| Article Access Statistics|
| Viewed||1154 |
| Printed||24 |
| Emailed||0 |
| PDF Downloaded||28 |
| Comments ||[Add] |
Click on image for details.
|Year : 2021 | Volume
| Issue : 1 | Page : 26-31
Sleep and Covid-19
Karuna Datta1, Manjari Tripathi2
1 Department of Sports Medicine, Armed Forces Medical College, Pune, India
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||26-Aug-2020|
|Date of Decision||26-Aug-2020|
|Date of Acceptance||18-Jan-2021|
|Date of Web Publication||24-Feb-2021|
Department of Neurology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Background: COVID-19 pandemic has affected the world globally causing widespread repercussions on individuals' physical, mental and emotional well-being. In such times, sleep is likely to be affected.
Objective: The aim of this study was to present the available literature on sleep and also the foresight as to the future national strategy to mitigate the effects of this pandemic.
Materials and Methods: An extensive literature search on PubMed, Google Scholar, Epistemonikos database (https://www.epistemonikos.org), PsycINFO for available literature on the prevalence of sleep problem on COVID-19 was done. Cross-citation search was also conducted to increase relevance of the review. The key words used were- (((((((((((insomnia)) OR (sleep)) OR (sleepiness)) OR (“sleep quality”)) OR (OSA)) OR (“obstructive sleep apnoea”)) OR (“obstructive sleep apnea”)) OR ((“sleep problem”)) AND “covid-19” OR covid19* OR “COVID-19” OR “2019-nCoV” OR cv19* OR “cv-19” OR “cv 19” OR “n-cov” OR ncov* OR “sars-cov-2” OR “sars-cov2” OR “2019-ncov” OR “SARS-Coronavirus-2” OR “SARS-Coronavirus2” OR (wuhan* AND (virus OR viruses OR viral)) OR (covid* AND (virus OR viruses OR viral)) OR “covid-19-related” OR “SARS-CoV-2-related” OR “SARS-CoV2-related” OR “2019-nCoV-related” OR “cv-19-related” OR “n-cov-related”). Inclusion criteria consisted of articles in English, published from Jan 2020 till 19 Apr 2020. Two reviewers independently screened each research study for inclusion and eligibility.
Results and Conclusion: Sleep is affected during COVID-19 pandemic in patients, their families, health-care workers and their families, population in isolation, and quarantine and as such in public. Limited literature exists with subjective data and no objective criteria were found to study sleep in COVID-19 pandemic. OSA was found to be a frequent baseline characteristic of COVID-19 patients. A need to follow guidelines is of paramount importance and strategies to better sleep in the population needs to be addressed.
Keywords: Covid-19, insomnia, OSA, sleep lab, sleep, systematic review
Key Message: Subjective sleep was disrupted during COVID-19 pandemic. Increased anxiety, stress, post-traumatic stress symptoms reported and correlated with bad sleep. OSA was a comorbidity in COVID-19 patients. Increased focus on improvement of sleep for better mental health of the population.
|How to cite this article:|
Datta K, Tripathi M. Sleep and Covid-19. Neurol India 2021;69:26-31
COVID-19 pandemic has caused widespread implications to physical and mental health. It has not only affected the patients per se, but also lives of their family members, contacts of these patients in isolation, quarantine and the attending healthcare workers. The population was in lockdown and was following social distancing to prevent spread of the disease further. Effects on sleep were documented during earlier such infectious diseases of SARS or MERS in patients, suspect cases, and health-care workers.,, COVID-19 is likely to cause similar effects adding anxiety of contracting the illness associated with fear in the population too. Mental health of patients, health-care workers, and population at large is important at this stage. This review was undertaken to understand the prevalence of the sleep problems during COVID-19 and gain foresight as to the future national strategy to mitigate the effects of this pandemic.
