Indian Journal of Sleep Medicine

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VOLUME 17 , ISSUE 3 ( July-September, 2022 ) > List of Articles

Original Article

Relationship between Insomnia and Blood Oxygen Levels in COVID-19 Patients Admitted to the Intensive Care Unit

Khadijeh Alizadeh Feremi, Nouraddin Mousavinasab, Zahra Gholipour

Keywords : COVID-19, Insomnia, Intensive care unit, Oximetry

Citation Information : Feremi KA, Mousavinasab N, Gholipour Z. Relationship between Insomnia and Blood Oxygen Levels in COVID-19 Patients Admitted to the Intensive Care Unit. Indian Sleep Med 2022; 17 (3):72-76.

DOI: 10.5005/jp-journals-10069-0103

License: CC BY-NC 4.0

Published Online: 19-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: It seems that inadequate sleep affects the oxygen levels in patients infected with coronavirus disease-2019 (COVID-19). However, few studies have worked on the effect of insomnia on the blood oxygen level. Therefore, this study aimed to determine the effect of insomnia on the blood oxygen level in patients admitted to the intensive care unit (ICU) due to infection with COVID-19. Materials and methods: This study was performed on 100 patients with COVID-19 referred to Imam Khomeini Hospital, affiliated with Mazandaran University of Medical Sciences, Sari, Iran. The insomnia severity index (ISI) was used to assess the severity of insomnia in the patients. They were then divided into four groups of patients with no insomnia, subthreshold, moderate, and severe insomnia. The patient's oxygen saturation was measured repeatedly at different times of day after hospitalization. Results: The findings demonstrated no significant differences between the four study groups regarding gender, marital status, education level, and occupational status (p >0.05). Moreover, no significant difference was observed between the four groups concerning lung involvement (F = 0.64; p = 0.58) and hospital stay (F = 1.23; p = 0.29). The mean of oxygen saturation in patients without insomnia was higher than in those who had insomnia before the study and on days 1–5 after hospitalization (F = 30.97; p <0.001). Conclusion: The results confirm the association between oxygen saturation and sleep disorder. The oxygen saturation level decreases in patients with different levels of insomnia (i.e., severe, moderate, and threshold insomnia) and patients affected by COVID-19 with acute pulmonary involvement. These patients are more susceptible to being hospitalized in specialized departments and mortality.

