COVID-19 illness in relation to sleep and burnout

Hyunju Kim; Sheila Hegde; Christine LaFiura; Madhunika Raghavan; Eric Luong; Susan Cheng; Casey M Rebholz; Sara B Seidelmann

doi:10.1136/bmjnph-2021-000228

COVID-19 illness in relation to sleep and burnout

BMJ Nutr Prev Health. 2021 Mar 22;4(1):132-139. doi: 10.1136/bmjnph-2021-000228. eCollection 2021.

Authors

Hyunju Kim^{1

2}, Sheila Hegde^{3

4}, Christine LaFiura⁵, Madhunika Raghavan⁵, Eric Luong⁶, Susan Cheng⁶, Casey M Rebholz^{1

2}, Sara B Seidelmann^{7

8}

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
² Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
³ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Envision Health Partners, Stamford, CT, USA.
⁶ Department of Cardiology, Schmidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Department of Medicine, Stamford Hospital, Stamford, Connecticut, USA.
⁸ Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA.

Abstract

Background: Sleep habits and burnout have been shown to be associated with increase in infectious diseases, but it is unknown if these factors are associated with risk of COVID-19. We assessed whether sleep and self-reported burnout may be risk factors for COVID-19 among high-risk healthcare workers (HCWs).

Methods: From 17 July to 25 September 2020, a web-based survey was administered to HCWs in six countries (France, Germany, Italy, Spain, UK, USA) with a high frequency of workplace exposure. Participants provided information on demographics, sleep (number of sleep hours at night, daytime napping hours, sleep problems), burnout from work and COVID-19 exposures. We used multivariable linear and logistic regression models to evaluate the associations between sleep, burnout and COVID-19.

Results: Among 2884 exposed HCWs, there were 568 COVID-19 cases and 2316 controls. After adjusting for confounders, 1-hour longer sleep duration at night was associated with 12% lower odds of COVID-19 (p=0.003). Daytime napping hours was associated with 6% higher odds, but the association varied by countries, with a non-significant inverse association in Spain. Compared with having no sleep problems, having three sleep problems was associated with 88% greater odds of COVID-19. Reporting burnout 'every day' was associated with greater odds of COVID-19 (OR: 2.60, 95% CI 1.57 to 4.31, p trend across categories=0.001), longer duration (OR: 2.98, 95% CI 1.10 to 8.05, p trend=0.02) and severity (OR: 3.26, 95% CI 1.25 to 8.48, p trend=0.02) compared with reporting no burnout. These associations remained significant after adjusting for frequency of COVID-19 exposures.

Conclusions: In six countries, longer sleep duration was associated with lower odds of COVID-19, but the association with daytime nap may not be consistent across countries. Greater sleep problems and high level of burnout were robustly associated with greater odds of COVID-19. Sleep and burnout may be risk factors for COVID-19 in high-risk HCWs.

Keywords: COVID-19; sleep.