Document Type : Review Articles


1 Social Determinant of Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Professional Health, Sirjan School of Medical Sciences, Sirjan, Iran

3 Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran

4 Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran



Background: Sleep health is a relatively new term in the sleep literature and an emerging concept in sleep medicine. Lack of attention to health sleep, leads to an increase in the incidence of various physical, mental, and immune disorders against infectious diseases.
Methods: This Narrative review study was conducted in September 2021. Studies and articles published in PubMed Databases, Web of Science, and Google search engine from 1983 to January 2021 were included in the study. All reviews and cross-sectional studies found through the keywords, including Sleep, sleep Health, Sleep Hygiene, Underlying diseases, COVID-19, and coronavirus, were reviewed regardless of the publicationlanguage.
Results: According to the collected evidence, sleep deprivation is one of the main causes of underlying diseases, and people with underlying diseases are most vulnerable to COVID-19. Also, East Asian countries such as China, Japan, and South Korea, with more scientific production in the field of healthy sleep, compared to EU member states, can protect themselves from diseases caused by unhealthy sleep and have lower mortality rate of COVID-19 infection.
Conclusion: given the vulnerability of underlying diseases to coronavirus, one of the most important functional areas and preventive factors in the occurrence of the underlying diseases that should be considered is sleep health. Encouraging and promoting sleep health is also important as a protective factor in preventing and managing COVID-19 infectious diseases. Sleep health might also be one of the important factors playing a role in the vulnerability of COVID-19 in different societies.