| » Methodology|| |
A systematic methodology was used for literature search. Inclusion criteria consisted of articles in English, published from Jan 2020 till 19 Apr 2020. An extensive literature search on Pubmed, Google scholar, Epistemonikos database (https://www.epistemonikos.org), PsycINFO for available literature on the prevalence of sleep problem on COVID-19 was done. Cross-citation search was also conducted to increase relevance of the review. The key words used for Pubmed was- (((((((((((insomnia)) OR (sleep)) OR (sleepiness)) OR (“sleep quality”)) OR (OSA)) OR (“obstructive sleep apnoea”)) OR (“obstructive sleep apnea”)) OR ((“sleep problem”)) AND “covid-19” OR covid19* OR “COVID-19” OR “2019-nCoV” OR cv19* OR “cv-19” OR “cv 19” OR “n-cov” OR ncov* OR “sars-cov-2” OR “sars-cov2” OR “2019-ncov” OR “SARS-Coronavirus-2” OR “SARS-Coronavirus2” OR (wuhan* AND (virus OR viruses OR viral)) OR (covid* AND (virus OR viruses OR viral)) OR “covid-19-related” OR “SARS-CoV-2-related” OR “SARS-CoV2-related” OR “2019-nCoV-related” OR “cv-19-related” OR “n-cov-related”).
Similar strategy was adapted for other databases. In Google Scholar the search results with the key words as mentioned were sorted as per relevance and first 200 references were taken for the review. Two reviewers independently screened each research study for inclusion and eligibility. The authors were contacted, in case full-text articles were not available. Full text articles and literature were screened and eligible search items included.
| » Results|| |
The PRISMA flow diagram for the review is shown in [Figure 1]. [Table 1] describes the types of articles finally included in the review. The original study articles and case series can be divided into primarily three types i.e., on patients, healthcare workers and their families and population at large. Details of the studies are given in [Supplementary Table 1]. The studies on patients showed Obstructive Sleep Apnoea as a frequent pre-existing comorbidity in COVID-19 patients,,, and a case series of five cases also reported that the patient with OSA had complement associated microvascular injury. Insomnia was found to be a major symptom in COVID-19 patients in a drug trial using favipiravir and arbidol. On the other hand, another study commented that hydroxychloroquine given as treatment might have caused insomnia. There was a study done by Liu et al. on patients. He subjectively analyzed sleep after giving progressive muscular relaxation (PMR) in the experimental group and the study reported a significant reduction in anxiety and sleep as compared to the control group.
Health-care workers reported excessive fatigue and increased sleepiness to as much as 9.3% and female nurses were found to be more prone. Insomnia prevalence was also found to be 34% amongst health-care in a study using Insomnia severity index (ISI), prevalence being higher in frontline health-care workers as compared to tertiary hospitals. In the same study, prevalence of depression and anxiety of 50.4% and 44.6%, respectively, was found. The prevalence of insomnia was found to be higher in healthcare workers (38.4%) as compared to non-healthcare workers (30.5%). Worry about being getting infected themselves, low educational level and perceived unhelpfulness of psychological support were found to be risk factors for insomnia in a study on medical staff, and an insomnia prevalence of 36.1% was found in them. Self-rating scales used to assess anxiety and stress increased scores, and some also reported that this decreased sleep quality and it was thought that anxiety and stress was due to bad sleep. Anxiety and stress as also found in family members of healthcare workers.
Several studies have been reported on the population while in isolation, quarantine or otherwise while at home during a lockdown. Anxiety, stress and bad sleep remained an important concern.,,,,,,,,, Anxiety as high as 69% was reported in quarantined population. In a study done in population by Rossi et al. reported a prevalence of 20.8% for anxiety, 17.3% had depression and 7.3% reported insomnia using ISI. Web-based population survey using Pittsburgh Sleep Quality Index (PSQI reported a prevalence of 18.2% reporting poor sleep quality. In a study conducted by Liu et al. using PSQI, 20.7% had bad sleep quality and 8.4% were unable to sleep for more than 30 minutes for more than two times a week and 13% woke up during the night more than three times a week.
