Effect of chronic non-communicable diseases (CNCDs) on the sleep of Brazilians during the COVID-19 pandemic.

This study aimed to investigate the effect of Chronic Noncommunicable Diseases (CNCDs) on the onset or increase in sleep problems during the COVID-19 pandemic period. The role of the report of sadness or nervousness during the pandemic was also evaluated as a mediator of this association. Data from a behavior survey during COVID-19, conducted in Brazil with 45,161 people (18 years old or older), from April 24 to May 24, 2020, were used. The outcome variable was the onset or increase in sleep problems, and the exposure variable was the presence of CNCDs. The adjusted Odds Ratio of the association between CNCDs and sleep was estimated, and a mediation analysis was performed to test the effect of the report of sadness or nervousness on this association, using the Karlson Holm Breen method. The increase in sleep problems was reported by 44.9% of the population, and 33.9% reported at least one CNCD. The chance of sleep problems was higher among people with diabetes (1.34; 1.05-1.71), hypertension (1.26; 1.06-1.50), and with coronary heart diseases (1.36; 1.13-1.65) or respiratory diseases (1.42; 1.04-1.93). Compared to people without CNCDs, individuals with at least one CNCD had a 36% greater chance of impaired sleep (1.36; 1.19-1.55). The report of sadness or nervousness explained 45.1% of the association between CNCD and sleep. Our findings alert us to care for the emotional state and sleep of chronic patients during the waves of the COVID-19 pandemic, and indicate the need for sleep monitoring in this population.