0394 Regional Differences in Self-Reported Sleep Health During the COVID-19 Lockdown

Abstract Introduction Insomnia symptoms increased globally during the COVID-19 pandemic, though regional patterns within the United States remain unclear. We hypothesized that adults in the U.S. South would have greater insomnia severity (Insomnia Severity Index; ISI) and poorer sleep quality (Pittsburgh Sleep Quality Index; PSQI), than adults in other U.S. regions during the pandemic, given the region’s higher rate of cardiovascular conditions, which are known to affect sleep. Methods U.S. adults were surveyed from April 2020 to October 2021 (approximately1000 per month; 42% female; ages 18-92). Sleep quality and insomnia were assessed using the PSQI and ISI. Responses from Alaska, Hawaii, and U.S. territories were excluded to focus on continental regional trends. Chi-square tests compared lockdown frequency by region. Mixed-effects models, controlling for demographics and including random intercepts for state, examined associations between region, lockdown status, and sleep outcomes. Right-skewed ISI scores were analyzed using a Tweedie generalized linear mixed-effects model. Results Lockdown prevalence differed significantly across U.S. regions ( χ2(3, N = 13,149) = 386.68, p < .0001, Cramér’s V = .17), with the West exhibiting the highest frequency. All participants were found to have a higher PSQI scores on average (b = 0.32, p < .001) and ISI score (~13% increase, b = 0.12, p < .001) during lockdowns compared to non-lockdown periods, but these effects did not differ significantly by region. Females reported greater insomnia symptoms than males (b = 0.15, p < .001). In separate models where exercise was evaluated as a potential predictor, this was not significantly associated with PSQI or ISI outcomes. Between-state variance was minimal in all models. Conclusion Lockdown status was associated with poorer sleep quality and greater insomnia severity across the United States, regardless of region. Although regional differences in lockdown prevalence were observed, these did not translate into regional differences in PSQI or ISI outcomes. Female sex was linked to increased sleep disturbances, while exercise was not a significant predictor. These findings highlight the widespread impact of pandemic-related disruptions on sleep. Future research should investigate behavioral and environmental factors that may contribute to variations in insomnia severity in the U.S. Support (if any)