Effect of vagus nerve stimulation (taVNS) on anxiety and sleep disturbances among elderly health care workers in the post COVID-19 pandemic

Abstract

BACKGROUND:

Healthcare workers (HCWs) have been significantly impacted by the pandemic. Elderly health care workers carry out a variety of duties at work and have years of clinical expertise. Anxiety and insomnia are among the more commonly encountered problems in senior physicians and other geriatric medical professional populations.

OBJECTIVE:

The study aims to determine the effect of vagal nerve stimulation on anxiety and sleep disturbances among geriatric medical professionals.

METHODS:

42 participants were enrolled in this study based on the inclusion and exclusion criteria. The participants were divided into two groups using the closed envelope approach, and they took part in therapy sessions lasting 30 minutes, three times per week for a period of four weeks. The Experimental group A received non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) and Control group A received Jacobson’s progressive muscle relaxation technique.

RESULTS:

With a p value of 0.001, taVNS stimulation significantly improved sleep quality and reduced anxiety after 4 weeks. The post-intervention assessment revealed a highly significant improvement in Group A, with a T value of 251 (p < 0.001).

CONCLUSION:

The findings suggest that taVNS may be an effective intervention for addressing anxiety and sleep issues in geriatric medical professionals. These results contribute to the exploration of non-invasive strategies to enhance the well-being of healthcare professionals working in demanding environments.

Keywords

Generalized Anxiety Disorder insomnia elderly health care workers post COVID-19 pandemic

1 Introduction

A severe and highly contagious variant of the condition known as acute respiratory syndrome is coronavirus illness (sars-coV-2). Clinical research has shown that the death rate from COVID-19 can increase by 20 times for every small increase in overtime exposure to a certain type of COVID variant [1]. Patients with COVID-19 often have increased serum levels, lower baseline red blood cells values, greater WBC and neutrophil counts, and lower lymphocytic and inflammatory counts [2]. People in the pandemic zones may have experienced a significant increase in anxiety as a result of COVID-19 as a stressor. Higher frequency of advised protective measures, higher perceived infection risk, and a higher chance of coming into contact with COVID-19 during the present outbreak are all COVID-19-related factors [3]. The COVID-19 pandemic poses a hazard to public mental health because of the rise in and prolonged emotions of anxiety and unease, loneliness and sadness, and the disruption of social and economic systems. In the early phases of this pandemic, depression and post-traumatic stress disorder (PTSD) symptoms are common among the general public, according to recent study from throughout the world [4]. Persistent anxiety and uncontrollable worry that lasts for at least six months is a sign of generalised anxiety disorder. This disorder is frequently linked to depression, substance misuse, physical health issues, and/or all of these [5]. Infectious disease outbreaks and control efforts are linked to severe psychological discomfort and other serious symptoms, such as poor sleep quality. Sleep becomes crucial in the face of the COVID-19 pandemic due to its many advantages for both physical and mental health. Lack of sleep might affect one’s ability to think clearly and make decisions [6]. It is widely acknowledged that healthcare workers experience higher levels of occupational mental health conditions and stress than the general population. Doctors coping with such situations in the future will benefit from understanding the particular difficulties faced by senior physicians and developing support techniques. Increased loads of work, overtime, and the emotional strain of caring for ill and dying patients are all associated with poor mental health outcomes in Health Care Workers (HCW). Senior physicians perform a variety of professional tasks (as leaders, instructors, and clinicians), have additional personal and family obligations, and have a wealth of clinical expertise. They are particularly positioned to expand our understanding of the pandemic’s effects given their background and experiences as leaders and physicians [7]. In addition to suffering personally, nurses who are depressed may also affect their coworkers and, maybe, the standard of care they deliver. In addition to suffering personally, nurses who are depressed may also affect their coworkers and, maybe, the standard of care they deliver [8]. Additionally, among healthcare professionals, those on the front lines who deal with these patients directly are more at risk than others [9]. The case fatality rate rises with age, and the COVID-19 pandemic is having a disproportionately greater impact on older persons. Beyond this, the senior population is suffering from isolation, a lack of essential services, and a stressed-out health care system. In addition to the exacerbated physical and mental health issues, these are also contributing to psychosocial and interpersonal problems. It is likely that during the pandemic, older people’s needs are being overlooked [10]. While the COVID-19 issue has forced all healthcare workers to carry heavier workloads and responsibilities, less has been spoken about how individuals who work in the geriatrics field are less frequently acknowledged as being severely affected by their potential burnout during the crisis [11]. Healthcare care workers (HCW) are crucial to the global effort to combat the COVID-19 pandemic. Since the beginning of the COVID-19 outbreak, worries about getting infected with the corona virus, worrying about infecting loved ones, having trouble getting personal protective equipment, waiting for test results, running out of certain medications, feeling under supported, and making snap decisions with scant information have increased. A sufficient number of doctors, nurses, chemists, and physical therapists who are capable of caring for a large number of patients are needed to maintain an adequate healthcare workforce during this pandemic [12]. Due to a lack of personal protective equipment, medical staff in general hospitals and other departments away from the front line may be at a significant risk of infection [13]. Poor sleep quality is thought to affect between 9 and 45% of the general population. Generally speaking, studies of healthcare professionals have shown that roughly 50% of doctors experience bad sleep. Healthcare workers frequently work shifts, deal with illness, suffering, and death, and are under a lot of stress, all of which can have a negative effect on sleep [14]. For medical workers anywhere in the world, the nature of care and the changing working arrangements owing to the pandemic could be quite stressful. In general, nurses decide to become nurses because they want to help others heal and maintain their best health. However, the condition we are in right now may leave very few options for those who become very ill as a result of COVID-19, particularly institutionalised seniors [15]. According to research, insomnia may be one of the main symptoms of Generalized Anxiety Disorder (GAD), especially in the working population [16, 17]. In order to treat anxiety disorders, it is necessary to use psychotherapy, medication, or a combination of the two. The treatment with the highest degree of evidence is cognitive behavioural therapy. Inhibitors of selective serotonin reuptake and inhibitors of the reuptake of serotonin are first-line medications [18]. The vagus nerve serves as a vital bridge between the central nervous system (CNS) circuits and the brain stem’s autonomic control circuitry, providing a vast afferent and efferent network of innervation for the viscera [19]. Epilepsy, depression, and, more recently, the use of vagus nerve stimulation as an adjuvant in post-stroke rehabilitation training are all conditions for which it is licenced. In preclinical models, Vagal nerve stimulation (VNS) has the potential to improve the consolidation of extinction memories while also lowering anxiety [20].Vagal nerve stimulation (VNS) has been shown in several trials to be effective in treating anxiety and drug-resistant anxiety through a number of patho physiological mechanisms [21]. Additionally, there are studies that back up the effectiveness of non-invasive neuromodulator (nVNS) methods like transcutaneous auricular vagus nerve stimulation (taVNS), which has been demonstrated to lessen anxiety symptoms in people with a primary diagnosis of severe depression [22] but has not yet been researched as a treatment for primary GAD associated with the COVID-19 pandemic in elderly medical workers. Since there are no studies that concentrate on the quality of sleep and take anxiety into account in this relationship among the working elderly community, it will make medical professionals’ lifestyles safer, healthier, and more productive while also enhancing their physical and emotional well-being. In order to determine the effectiveness of vagal nerve stimulation in reducing nervousness and sleep disorders among elderly medical professionals during the COVID-19 pandemic, we initiated this research.