Another web-based survey using ISI reported an overall of 33.9% prevalence and health-care workers were found to be more affected than non-healthcare workers.
Post-traumatic symptom scores (PTSS) of 37% were found and a significantly higher prevalence of posttraumatic symptom scores was found in respondents who had poorer sleep. Similarly higher anxiety and depression scores correlated with bad sleep. An interesting report on Japanese citizens showed the population strategies including taking adequate sleep being advocated officially and a scale made for 'fear of COVID-19' includes a question related to not able to sleep and worry about getting the disease.
| » Discussion|| |
Literature search showed that most of the data pertaining to sleep or to prevalence of sleep problem related to COVID-19 pandemic are studies which have used self-rating scales, questionnaires, or just a few questions on sleep. It suggests that there is a high prevalence of sleep problems during COVID-19 pandemic.,,,
Many studies found that poor sleep correlated with anxiety, depression, stress and posttraumatic stress symptoms increasing a likelihood or post-traumatic stress disorder.,,,, Studies also report that increase in anxiety may lead to impairment in sleep.,, Increased anxiety has been reported in healthcare workers, their families, patients, population in isolation and in quarantine and while working from home due to which improving anxiety and sleep in them may help.,,,
A need to address sleep exists in the present times for healthcare workers, patients and population as such.,,,,, Good sleep and diet were advocated in the government strategies sent out to public regarding COVID as mentioned in paper by Muto et al. and if followed can better physical and mental health outcomes.
Getting adequate sleep has been advocated for school children. It has been emphasized that screen time should be regulated during the social distancing and work from home scenario. Since the schools are closed, role of parents in regulating the child's sleep hygiene and sleep health becomes important.,, Elderly also are required to take care of their sleep.,,
Across the globe, there is a felt need to address sleep by advocating good sleep practices, ensuring adequate amount of time at night and looking after mental and emotional health,, by developing online platforms to promote good sleep and also for psychological consultations.,,, Social support system has been found to be important to prevent psychological problems. Psychological crisis prevention during these testing times is therefore vital.,, Increased misinformation to healthcare workers needs to be dealt with. Leadership positions at hospitals and healthcare systems should ensure mitigation of such misinformation. They should also ensure that adequate time is given to healthcare workers to rest and sleep,, to prevent burnout and fatigue.,, Also health strategies for prevention and treatment should be devised for them. Adequate sleep and preventing sleep disruption can prevent collaborative delirium prevention in COVID-19 patients. Castro et al. communicated that psychological symptoms should be addressed and should not be missed out. Nonpharmacological approaches like CBTI, progressive muscular relaxation and indigenous solutions using yoga nidra can also be tried, to improve sleep. These are also important to help in special situations like the homeless, for whom space may be provided to sleep, in pregnancy, in mental illness patients, etc., It is important to make people understand that individualized strategy works the best and the individual should identify his own strategy to better his sleep.
A few case series have brought out that OSA,,,, did remain an important and frequent baseline characteristic in COVID-19 patients. Various societies have issued guidelines e.g., American academy of Sleep Medicine regarding sleep lab protocols. Infectious Disease Society of America guidelines regarding the infection prevention of COVID-19 and disinfection and sterilization guidelines from Centres for Disease Control and Prevention. It is required for us to follow recommended guidelines regarding sleep studies in the lab or home monitoring. Guidelines for attending to patients with OSA in a sleep lab and sleep consultations also has been clearly spelt out and must be followed primarily because of the fear of spread of COVID infected OSA patients.
All sleep labs must follow the recommendations,, of which few salient ones are- Adequate postage regarding the pandemic must be put in the sleep clinic and lab and as per the recommended infection control procedures routine cleaning followed by disinfection done. Personal protective equipment (PPE) must be procured in adequate amount. Telemedicine consults are preferred and in high endemic areas, it is recommended not to perform non-invasive ventilation. If the patient is critical, a prior screening for COVID-19 is mandatory. Clinicians to wear mask at all times in clinics and sleep technologists and sleep lab staff should wear PPE. In patients where aerosol generation is likely e.g., positive airway titration, N95 mask, face shields and gloves must be worn by technologists and staff. They should also be in a long-sleeved gown and cap.
