Sleep health improvement trajectories after a pandemic: insights from a national health survey

STUDY OBJECTIVES: This study aimed to evaluate sleep health improvement trends in Catalonia, Spain, from 2020 to 2023 following the COVID-19 pandemic, and to identify disparities across demographic and socioeconomic groups. METHODS: This repeated cross-sectional study analyzed 11 794 responses from eight waves of the Catalan Health Survey. Sleep health was assessed using the SATED and Ru-SATED questionnaires, covering six dimensions: Satisfaction, Alertness, Timing, Efficiency, Duration, and Regularity. Trends over time were evaluated, and stratified and interaction models assessed differences by sex, age, BMI, material deprivation, comorbidity burden, and living situation. Survey weights ensured population representativity. RESULTS: Sleep health improved from mid-2021, then stabilized. Efficiency plateaued by late 2020, while Satisfaction remained the most unstable dimension. Sleep regularity diminished during the 2020 lockdowns but improved promptly afterward. Females consistently scored lower than males, though their improvement trajectories were similar (p-for-interaction = .906). Older adults (65+) and individuals with excess weight exhibited distinctive improvement trends (p-for-interaction = .023). Material deprivation was the strongest predictor of poor sleep health and delayed improvement (p-for-interaction = .024). Living alone had a temporary negative impact during lockdowns, which resolved by 2022. Finally, comorbidity burden affected baseline scores but not improvement trends (p-for-interaction = .467). CONCLUSIONS: Sleep health improvement post-pandemic was uneven across sleep dimensions and population subgroups. Behavioral sleep dimensions improved earlier, while subjective satisfaction lagged. Socioeconomic factors, particularly material deprivation, were strongly associated with poorer and slower improvements. These findings highlight the importance of incorporating sleep health into pandemic preparedness and tailoring interventions to address both behavioral and structural determinants of health.