2 Method

2.1 Study design and setting

Between November 2021 and May 2023, an experimental investigation was conducted as a component of a research project within the private hospital in south part of India. The aim was to assess the potential effect of vagal nerve stimulation on sleep quality and anxiety levels among elderly health care workers.

2.2 Participants and selection criteria

The elderly health care workers employed in suburban hospitals in the southern part of India as its participants. A broad invitation was extended to elderly health care workers within the hospitals and with their consent; they became part of the research. As per the inclusion criteria, individuals aged 60 and above, who exhibited symptoms of anxiety based on the GAD and reported sleep-related issues using the Epworth Sleepiness Scale (ESS), were considered eligible for the study. Those who had no prior history of psychiatric conditions, showed no signs of anxiety or sleep disturbances, or had lost interest in participating were excluded from the study. Consequently, a total of 42 participants were enrolled in this research initiative. All 42 participants were duly informed about the study’s objectives, and their informed consent was obtained. To ensure randomization, these participants were then divided into two groups, each consisting of 21 individuals, using the closed envelope method and the assessor who assed the GAD and ESS was blinded.

2.3 Procedure

The Group A-taVNS therapy group (Experimental), treated with non-invasive transcutaneous electrical nerve stimulation of the auricular branch of left vagus nerve (taVNS) over the cymba, concha, tragus of ear. All participants received weekly 4 session of stimulation for a period of 4 weeks. Each session of stimulation lasted up to 30 minutes and the taVNS parameter used to treat will be (frequency 20 Hz and pulse width 80μs).

On the other hand Group B-Progressive muscle relaxation therapy group (Control), treated with Jacobson’s progressive relaxation technique 4 days per week for a period of 4 weeks. Each session will last 20–30 minutes.

To gauge the effectiveness of the treatments, the researchers utilized the GAD 7 and the ESS as outcome measures, both before and after the intervention. The data collected from these assessments were organized into tables and subjected to thorough statistical analysis.

