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Health Care Worker Burnout and Sleep Disturbance Linked With Heightened Infection Risk, Severe COVID-19


Among health care workers, disrupted sleep and daily burnout were associated with a greater risk of developing COVID-19, as well as having more severe symptoms and a longer recovery period.

Health care workers experiencing sleep issues and daily burnout may be at greater risk of COVID-19 and a more severe disease course, according to study findings published this week in BMJ Nutrition, Prevention & Health.

Since the onset of the pandemic, the risk of burnout and insufficient sleep has grown substantially among health care workers. Along with its link to worse patient outcomes, physician burnout, which is associated with inadequate sleep, may increase risk of infectious diseases, note the study authors. Moreover, sleep habits and stress have also been indicated as risk factors for susceptibility to the common cold, although it is unknown whether this may translate to COVID-19.

As health care workers are already at a high risk of coronavirus infection while treating patients with the disease, researchers sought to determine whether sleep and burnout may serve as additional risk factors for COVID-19 among these populations. They conducted an online survey of health care workers regularly in contact with patients with COVID-19 (N = 2884), such as those in emergency or intensive care units, of 6 countries (France, Germany, Italy, Spain, United Kingdom, and United States).

Polling respondents from July 17 to September 25, 2020, each participant provided self-reported information on demographics, sleep (number of sleep hours at night, daytime napping hours, sleep problems), burnout from work, and COVID-19 exposures. Researchers used multivariable linear and logistic regression models to assess the associations among sleep, burnout, and COVID-19.

Of the study cohort, 568 health care workers had COVID-19, with the remaining 2316 serving as controls. Those infected were noted to be slightly younger, more likely to be physicians, and more likely to practice internal medicine. Furthermore, infected respondents were more likely to report fewer sleep hours at night, slightly more daytime napping hours, 1 or more sleep problems, and burnout from work at least monthly.

After adjusting for confounders, researchers found that each additional hour of sleep at night was associated with 12% lower odds of COVID-19 infection (odds ratio [OR], 0.88; 95% CI, 0.81-0.96; P = .003). Conversely, a 1-hour increase in daytime napping hours was associated with a 6% greater risk of COVID-19 (OR, 1.06; 95% CI, 1.01-1.12; P = .03), but the association varied by countries, with a nonsignificant inverse association found in Spain.

Notably, participants who reported 3 sleep problems (difficulty sleeping at night, poor sleep continuity, frequent sleeping pill use) were associated with an almost 2-fold greater odds of COVID-19 (OR, 1.88; 95% CI, 1.17-3.01; Ptrend = .22).

In addition to sleep issues, reporting burnout on a daily basis was associated with a more than 2 times greater odds of COVID-19 (OR, 2.60; 95% CI, 1.57-4.31, Ptrend = .001), as well as significantly longer duration (OR, 2.98; 95% CI, 1.10-8.05, Ptrend = .02) and severity (OR, 3.26; 95% CI, 1.25-8.48; Ptrend = .02), compared with reporting no burnout.

These associations remained significant after adjusting for frequency of COVID-19 exposures.

“This study spotlights an often neglected area of wellbeing: the need for quality sleep and recharge time to prevent burnout and its consequences,” said Minha Rajput-Ray, MBChB, medical director of NNEdPro Global Centre for Nutrition & Health, which co-owns the journal with BMJ, in a statement. “From an occupational and lifestyle medicine perspective, a better understanding of the effects of shift work and sleep is essential for the wellbeing of healthcare staff and other key workers.”


Kim H, Hegde S, LaFiura C, et al. COVID-19 illness in relation to sleep and burnout. BMJ Nutr Prev Health. Published online March 22, 2021. doi:10.1136/bmjnph-2021-000228

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