Sources of Stress in Relation to Sleep Health During the COVID-19 Pandemic: Findings from the National Couples’ Health and Time Study

OBJECTIVE: To assess associations between sources of stress and sleep health among married/cohabitating US adults during the COVID-19 pandemic. METHODS: We analyzed the National Couples' Health and Time Study, an online survey completed 2020-2021. Stressors were categorized into five domains--1) COVID-19 infection; 2) resources/insurance; 3) overall health; 4) job/income; and 5) public health recommendations. Sleep quality and duration (<7 and 7-9) were measured. Adjusted prevalence ratios (aPRs) and Accepted manuscript ACCEPTED MANUSCRIPT95% CIs were obtained from survey-weighted logistic regression models by estimating predicted marginal probabilities. RESULTS: Among 3,642 individuals, 46.6% were aged 35-50 years and 44.1% were college graduates. Within racial and/or ethnic groups, the weighted prevalence of overall health stress was 62.0% among Latino and 55.8% among White individuals; the weighted prevalence of job/income stress was 64.3% among Black/African American and 57.6% among White individuals; and the weighted prevalence of public health recommendations stress was highest among White individuals (34.1%), compared with Black/African American (28.1%) and Latino (27.8%) individuals. Overall health stress was associated with poor/fair sleep quality (aPR=1.35; 95% CI: 1.14-1.60) and <7 hours sleep (aPR=1.19; 95% CI: 1.03-1.39). Job/income stress was associated with fair/poor sleep quality (aPR=1.46; 95% CI: 1.24-1.72) and <7 hours sleep (aPR=1.31; 95% CI: 1.13-1.52). Race-stratified models showed job/income stress significant among Latino and White individuals for both sleep outcomes, and overall health stress among Latino individuals for duration. CONCLUSION: Overall health stress and job/income stress were associated with poorer sleep health among married and cohabiting individuals. Futurework is needed on stress-management and sleep health promotion.