired by the pandemic. Our multivariate analyses showed that age, female sex, significant weight change (decrease or increase), prevalent anxiety, new-onset burnout, family income reduction > 30%, and previous/current care of patients with COVID-19 were independently associated with new-onset or worsening preexisting insomnia episodes. A recent survey study of 7,208 Dutch health care workers showed that health care workers who are in direct contact with COVID-19 patients report more sleep problems and are more physically exhausted than those who are not in direct contact with COVID-19 patients.25 Contrary to our hypothesis, we did not find associations with regional COVID-19 death incidence regarding insomnia outcome. Also, increased work hours were associated with less chance of having new-onset insomnia or exacerbation of preexisting insomnia episodes, but the magnitude of the odds ratio and 95% confidence interval suggest that its impact may not have clinical relevance. Increased work hours, change in weight, prevalent anxiety, new-onset burnout, and new-onset/worsening preexisting insomnia episodes have a significant impact on sleep quality and quantity. Taken together, we observed a huge burden of insomnia and other sleep disturbances in Brazilian health care professionals during the pandemic.Our main results revealed a worrisome scenario. Almost a third of health care professionals, particular nurse technicians and nurses, presented new onset or worsening of preexisting insomnia during the pandemic. A previous study reported a prevalence of insomnia of 34% among health care workers during the pandemic.11 In the present study, a high prevalence of insomnia episodes contributed to a significant increase of new pharmacological treatments for insomnia in a short period. Moreover, 44.2% of all surveyed participants and 66.8% of those with new-onset or worsening insomnia reported anxiety during the pandemic. Anxiety is a well-known risk factor for insomnia and has been described in up to 44.7% of health care workers during the COVID-19 pandemic.26,27 New-onset burnout was also an independent predictor of new-onset or worsening preexisting insomnia in our study. Burnout was reported by 20.1% of the participants and by 31.6% of those complaining of insomnia episodes. Consistently, a high prevalence of burnout during the pandemic (21.8%) has been previously reported among otolaryngologists and residents.28 Female sex was also an independent predictor of new-onset or worsening insomnia episodes in the present study. The majority of our survey participants were women (76%), which is in line with a recent report of the World Health Organization that estimated that women comprise 67% of the world health care workforce.29 Among all participants reporting new-onset or worsening insomnia episodes, 82.8% were women. Potential explanations for the increased burden of insomnia among women may be associated with multifactorial variables, including the common role of caretaker, work–family conflicts, and economic inequality.30 Taken together, new onset and worsening of insomnia episodes is frequent among health care workers during the COVID-19 pandemic. Preventing and treating anxiety and burnout may help mitigate insomnia burden and long-term adverse consequences, especially among women. In this scenario, our study underscores the need for active interventions such as cognitive behavior therapy for insomnia for the susceptible health care population who are presenting insomnia. Cognitive behavior therapy for insomnia is considered the gold-standard treatment for insomnia,31 even when associated with medical, neurological, and psychiatric comorbidities.32Our secondary outcomes also revealed relevant findings. The ne