Home portable systems, auto PAP adjusting machines are preferred for OSA patients to be considered. In case home sleep apnea testing is performed, devices should be disinfected and be used for the next patient preferably only after 72 hours. Disposable nasal pressure transducers, ventilator tube to be used and all the sensors and equipment should be carefully cleaned and disinfected with non-corrosive chlorine-containing disinfectant or 75% ethanol between each patient use. Restart of the lab should be only done after taking due consideration of the local epidemic situation following the guidelines for consult and screening carefully.
There are a few limitations of this review. Due to the increased availability of literature, only first 200 publications in Google scholar after sorting for relevance were taken which is though a recommended method and was done to exclude irrelevant numbers. Secondly some preprints or non-peer-reviewed literature have also been included to make the literature more representative of the available research. The strategies to find out prevalence of sleep problems were very variant, with only a very few studies which used standard questionnaires, making it difficult to do statistical analysis.
There is a need to conduct RCT with objective sleep parameters to identify possible solutions. Considering an impending sleep problem in the times to come, a dedicated work force to develop population-based strategies to better sleep may be required.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Kim HC, Yoo SY, Lee BH, Lee SH, Shin HS. Psychiatric findings in suspected and confirmed middle east respiratory syndrome patients quarantined in Hospital: A retrospective chart analysis. Psychiatry Investig 2018;15:355-60.
Wu KK, Chan SK, Ma TM. Posttraumatic stress after SARS. Emerg Infect Dis 2005;11:1297-300.
Su TP, Lien TC, Yang CY, Su YL, Wang JH, Tsai SL, et al
. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: A prospective and periodic assessment study in Taiwan. J Psychiatr Res 2007;41:119-30.
Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: A prospective exploratory study. Syst Rev 2017;6:245.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.
Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al
. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA 2020;323:1612-4.
Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al
. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch Chest Dis 2020;90. doi: 10.4081/monaldi. 2020.1294.
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al
. Covid-19 in critically ill patients in the Seattle region – case series. N Engl J Med 2020;382:2012-22.
Liu X, Liu X, Xu Y, Xu Z, Huang Y, Chen S, et al
. Ventilatory ratio in hypercapnic mechanically ventilated patients with COVID-19 associated ARDS. Am J Respir Crit Care Med 2020;201:1297-9.
Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al
. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020;220:1-13.
Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract 2020;39:101132.
Sun N, Shi S, Jiao D, Song R, Ma L, Wang H, et al
. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control 2020;48:592-8.
Yifan T, Ying L, Chunhong G, Jing S, Rong W, Zhenyu L, et al
. Symptom cluster of ICU nurses treating COVID-19 pneumonia patients in Wuhan, China. J Pain Symptom Manage 2020;60:e48-53.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al
. Factors associated with mental health outcomes among health-carecare workers exposed to Coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
Zhang W-R, Wang K, Yin L, Zhao W-F, Xue Q, Peng M, et al
. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom 2020;89:242-50.
Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al
. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 Novel Coronavirus disease outbreak. Front Psychiatry 2020;11:306.
Cai H, Tu B, Ma J, et al. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit; 26. Epub ahead of print 23 March 2020. DOI: 10.12659/MSM.924171.
Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with Coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549.
Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al
. Work stress among Chinese nurses to support Wuhan for fighting against the COVID-19 epidemic. J Nurs Manag 2020;28:1002-9.
Ying Y, Kong F, Zhu B, Ji Y, Lou Z, Ruan L. Mental health status among family members of health-care workers in Ningbo, China during the Coronavirus disease 2019 (COVID-19) outbreak: A cross-sectional study. BMC Psychiatry 2020;20:379.