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  1. Gozalbo-Rovira R, Gimenez E, Latorre V, et al. SARS-CoV-2 antibodies, serum inflammatory biomarkers and clinical severity of hospitalized COVID-19 patients. J Clin Virol 2020;131:104611. DOI: 10.1016/j.jcv.2020.104611.
  2. Jain A, Singariya G, Kamal M, et al. COVID-19 pandemic: Psychological impact on anaesthesiologists. Indian J Anaesth 2020;64(9):774–783. DOI: 10.4103/ija.IJA_697_20.
  3. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: The potential role for antifibrotic therapy. Lancet Respir Med 2020; 8(8):807–815. DOI: 10.1016/S2213-2600(20)30225-3.
  4. Franceschini C, Musetti A, Zenesini C, et al. Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Front Psychol 2020;11:574475. DOI: 10.3389/fpsyg.2020.574475.
  5. Zhuo K, Gao C, Wang X, et al. Stress and sleep: A survey based on wearable sleep trackers among medical and nursing staff in Wuhan during the COVID-19 pandemic. Gen Psychiatr 2020;33(3):e100260. DOI: 10.1136/gpsych-2020-100260.
  6. De Mello MT, Silva A, Guerreiro R de C, et al. Sleep and COVID-19: Considerations about immunity, pathophysiology, and treatment. Sleep Sci 2020;13(3):199–209. DOI: 10.5935/1984-0063.20200062.
  7. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet 2020;395(10227):912–920. DOI: 10.1016/S0140-6736(20) 30460-8.
  8. Sattar N, McInnes IB, McMurray JJ. Obesity is a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation 2020;142(1):4–6. DOI: 10.1161/CIRCULATIONAHA.120.047659.
  9. Lighter J, Phillips M, Hochman S. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis 2020;71(15):896–897. DOI:10.1093/cid/ciaa415.
  10. Zhan Y, Liu Y, Liu H, et al. Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey. J Nurs Manag 2020;28(7):1525–1535. DOI: 10.1111/jonm.13094.
  11. Vitale E, Mea R, Dio FD, et al. Anxiety, insomnia and body mass index scores in Italian nurses engaged in the care of COVID-19 patients. Endocr Metab Immune Disord Drug Targets 2020;21(9):1604–1612. DOI: 10.2174/1871530320666201016150033.
  12. Thorpy M, Figuera-Losada M, Ahmed I, et al. Management of sleep apnea in New York City during the COVID-19 pandemic. Sleep Med 2020;74:86–90. DOI: 10.1016/j.sleep.2020.07.013.
  13. Daher A, Balfanz P, Aetou M, et al. Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit. Sci Rep 2021;11(1):2256. DOI: 10.1038/s41598-021-81444-9.
  14. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2(4):297–307. DOI: 10.1016/s1389-9457(00)00065-4.
  15. Nitzan M, Nitzan I, Arieli Y. The various oximetric techniques used for the evaluation of blood oxygenation. Sensors 2020;20(17):4844. DOI: 10.3390/s20174844
  16. Andrés-Blanco AM, Álvarez D, Crespo A, et al. Assessment of automated analysis of portable oximetry as a screening test for moderate-to-severe sleep apnea in patients with chronic obstructive pulmonary disease. PLoS ONE 2017;12(11):e0188094. DOI: 10.1371/journal.pone.0188094.
  17. Alizadeh K, Esmaeili R, Shorofi SS, et al. Effect of Urtica dioica (nettle) on quality of sleep in hemodialysis patients: A randomized clinical trial. J Herbal Med 2021;28:100356. DOI: 10.1016/j.hermed.2020.100356.
  18. Bigalke JA, Greenlund IM, Carter JR. Sex differences in self-report anxiety and sleep quality during COVID-19 stay-at-home orders. Biol Sex Diff 2020;11(1):1–11.
  19. Mello MTD, Silva A, Guerreiro RdeC, et al. Sleep and COVID-19: Considerations about immunity, pathophysiology, and treatment. Sleep Sci 2020;13(3):199–209. DOI: 10.5935/1984-0063.20200062.
  20. Serrano MM, Pérez-Sánchez JR, Sánchez SP, et al. Serotonin syndrome in two COVID-19 patients treated with lopinavir/ritonavir. J Neurol Sci 2020;415:116944. DOI: 10.1016/j.jns.2020.116944.
  21. Costa LHA, Santos BM, Branco LGS. Can selective serotonin reuptake inhibitors have a neuroprotective effect during COVID-19? Eur J Pharmacol 2020;889:173629. DOI: 10.1016/j.ejphar.2020.173629.
  22. Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020;323(22):2329–2330. DOI: 10.1001/jama.2020.6825.
  23. Wang DH-M, Chen P-H, Yu TH-K, et al. The effects of corporate social responsibility on brand equity and firm performance. J Business Res 2015;68(11):2232–2236. DOI: 10.1016/j.jbusres.2015.06.003.
  24. Iaccarino G, Grassi G, Borghi C, et al. Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension. PLoS One 2020;15(10):e0237297. DOI: 10.1371/journal.pone.0237297.
  25. Laharnar N, Grote L, Zou D, et al. Overnight pulse wave analysis to assess autonomic changes during sleep in insomnia patients and healthy sleepers. PLoS One 2020;15(5):e0232589. DOI: 10.1371/journal.pone.0232589.
  26. Salles C, Barbosa HM. COVID-19 and obstructive sleep apnea. J Clin Sleep Med 2020;16(9):1647. DOI: 10.5664/jcsm.8606.
  27. He S, Chen X-X, Ge W, et al. Are anti-inflammatory cytokines associated with cognitive impairment in patients with insomnia comorbid with depression? A pilot study. Nat Sci Sleep 2021;13:989–1000. DOI: 10.2147/NSS.S312272.
  28. Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: Implications for comorbidities. Chest 2015;147(1):266–274. DOI: 10.1378/chest.14-0500.
  29. Kryger M, Thomas R. Home PAP devices in patients infected with COVID-19. J Clin Sleep Med 2020;16(7):1217–1219. DOI: 10.5664/jcsm.8490.
  30. Radovanovic D, Rizzi M, Pini S, et al. Helmet CPAP to treat acute hypoxemic respiratory failure in patients with COVID-19: A management strategy proposal. J Clin Med 2020;9(4):1191. DOI: 10.3390/jcm 9041191.
  31. Xia Y, Kou L, Zhang G, et al. Investigation on sleep and mental health of patients with Parkinson's disease during the Coronavirus disease 2019 pandemic. Sleep Med 2020;75:428–433. DOI: 10.1016/j.sleep.2020.09.011.
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