2.4 Outcome measures

2.4.1 GAD

The GAD-7’s seven items have a total score that can range from 0 to 21. 0–4 represents very little anxiety, 5–9 represents mild anxiety, 10–14 represents moderate anxiety, and 15–21 represents severe anxiety.

2.4.2 ESS

The ESS has eight rating items. The possible total scores are 0 to 24, inclusive. The following is an interpretation of scores: Lower levels of normal daytime sleepiness range from 0 to 5, normal daytime sleepiness from 6 to 10, mild to moderate levels of excessive daytime symptoms from 13 to 15, and severe levels from 16 to 24. In this study, the co-investigators who evaluated the GAD and ESS were blinded.

2.5 Data analysis

A statistical analysis was conducted to address anxiety and sleep disorders in elderly health care workers. The study recorded pre- and post-test values for the GAD and ESS. Within-group analysis was performed using the Wilcoxon signed rank test, while between-group analysis was carried out using the Mann-Whitney U test, with a significance level set at p < 0.001.

3 Results

In this study, we examined how transcutaneous auricular vagal nerve stimulation (taVNS) affected anxiety and sleep disorders in elderly health care workers. No dropouts in either group till the completion of study. Group A-taVNS therapy group (Experimental) had an average age of 62.23 years (±2.90 SD), with 10 male participants and 11 female participants. In contrast, Group B-Progressive muscle relaxation therapy group (Control) had an average age of 61.27 years (±2.72 SD), with 12 male participants and 9 female participants (Table 1).

Table 1
Baseline characteristics of population included

Characteristics Group A Group B

Age (mean±SD) 62.23±2.90 61.27±2.72

No. of. males 10 12

No. of. females 11 9

GAD 15.6±1.58 15.19±2.87

ESS 19.6±2.31 19.1±2.93

Characteristics	Group A	Group B
Age (mean±SD)	62.23±2.90	61.27±2.72
No. of. males	10	12
No. of. females	11	9
GAD	15.6±1.58	15.19±2.87
ESS	19.6±2.31	19.1±2.93

The initial measurements for GAD scores were 15.6 (±1.58) for Group A-taVNS therapy group (Experimental) and 15.19 (±2.87) for Group B-Progressive muscle relaxation therapy group (Control). For ESS scores, Group A-taVNS therapy group (Experimental) had an initial score of 19.6 (±2.31), while Group B-Progressive muscle relaxation therapy group(Control) had an initial score of 19.1 (±2.93).

In the Group A-taVNS therapy group (Experimental), the pre-test had a mean GAD score of 13 with a standard deviation (SD) of 15.0. The Wilcoxon signed rank test yielded a W value of –231 and a Z value of –4.031, indicating a statistically significant difference (p < 0.001) in GAD (Table 2). Also the ESS values showed the pre-test had a mean score of 18 with a standard deviation (SD) of 19.5. The Wilcoxon signed rank test yielded a W value of –231 and a Z value of –4.059, indicating a statistically significant difference (p < 0.001) in ESS (Table 4).

Table 2

Pre- and post-test values of Group A-taVNS therapy group (Experimental) obtained using GAD

Test	Mean	SD	W value	Z value	P value
Pre-test	13	15	–231	–4.031	< 0.001
Post-test	8	10.0

Comparison of pre- and post-test values of Group A-taVNS therapy group (Experimental) obtained using GAD, reduction of anxiety symptoms by transcutaneous vagal nerve stimulation.

Table 3

Pre- and post-test values of Group B-Progressive muscle relaxation therapy group (Control) obtained using GAD

Test	Mean	SD	W value	Z value	P value
Pre-test	8	10	188	3.801	< 0.001
Post-test	12.0	14.0

Group B (control group) also showed a considerable improvement in reducing anxiety symptoms, revealing a Z value of 3.801 and W = 153.

Table 4

Pre- and post-test measurements of Group A-taVNS therapy group (Experimental) obtained using ESS, indicating the improvement in sleep quality

Test	Mean	SD	W value	Z value	P value
Pre-test	18	19.5	–231	–4.059	< 0.001
Post-test	12	13.0

In the Group B-Progressive muscle relaxation therapy (Control), the pre-test had a mean GAD score of 8 with a standard deviation (SD) of 10.0. The Wilcoxon signed rank test yielded a W value of 188 and a Z value of 3.801, indicating a statistically significant difference (p < 0.001) in GAD (Table 3). Similarly the ESS values revealed the pre-test had a mean score of 20 with a standard deviation (SD) of 21.5. The Wilcoxon signed rank test yielded a W value of –171 and a Z value of –3.841, indicating a statistically significant difference (p < 0.001) in ESS (Table 5).

