Prevalence and variables associated with insomnia among COVID-19 survivors in Colombia Insomnia in COVID-19 survivors

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John Carlos Pedrozo-Pupo
Carmen Cecilia Caballero-Domínguez
Adalberto Campo-Arias


Coronavirus disease, Survivors, Sleep disorders, Insomnia, Cross-sectional studies


Background and aim of the work. The prevalence of insomnia is higher in COVID-19 survivors. However, there is little information about his associated variables. The aimed to know the prevalence and variables associated with insomnia among COVID-19 survivors in Colombian adults. Method. Three hundred and thirty COVID-19 survivors participated in a cross-sectional study. Insomnia was quantified with the Athens Insomnia Scale (cut-off score ≤ 6, Cronbach's alpha of 0.90). Results. COVID-19 survivors were between 18 and 89 years (Mean = 47.7, SD = 15.2); the majority were women (61.5%), university-educated (62.4%), low income (71.2%), married or free union (66.1%), not healthcare workers (85.8%), without comorbidities (63.0%), asymptomatic or mild COVID-19 (66.1%), duration of COVID-19 symptoms in less than three weeks (80.0%) and remission of symptoms less two months by the day of study participation (73.0%). Scores on the Athens Insomnia Scale were observed between 0 and 24 (M = 7.3, SD = 5.1, Me = 7, IQR = 3 – 10), 60% presented insomnia. Insomnia was associated with post-traumatic stress symptoms (OR = 8.8, 95%CI 2.7 – 29.5), COVID-19 symptoms for more than three weeks (OR = 2.1, 95%CI 1.1 – 3.9), female gender (OR = 1.9, 95%CI 1.2 – 3.2) and married or free union marital status (OR = 1.8, 95%CI 1.1 – 3.0). Conclusion. The frequency of insomnia in COVID-19 survivors is high and mainly related to post-traumatic stress, symptoms of COVID-19 for more than three weeks, and the female gender. It is necessary to implement follow-up studies over time to evaluate the persistence of insomnia.