Rosen Z, Weinberger-Litman SL, Rosenzweig C, Rosmarin DH, Muennig P, Carmody ER, et al
. Anxiety and distress among the first community quarantined in the US due to COVID-19: Psychological implications for the unfolding crisis. 2020; https://psyarxiv.com/7eq8c
. doi: 10.31234/osf.io/7eq8c.
Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al
. COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey. medRxiv 2020; doi: https://doi.org/10.1101/2020.04.090.20057802
Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res 2020;288:112954.
Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al
. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res 2020;287:112921.
Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the Coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit 2020;26:e923921.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety and perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatry 2020;51:102083.
Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med 2021;26:13-22.
Mai M, Wang J, Xia D, Guo X, Li F, Chen Y, et al
. Survey of anxiety and depression in p; atients with suspected and confirmed cases of COVID-19 during hospitalization and isolation. 2020; doi: 10.21203/rs. 3.rs-17959/v1.
Losada-Baltar A, Jiménez-Gonzalo L, Gallego-Alberto L, Pedroso-Chaparro MDS, Fernandes-Pires J, Márquez-González M. “We're staying at home”. Association of self-perceptions of aging, personal and family resources and loneliness with psychological distress during the lock-down period of COVID-19. J Gerontol B Psychol Sci Soc Sci 2021;76:e10-6.
Muto K, Yamamoto I, Nagasu M, Tanaka M, Wada K. Japanese citizens' behavioral changes and preparedness against COVID-19: How effective is Japan's approach of self-restraint? medRxiv 2020; doi: https://doi.org/10.1101/2020.03.31.20048876
Ahorsu DK, Lin C-Y, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation. Int J Ment Health Addict 2020:1-9. doi: 10.1007/s11469-020-00270-8 [Epub ahead of print]
Zhang F, Shang Z, Ma H, Jia Y, Sun L, Guo X, et al
. High risk of infection caused posttraumatic stress symptoms in individuals with poor sleep quality: A study on influence of coronavirus disease (COVID-19) in China. medRxiv 2020; doi: https://doi.org/10.1101/2020.03.220.20034504
Bo H, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al
. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med 2020;1-2. doi: 10.1017/S0033291720000999. Online ahead of print.
Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al
. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun 2020;88:916-9.
Dong M, Zheng J. Letter to the editor: Headline stress disorder caused by Netnews during the outbreak of COVID-19. Health Expect 2020;23:259-60.Health-care
Yuan R, Xu Q, Xia C, Lou C, Xie Z, Ge Q, et al
. Psychological status of parents of hospitalized children during the COVID-19 epidemic in China. Psychiatry Res 2020;288:112953.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al
. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.
Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med 2020;383:510-2.
Rana W, Mukhtar S, Mukhtar S. Mental health of medical workers in Pakistan during the pandemic COVID-19 outbreak. Asian J Psychiatry 2020;51:102080.
Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care 2020;24:120.
de Medeiros Carvalho PM, Moreira MM, de Oliveira MNA, Landim JMM, Neto MLR. The psychiatric impact of the novel coronavirus outbreak. Psychiatry Res 2020;286:112902.
Kim S-W, Su K-P. Using psychoneuroimmunity against COVID-19. Brain Behav Immun 2020;87:4-5.
Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. The Lancet 2020;395:945-7.
Coyne LW, Gould ER, Grimaldi M, Wilson KG, Baffuto G, Biglan A. First things first: Parent psychological flexibility and self-compassion during COVID-19. Behav Anal Pract 2020:1-7. doi: 10.1007/s40617-020-00435-w [Epub ahead of print]
Szabo T, Richling S, Embry DD, Biglan A, Wilson KG. From helpless to hero: Promoting values-based behavior and positive family interaction in the midst of Covid-19. Behav Anal Pract 2020;13:568-76.
Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088-95.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatry 2020;33:e100213.
Wang H, Li T, Gauthier S, Yu E, Tang Y, Barbarino P, et al
. Coronavirus epidemic and geriatric mental healthcare in China: How a coordinated response by professional organizations helped older adults during an unprecedented crisis. Int Psychogeriatr 2020:1-4. Published online 2020 Apr 9. doi: 10.1017/S1041610220000551.
