Influence of N95 Mask-related Hypoxemia on Headache, Stress, Anxiety, and Quality of Sleep during COVID-19 Patient Care among Frontline Health Care Professionals

Abstract

Background: Prolonged use of N95 masks by health care workers might affect physical health due to mask-related hypoxia in addition to the psychological effects of N95 masks. We tried to explore the association of N95 mask-related hypoxia and headache with stress, quality of sleep, and anxiety in the current study. Materials and methods: The sample (N = 78) consisted of 41 doctors and 37 nurses involved in COVID-19 patient care and using N95 masks with or without PPE for at least 4 hours. Perceived stress scale (PSS), Coronavirus anxiety scale (CAS), and Pittsburgh sleep quality index (PSQI) were administered, and physical parameters like heart rate and oxygen saturation (SpO2) were measured. Results: Around 42% of the study participants experienced headaches after wearing an N95 mask and had a higher increase in heart rate (mean percent:10.5% vs 6.3%) and decline in SpO2 (mean percent: 2.6% vs 1.5%) compared to those who didn’t develop a headache after N95 mask use. Independent samples t-test showed a mean difference for PSS and CAS between those who experienced headaches and those who didn’t. The mean PSQI scores among the study participants were 8.91 ± 5.78; the score among those participants with and without headache was 10.57 ± 3.11 and 7.68 ± 2.53, respectively. Conclusion: Perceived corona anxiety, poor sleep quality, and corona anxiety are associated with N95-related headaches and SpO2 drop among health professionals who wear N95 masks for at least 4 hours.

Effect of Surgical Masks and N95 Respirators on Anxiety

“…In this study, after wearing the N95 respirator for 4 weeks, patients with anxiety reached the level of clinical insomnia, which is consistent with previous research demonstrating that N95 respirators could reduce sleep quality. 43 Whether wearing an N95 respirator further increases insomnia by increasing the severity of anxiety or directly is unclear and requires further research.…”

“…9 Physio-metabolic side effects of face-mask wearing, such as hypoxia, may exacerbate anxiety. 43 Anxiety and insomnia are mutual risk factors. 44 Individuals with anxiety often experience sleep disturbances, and insufficient sleep can further exacerbate anxiety.…”