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1. Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007; 3(Suppl.): S7–S10.
2. Dois Y, Minowa M, Okawa M, Uchiyama M. Prevalence of sleep disturbance and hypnotic medication use in relation to sociodemographic factors in the general Japanese adult population. J Epidemiol. 2020; 10(2): 79–86.
3. Zheng W, Luo XN, Li HY, Ke XY, Dai Q, Zhang CJ, et al. Prevalence of insomnia symptoms and their associated factors in patients treated in outpatient clinics of four general hospitals in Guangzhou, China. BMC Psychiatry. 2018; 18(1): 232.
4. Khurshid KA. Comorbid insomnia and psychiatric disorders: an update. Innov Clin Neurosci. 2018; 15(3-4): 28–32.
5. Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Fam Med Prim Care. 2016; 5(4): 780–784.
6. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007; 30(2): 213–218.
7. Enomoto K, Adachi T, Yamada K, Inoue D, Nakanishi M, Nishigami T, et al. Reliability and validity of the Athens Insomnia Scale in chronic pain patients. J Pain Res. 2018; 11: 793–801.
8. Xu F, Wang X, Yang Y, Zhang K, Shi Y, Xia L, et al. Depression and insomnia in COVID-19 survivors: a cross-sectional survey from Chinese rehabilitation centers in Anhui province. Sleep Med. 2021.
9. Geng F, Liang Y, Li Y, Fang Y, Pham TS, Liu X, et al. Bidirectional associations between insomnia, post-traumatic stress disorder, and depressive symptoms among adolescent earthquake survivors: a longitudinal multiwave cohort study. Sleep. 2019; 42(11): zsz162.
10. Ali, R. M., Zolezzi, M., Awaisu A. A systematic review of instruments for the assessment of insomnia in adults. Nat Sci Sleep. 2020; 12: 377-409.
11. Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res. 2000; 48(6): 555–560.
12. Takami M, Kadotani H, Nishikawa K, Sumi Y, Nakabayashi T, Fujii Y, et al. Quality of life, depression, and productivity of city government employees in Japan: A comparison study using the Athens insomnia scale and insomnia severity index. Sleep Sci Pract. 2018; 2(1): 1-8.
13. Monterrosa-Castro A, Marrugo-Flórez M, Romero-Pérez I, Chedraui P, Fernández-Alonso AM, Pérez-López FR. Prevalence of insomnia and related factors in a large mid-aged female Colombian sample. Maturitas. 2013; 74(4): 346–351.
14. Altena E, Baglioni C, Espie CA, Ellis J, Gavriloff D, Holzinger B, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. J Sleep Res. 2020; 29(4): e13052.
15. Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020; 289: 113076.
16. McCall WV, Mensah-Bonsu D, Withers AE, Gibson RW. Short-term insomnia disorder in health care workers in an academic medical center before and during COVID-19: rates and predictive factors. J Clin Sleep Med. 2021; 17(4): 749–755.
17. Abdulah DM, Musa DH. Insomnia and stress of physicians during COVID-19 outbreak. Sleep Med X. 2020; 2: 100017.
18. Hashim HT, Varney JA, Ramadhan MA, Sarfraz A, Sarfraz Z, Murry K. Insomnia among recovered COVID-19 patients. J Sleep Disord Ther. 2021; 10(3): 328.
19. Tselebis A, Lekka D, Sikaras C, Tsomaka E, Tassopoulos A, Ilias I, et al. Insomnia, perceived stress, and family support among nursing staff during the pandemic crisis. Healthcare. 2020; 8(4): 434.
20. Krupa S, Filip D, Mędrzycka-Dąbrowska W, Lewandowska K, Witt P, Ozga D. Sleep disorders among nurses and other health care workers in Poland during the COVID-19 pandemic. Appl Nurs Res. 2021; 59: 151412.
21. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020; 89: 594-600.
22. Bautista E, Cortés-Álvarez NY, Vuelvas-Olmos CR, González T, Morales N, Flores de los Ángeles C, et al. [Symptoms and psychological effects in survivors of COVID-19]. México; CONCYTEP; 2020.
23. Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020; 16(8): 1417-1418.
24. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington: American Psychiatric Publishing; 2013.
25. Mahmoudi H, Saffari M, Movahedi M, Sanaeinasab H, Rashidi‐Jahan H, Pourgholami M, et al. A mediating role for mental health in associations between COVID‐19‐related self‐stigma, PTSD, quality of life, and insomnia among patients recovered from COVID‐19. Brain Behav. 2021; 11(5): e02138.
26. [Current situation: new Coronavirus (COVID-19)]. Bogotá: Ministerio de Salud y la Protección Social de Colombia; 2021. Accessed August 6th, 2021.
27. Short NA, Ennis CR, Oglesby ME, Boffa JW, Joiner TE, Schmidt NB. The mediating role of sleep disturbances in the relationship between post-traumatic stress disorder and self-injurious behavior. J Anxiety Disord. 2015; 35: 68–74.
28. Nasserie T, Hittle M, Goodman SN. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: A systematic review. JAMA Network Open. 2021; 4(5): e2111417.
29. Stam HJ, Stucki G, Bickenbach J. Covid-19 and post-intensive care syndrome: A call for action. J Rehab Med. 2020; 52(4): jrm00044.
30. Rovere-Querini P, De Lorenzo R, Conte C, Brioni E, Lanzani C, Yacoub MR, et al. Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed. 2020; 91(9-S): 22–28.
31. Katz MH. Multivariable analysis. Second edition. Cambridge: Cambridge University Press; 2006.
32. Campo-Arias A, Monterrosa-Castro A, Herazo E, Monterrosa-Blanco A. Consistency and internal structure of the Athens Insomnia Scale in Colombian climacteric women. Eur Gynecol Obstetr. 2020; 2(2): 123-136.
33. Meltzer-Brody S, Churchill E, Davidson JR. Derivation of the SPAN, a brief diagnostic screening test for post-traumatic stress disorder. Psychiatry Res. 1999; 88(1): 63–70.
34. Pedrozo-Pupo JC, Campo-Arias A. Depression, perceived stress related to COVID, post-traumatic stress, and insomnia among asthma and COPD patients during the COVID-19 pandemic. Chron Respir Dis. 2020; 17: 1479973120962800.
35. Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989; 79(3): 340–349.
36. Hosmer D, Taber S, Lemeshow S. The importance of assessing the fit of logistic regression models: A case study. Am J Public Health. 1991; 81(12): 1630–1635.
37. [Resolution 008430 which establishes the scientific, technical and administrative standards for health research]. Bogotá: Ministerio de Salud de Colombia; 1993.
38. World Medical Association. Declaration of Helsinki. Geneva: WMA; 2018.
39. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002; 359(9302): 248-252.
40. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad PG, Mukunzi JN, McIntee SE, et al. Prevalence of symptoms of depression, anxiety, insomnia, post-traumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2021; 295: 113599.
41. Matteson-Rusby SE, Pigeon WR, Gehrman P, Perlis ML. Why treat insomnia? Prim Care Compan J Clin Psychiatry. 2010; 12(1): PCC.08r00743bro
42. De Lorenzo R, Cinel E, Cilla M, Compagnone N, Ferrante M, Falbo E, et al. Physical and psychological sequelae at three months after acute illness in COVID-19 survivors. Panminerva Med. 2021.
43. Nakamura ZM, Nash RP, Laughon SL, Rosenstein DL. Neuropsychiatric complications of COVID-19. Cur Psychiatry Report. 2021; 23(5): 1-9.
44. Hawton K, van Heeringen K. Suicide. Lancet. 2009; 373(9672): 1372-1381.
45. Streiner D, Norman G. Health measurement scales: A practical guide to their development and use. 4th edition. Oxford: Oxford University Press; 2008.