Torales J, O'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry 2020;66:317-20.
Fessell D, Cherniss C. Coronavirus disease 2019 (COVID-19) and beyond: Micropractices for burnout prevention and emotional wellness. J Am Coll Radiol 2020;17:746-8.
Santarone K, McKenney M, Elkbuli A. Preserving mental health and resilience in frontline healthcare workers during COVID-19. Am J Emerg Med 2020;38:1530-1.
Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al
. Timely mental health-care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.
Kapoor A, Guha S, Das MK, Goswami KC, Yadav R. Digital healthcare: The only solution for better healthcare during COVID-19 pandemic? Indian Heart J 2020;72:61-4.
Liu S, Yang L, Zhang C, Xiang Y-T, Liu Z, Hu S, et al
. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020;7:e17-8.
Bachireddy C, Chen C, Dar M. Securing the safety net and protecting public health during a pandemic: Medicaid's response to COVID-19. JAMA 2020;323:2009-10.
Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health-care workers. CMAJ 2020;192:e459-60.
Zhang J, Wu W, Zhao X, Zhang W. Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: A model of West China hospital. Precis Clin Med 2020;3:3-8.
Datta R, Yadav AK, Singh A, Datta K, Bansal A. The infodemics of COVID-19 amongst healthcare professionals in India. Med J Armed Forces India 2020;76:276-83.
Jun J, Tucker S, Melnyk B. Clinician mental health and well-being during global healthcare crises: Evidence learned from prior epidemics for COVID-19 pandemic. Worldviews Evid Based Nurs 2020;17:182-4.
Jin H, Hong C, Chen S, Zhou Y, Wang Y, Mao L, et al
. Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc Neurol 2020;5:146-51.
Vieira CM, Franco OH, Restrepo CG, Abel T. COVID-19: The forgotten priorities of the pandemic. Maturitas 2020;136:38-41.
Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92:129-46.
Dewey C, Hingle S, Goelz E, Linzer M. Supporting clinicians during the COVID-19 pandemic. Ann Intern Med 2020;172:752-3.
Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al
. Impact of coronavirus syndromes on physical and mental health of health-care workers: Systematic review and meta-analysis. J Affect Disord 2020;275:48-57.
LaHue SC, James TC, Newman JC, Esmaili AM, Ormseth CH, Ely EW. Collaborative Delirium Prevention in the Age of COVID-19. J Am Geriatr Soc 2020;68:947-9.
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:e13052.
Datta K, Tripathi M, Mallick HN. Yoga Nidra: An innovative approach for management of chronic insomnia- A case report. Sleep Sci Pract 2017;1:7.
Datta K, Tripathi M, Verma M, Masiwal D, Mallick HN. Yoga nidra Practice Shows Improvement in Sleep in Chronic Insomnia Patients: A Randomised Controlled Trial. Nat Med J India (in press) Accepted for publication on 20 Dec 2019).
Poon LC, Yang H, Kapur A, Melamed N, Dao B, Divakar H, et al
. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals. Int J Gynecol Obstet 2020;149:273-86.
Druss BG. Addressing the COVID-19 pandemic in populations with serious mental illness. JAMA Psychiatry JAMA Psychiatry 2020;77:891-2.
Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al
. Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. Lancet Psychiatry 2020;7:e43.
Gupta R, Kumar VM, Tripathi M, Datta K, Narayana M, Sarmah KR, et al
. Guidelines of the Indian society for sleep research (ISSR) for practice of sleep medicine during COVID-19. Sleep Vigil 2020;1-12. doi: 10.1007/s41782-020-00097-2. Online ahead of print.
Barker J, Oyefeso O, Koeckerling D, Mudalige NL, Pan D. COVID-19: Community CPAP and NIV should be stopped unless medically necessary to support life. Thorax 2020;75:367.