  1. Dzierzewski JM, Sabet SM, Ghose SM, Perez E, Soto P, Ravyts SG, et al. Lifestyle Factors and Sleep Health across the Lifespan. Int J Environ Res Public Health. 2021;18(12):6626. doi: 3390/ijerph18126626.
  2. Aschbrenner KA, Naslund JA, Salwen‐Deremer JK, Browne J, Bartels SJ, Wolfe RS, et al. Sleep quality and its relationship to mental health, physical health, and health behaviors among young adults with serious mental illness enrolled in a lifestyle intervention trial. Early Interv Psychiatry. 2021, 16(8):18-35. doi: 10.1111/eip.13129.
  3. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9-17. doi: 10.5665/sleep.3298. PMID: 24470692. PMCID: PMC3902880.
  4. Albakri U, Drotos E, Meertens R. Sleep Health Promotion Interventions and Their Effectiveness: An Umbrella Review. Int J Environ Res Public Health. 2021 21;18(11):5533. doi: 10.3390/ijerph18115533. PMID: 34064108. PMCID: PMC8196727.
  5. Li L; Wu C; Gan Y; Qu X; Lu Z. Insomnia and the risk of depression: A meta-analysis of prospective cohort studies. BMC Psychiatry 2016, 16(1): 375. doi: 1186/s12888-016-1075-3.
  6. Goldstein A.N; Walker M.P. The role of sleep in emotional brain function. Annu. Rev Clin Psychol. 2014, 10, 679–708.
  7. Lo J; Groeger J.A; Cheng G.H; Dijk D.J; Chee M. Self-reported sleep duration and cognitive performance in older adults:A systematic review and meta-analysis. Sleep Med. 2016, 17: 87–98. doi: 10.1016/j.sleep.2015.08.021.
  8. Nazari H; Moradi A; Rahmani K. A systematic review of the effect of various interventions on reducing fatigue and sleepinesswhile driving. Chin. J Traumatol Zhonghua Chuang Shang Za Zhi. 2017, 20(5): 249–258. doi: 1016/j.cjtee.2017.03.005.
  9. Ramadan M; Al-Saleh K. The association of sleep deprivation on the occurrence of errors by nurses who work the night shift. Curr. Health Sci. J. 2014, 40(2): 97–103.
  10. Uezu E, Taira K, Tanaka H, Arakawa M, Urasakii C, Toguchi H, et al. Survey of sleep‐health and lifestyle of the elderly in Okinawa. PCN Rep. 2000;54(3):311-3.
  11. Paudel ML, Taylor BC, Ancoli-Israel S, et al.; Osteoporotic Fractures in Men (MrOS) Study. Rest/activity rhythms and mortality rates in older men: MrOS Sleep Study. Chronobiol Int. 2010;27(2):363-77.
  12. Sleep quality and COVID-19 outcomes: the evidence-based lessons in the framework of predictive, preventive, and personalized (3P) medicine. EPMA J. 2021. doi: 10.1007/s13167-021-00245-2.
  13. Ohayon, M.M. Epidemiological overview of sleep disorders in the general population. Sleep Med Res. 2011, 2(?): 1–9
  14. Chatto V.K; Manzar M.D; Kumar S; Burman D; Spence D.W; Pandi-Perumal S.R. The global problem of insufficient sleep and its serious public health implications. Healthcare. 2018, 7(1).
  15. Hafner M; Stepanek M; Taylor J; Troxel W.M; van Stolk C. Why sleep matters—The economic costs of insufficient sleep: A cross-country comparative analysis. Rand Health Q. 2017, 6(11).
  16. Ohayon M.M; Carskadon M.A; Guilleminault C; Vitiello M.V. Meta-Analysis of Quantitative Sleep Parameters FromChildhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004, 27:1255–1273.
  17. Foley D.J; Mon Jan A.A; Brown S.L; Simonsick E.M; Wallace R.B; Blazer D.G. Sleep Complaints Among Elderly Persons: AnEpidemiologic Study of Three Communities. Sleep. 1995, 18: 425-432.
  18. Vitiello M.V; Moe K.E; Prinz P.N. Sleep Complaints Cosegregate with Illness in Older Adults Clinical Research Informed by and Informing Epidemiological Studies of Sleep. J. Psychosom. Res. 2002, 53: 555–559.
  19. He L, Zhao W, Gao Y, Gao X, Lei X. The effect of COVID-19 lockdowns on sleep time perception: Comparing actigraphy and sleep diary measures. Int J of Psych. 2021; 167:86-93.
  20. Brand S, Kalak N, Gerber M, Kirov R, Pühse U, Holsboer-Trachsler E. High self-perceived exercise exertion before bedtime is associated with greater objectively assessed sleep efficiency. Sleep Med. 2014 Sep;15(9):1031-6. doi: 10.1016/j.sleep.2014.05.016. PMID: 25087193.
  21. Prather AA, Janicki-Adverts D, Hall MH, et al. Behaviorally assessed sleep and susceptibility to the common cold. Sleep. 2015,38:1353e9. doi: 10.5665/sleep.4968.
  22. Kang YJ. The mortality rate of infection with COVID-19 in Korea from the perspective of underlying disease. Disaster Med Public Health Prep. 2020;14(3):384-6.
  23. Vandekerckhove M, Wang YL. Emotion, emotion regulation and sleep: An intimate relationship. AIMS Neurosci. 2017 Dec 1;5(1):1-17. doi: 10.3934/Neuroscience.2018.1.1. PMID: 32341948. PMCID: PMC7181893.
  24. de Almonds KM, Marín Agudelo HA, Jiménez-Correa U. Impact of Sleep Deprivation on Emotional Regulation and the Immune System of Healthcare Workers as a Risk Factor for COVID 19: Practical Recommendations from a Task Force of the Latin American Association of Sleep Psychology. Front Psychol. 2021 20; 12:564227. doi: 10.3389/fpsyg.2021.564227. PMID: 34093295. PMCID: PMC8172768.
  25. Lin CL, Liu TC, Chung CH, Chien WC. Risk of pneumonia in patients with insomnia: A nationwide population-based retrospective cohort study. J Infect Public Health. 2018 Mar-Apr;11(2):270-274. doi: 10.1016/j.jiph.2017.08.002. PMID: 28916233.
  26. Prather AA, Leung CW. Association of Insufficient Sleep with Respiratory Infection Among Adults in the United States. JAMA Intern Med. 2016 Jun 1;176(6):850-2. doi: 10.1001/jamainternmed.2016.0787. PMID: 27064773; PMCID: PMC4899278.
  27. Rajabnezhad MR, Rajabnezhad S, Rastegar F, Nicknejad S. The role of sleep functions in human health from the perspective of the Holy Quran. q med.2011. 1(2):30-35. doi: 10.5112.
  28. Petrov ME, Pituch KA, Kasraeian K, Jiao N, Mattingly J, Hasanaj K, et al. Impact of the COVID-19 pandemic on change in sleep patterns in an exploratory, cross-sectional online sample of 79 countries. Sleep Health. 2021 1;7(4):451-8.
  29. Yuksel D, McKee GB, Perrin PB, Alzueta E, Caffarra S, Ramos-Usuga D, et al. Sleeping when the world locks down: Correlates of sleep health during the COVID-19 pandemic across 59 countries. Sleep Health. 2021 1;7(2):134-42.
  30. Giri A, Srinivasan A, Sundar IK. COVID-19: Sleep, Circadian Rhythms, and Immunity–Repurposing Drugs and Chronotherapeutics for SARS-CoV-2. front Neurosci. 2021;15.
  31. Serrano-Ripoll MJ, Zamanillo-Campos R, Castro A, Fiol-de Roque MA, Ricci-Cabello I. Insomnia and sleep quality in healthcare workers fighting against COVID-19: a systematic review of the literature and meta-analysis. Actas Esp Psiquiatr. 2021 1;49(4):155-79.
  32. Iannella G, Vicini C, Lechien JR, Ravaglia C, Poletti V, di Cesare S and et al. Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea. Ear Nose Throat J. 2021.
  33. Ahmed O, Hossain KN, Siddique RF, Jobe MC. COVID-19 fear, stress, sleep quality and coping activities during the lockdown, and personality traits: a person-centered approach analysis. Individ Differ. 2021. 1;178:110.
  34. Andreu-Caravaca L, Ramos-Campo D, Manonelles P, Abellán-Aynés O, Chung LH, Rubio-Arias JÁ. Effect of COVID-19 home confinement on sleep monitorization and cardiac autonomic function in people with multiple sclerosis: A prospective cohort study. Physiol & Behav. 2021; 1;237-113392.
  35. Jamieson D, Kannis-Demand L, Beaudequin DA, Schwenn P, Shan Z, McLoughlin LT, et al. Can measures of sleep quality or white matter structural integrity predict the level of worry or rumination in adolescents facing stressful situations? Lessons from the COVID-19 pandemic. J of Adol. 2021.91: 110-118. doi: 10.1016/j.
  36. Willows S, Alam SB, Sandhu JK, Kulka M. A Canadian perspective on severe acute respiratory syndrome coronavirus2 infections and treatment: how prevalent underlying inflammatory disease contributes to pathogenesis. Bio and Cell Biol. 2021;99(2):173-94.