Abstract

--- - "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." - Statement of Significance This study offers new insights into how sleep health changed in the general population following the COVID-19 pandemic. By analyzing trends across multiple dimensions of sleep, we found that behavioral aspects improved early while subjective satisfaction remained low, likely reflecting ongoing psychosocial stress. The slower improvement observed among socioeconomically disadvantaged groups illustrates the influence of structural inequities on sleep outcomes. These findings highlight the need to integrate sleep health into public health response strategies and to design targeted interventions that address both behavioral and social determinants. Future work should explore targeted interventions and policies that promote equitable sleep health in the context of public health crises and their posterior transition periods.