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How fatigue and sleep can impact the spread of COVID-19?

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Research from Johns Hopkins University certifies that inappropriate rest would impact the spread of infectious diseases

First-line healthcare workers are at high risk of contracting COVID-19 infection, caused by SARS-CoV-2. They have played a vital role in treating patients and containing the community transition from COVID-19. 

As such, HCWs are particularly vulnerable to contracting the infection, as shown by a recent Scottish study that found the risk of hospital admission due to COVID-19 was 1.8 to 3.3 times higher in treating HCWs to COVID-19 patients and their household members compared to healthcare workers who were not treating COVID-19 patients.

Although exposure to the virus is the most potent risk factor, the well-being of healthcare workers contributes to an increased risk of COVID-19 infection. Specifically, stress and sleep habits have been shown to increase the risk of infectious diseases. For example, in research on healthy men and women ages 18 to 55, short sleep duration was associated with a higher chance of developing a cold after viral exposure.

Similarly, a high level of exhaustion was prospectively associated with an increased risk of the common cold and flu-like illnesses in the general population. Only one study examined the association between sleep duration and COVID-19 in Chinese adults and found that lack of sleep was associated with greater severity of COVID-19 compared to the recommended sleep state. However, this previous study had no detailed questions about sleep habits, and no previous study has examined whether other sleep habits and self-reported exhaustion are associated with COVID-19.

Therefore, the new goal of the Johns Hopkins University group of specialists was to assess whether sleep habits and self-reported exhaustion may be risk factors for COVID-19.

To do this, they conducted a survey in six countries, a longer duration of sleep at night was associated with a lower probability of COVID-19. In contrast, more nap hours during the day, reporting three sleep problems, and a higher level of exhaustion were strongly associated with higher odds of COVID-19. 

However, the association between nap times during the day and the virus differed by country. The high level of exhaustion was associated with a longer duration and severity of the disease. 

“Our findings add to the literature that the duration of sleep at night, sleep disorders, and exhaustion can be risk factors for viral diseases like covid-19,” explains Hyunju Kim, lead author of the study.

The short duration of sleep was associated with a higher chance of developing a cold after viral exposure

Rest to ward off the virus

This document is the first to report an association between sleep habits (hours of sleep at night, hours of nap during the day, severe sleep problems) and COVID-19 in several countries. It has been speculated that lack of sleep may play a role in COVID-19. 

A previous study found that self-reported sleep deprivation was associated with higher odds, while daily sleep time of 1 hour longer was associated with lower odds of ≥20 days of hospital stay due to COVID-19. 

“Our results on the hours of sleep at night are in agreement with that previous study,” continues the scientist, “but we contributed to the literature by providing more complete information on sleep habits .”

Several previous studies have already shown that a short duration of sleep before exposure to the virus is prospectively associated with an increased risk of acute infectious diseases, such as pneumonia and the common cold. 

Similarly, sleep disturbance has been associated with a higher chance of a cold. The mechanism underlying these associations remains unclear, but it has been hypothesized that sleep disorders may negatively influence the immune system by increasing pro-inflammatory cytokines and histamines.

Similar to sleep, exhaustion has been reported to be cross-sectionally associated with the common cold and influenza-like illnesses and prospectively associated with influenza-like illnesses in the general population. 

Burnout has also been associated with chronic diseases, such as diabetes, cardiovascular disease, musculoskeletal disease, and all-cause mortality. These studies have suggested that exhaustion can predict disease directly or indirectly. Occupational stress damages the immune system and changes cortisol levels, and increases health risk behaviors.

“In the context of the global pandemic,” the specialists point out in their research,” exhaustion is unlikely to increase risk behaviors, which would then increase exposure to the virus.” 

Another consideration may be that burnout leads to fatigue and increases errors in putting on and taking off protective equipment or poor hand hygiene, increasing risk. “However,” they continue, “even when we adjusted for COVID-19 exposures, the association between exhaustion and COVID-19 persisted, suggesting that a negative impact on the immune system may have played an important role.”

Specialists found the association between nap times during the day and the odds of COVID-19 interesting. “There may be cultural differences in daytime naps,” Hyunju Kim explains. “The daytime nap can be a marker of lack of sleep or stress in some countries, while it can be a tradition, as it happens in certain parts of Spain. In line with this hypothesis, when we stratified the association between daytime naps and COVID-19 by country, there was a non-significant inverse association for Spain and a positive association for other countries (for example, France and the USA) ”.

The strengths of the study include the inclusion of high-risk STs from six different countries at the height of the pandemic, the use of questions about sleep problems and work exhaustion that have been extensively tested in epidemiological studies, and a rigorous adjustment of the covariates. They were able to identify health workers at risk in the initial phase of the pandemic by taking advantage of a large network of health providers.

In conclusion, they found that lack of sleep at night, severe problems, and a high level of exhaustion can be risk factors for COVID-19 in front-line healthcare workers. The association between daytime naps and COVID-19 appears to differ between countries. 

“Our results highlight the importance of the well-being of health professionals during the pandemic,” concludes Hyunju Kim. “Knowledge of these risk factors in health workers will be helpful in maintaining a healthy and productive workforce. “

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