**7. Effect of occupation stress on sleep pattern IN frontline health workers during COVID-19 outbreak**

A number of studies indicated the effects of occupational stress on sleep patterns in frontline healthcare providers during COVID-19. For instance, Hassinger et al. [13] reported that 68% of frontline healthcare workers exhibited aberration in their normal sleep patterns such as insomnia and daytime somnolence during COVID-19 outbreak with physicians being more affected than nurses**.** A total of 43% had increased daytime somnolence and 37 experienced a reduction in sleep efficiency. An increase in daytime sleepiness occurs when normal circadian nocturnal sleep is insufficient.

#### *Occupational Stress-Related Sleep Anomaly in Frontline COVID-19 Health Workers… DOI: http://dx.doi.org/10.5772/intechopen.109148*

Jahrami et al. [43] conducted a systematic review in 13 countries with the aim of evaluating how COVID-19 pandemic had affected the sleep of the general population including frontline healthcare providers in the previous eight-month from July 2020. Although the review showed that the rate of sleep problems such as insomnia was 36%, there was no specific information about the prevalence of the abnormality across frontline healthcare workers. Sanghera et al. [44] concluded that insomnia was one of the negative impacts of SARS-CoV-2, with a prevalence range of 7.4–37.4%. Marvaldi et al. [45] in their systematic review identified sleep disorders as one of the prevalent health problems among frontline health workers accounting for 44.0%. However, the nature of sleep disorder was not too clear. In China, Jing et al. [46] assessed sleep disorders among 801 frontline healthcare workers using the Pittsburgh Sleep Quality Index, Visual Analogue Scale, and Athens Insomnia Scale. Frontline healthcare workers were shown to have a greater Pittsburgh Sleep Quality Index when compared with non-frontline workers.

Conroy et al. [47] utilized internet-based cross-sectional survey data retrieved from frontline healthcare personnel over a period of 1 month in the United States of America. There was a reduction in total sleep time in workers who reported to work continuously when compared with workers who work from home. According to the trend of the study, it was much more possible for the sleeping length of personnel who worked from home as a circadian rhythm to be entrained. In France, Germany, United Kingdom, USA, Italy, and Spain, Kim et al. [48] conducted an internet-based survey among frontline healthcare workers to identify the association between sleep pattern and COVID-19 susceptibility. The study was for 2 months and a total of 2884 frontline healthcare workers drawn from the countries were used. It was reported that the more sleep disorders such as insomnia, the more the risk of COVID-19. In Bahrain, Jahrami et al. [49] investigated the quality of sleep of frontline personnel during COVID-19 outbreak using 280 healthcare personnel through internet-based Pittsburgh Sleep Quality Index. While 75% of frontline health personnel and 76% of non-frontline health personnel claimed that they did not sleep well, respectively. In India, Gupta et al. [50] assessed the impact of COVID-19 pandemic on sleep quality among healthcare personnel and noted that 31.5% of the healthcare workers experienced poor sleep quality. In frontline healthcare workers, Rossi et al. [51] conducted an internet-based cross-sectional investigation through web-based questionnaires and reported that 8.27% of respondents experienced insomnia. Wang et al. [52] investigated the effect of COVID-19 on sleep quality of healthcare personnel in Wuhan Pediatric healthcare center using a self-reported questionnaire. The questionnaire contained the Pittsburgh Sleep Quality Index and the result indicated that 38% of the respondents experienced sleep disturbance. Shaukat et al. [53] noted in their review that frontline healthcare personnel were at risk of COVID-19-induced insomnia. Zeng et al. [54] reported in their review that the prevalence of abnormal sleep patterns was 61% in nursing staff. Among the sleep patterns taken into consideration include daytime dysfunction, sleep latency, and sleep duration. Stewart et al. [55] evaluated the sleep pattern in USA frontline health professionals during COVID-19 outbreak using online platforms such as Instagram, Facebook, and Twitter. The result indicated that 95.5% of respondents reported sleep abnormalities. Thirty percent indicated moderate or severe insomnia and 60.9% experienced sleep disruptions attributable to device utilization. In a systematic review by Salari et al. [56] the prevalence of sleep abnormalities in frontline physicians and nurses during COVID-19 pandemic was found to be 41.6 and 34.8%, respectively. In Western China, Yue et al. [57] in

their cross-sectional investigation discovered via self-administered questionnaire that out of 543 respondents who were frontline medical staff, nearly 40% claim to experience insomnia.