Table 5

Pre- and post-test measurements of Group B-Progressive muscle relaxation therapy group (Control) obtained using ESS

Test	Mean	SD	W value	Z value	P value
Pre-test	20	21.5	–171	–3.841	< 0.001
Post-test	18	20.0

In the post test analysis of GAD between the groups, Group A-taVNS therapy group (Experimental) had a mean value of 8.0 with a standard deviation of 10.0. Group B-Progressive muscle relaxation therapy group(Control), on the other hand, had a mean value of 12.0 with a standard deviation of 14.0, and the T value was 269, indicating a highly significant difference (p < 0.001). Whereas in ESS, Group A-taVNS therapy group (Experimental) had a mean value of 12.0 with a standard deviation of 13.0 and Group B-Progressive muscle relaxation therapy group (Control) had a mean value of 18.0 with a standard deviation of 20.0. The T value was 251, indicating a highly significant difference (p < 0.001) (Tables 6 and 7).

Table 6

Post-test measurements of both Group A-taVNS therapy group (Experimental) and Group B-Progressive muscle relaxation therapy group (Control) obtained using GAD, indicating the difference in improvement of reducing anxiety

Group	Mean	SD	T value	p value
Group A	8.0	10	269	< 0.001
Group B	12	14.0

Table 7

Post-test measurements of both Group A-taVNS therapy group (Experimental) and Group B-Progressive muscle relaxation therapy group (Control) obtained using ESS,indicating the difference in improvement of sleep quality

Group	Mean	SD	T value	P value
Group A	12.0	13	251	< 0.001
Group B	18.0	20.0

Even though both groups improved, taVNS had a more notable impact on anxiety and sleep problems among older medical professionals than conventional therapy over the course of the 4-week programme. The Mann-Whitney U test was used to examine the post-test results and revealed a statistical significance of 0.001.

4 Discussion

This study describes a non-invasive technique for vagus nerve stimulation (taVNS) that reduces nervousness and sleep problems in a group of elderly medical professionals. The COVID-19 outbreak has had serious impacts; therefore, doctors and nurses need to change how they interact with patients. Hospital patients have greatly benefited from the assistance provided by medical personnel. Senior physicians made up a distinctive community with knowledge of healthcare system workflow and policies. As hospital administrators and clinicians, they offered crucial insights on psychosocial pressures connected to work-related concerns as well as on larger societal issues from the perspective of community members. Senior doctors expressed concerns about how the COVID-19 pandemic may affect the standard of patient care. Elderly health care workers may have physical and mental health problems that are made worse by social isolation, excessive social media use, and loneliness. Among people, the inability to fall asleep and stay asleep is a common concern.

In 2022, Doherty et al. conducted a study and he stated that senior doctors’ reports provide evidence of the pandemic’s wide-ranging effects on individuals and workplaces, which exacerbate mental health. Similar to this, a recent study of senior specialist doctors in Ireland found that 77% of them had experienced burnout and that the COVID-19 pandemic had negatively impacted their mental health in 64% of cases [23].

In 2020, Uzma Urooj et al. conducted a study and he concluded that the survey was completed by 1257 out of the 1830 people who were contacted, for a participation rate of 68.7 percent; 76.7 percent of the population were women, and 64.7% were between the ages of 26 and 40. Sixty-eight percent of participants were nurses, and forty-two percent were doctors. A sizable majority of participants (50.4%), anxiety (44.6%), sleeplessness (34.0%), and distress (71.5%) symptoms were recorded [24].

In 2021, Dogru-Huzmeli et al. conducted a studyand he claims that considerable levels of anxiety and burnout were reported by both the frontline healthcare workers on COVID-19 and those who worked on the normal ward. According to COVID-19, frontline healthcare professionals experienced higher levels of anxiety and fatigue. The feeling of being exhausted led to tiredness and a loss of motivation at work. Support for medical workers was viewed as vital for preserving their mental health [25].

In 2020, Nishi Suryavanshi et al. conducted a study and he concluded that there were high rates of anxiety and sadness among young, single Health Care Professions (HCP) caring for COVID-19 patients in severely affected areas of India. Additionally, we discovered that HCPs’ general quality of life during the COVID pandemic was significantly impacted by moderate to severe despair and anxiety. The frontline HCPs’ mental health must be protected if COVID-19 response and control activities are to be successful [26]. In 2008, A pilot trial on vagus nerve stimulation for treatment-resistant anxiety disorder was conducted by Mark S. George and colleagues. The authors stated that patients with treatment-resistant anxiety disorders generally tolerated VNS treatment, and there was evidence of acute and long-term improvement in some patients [27]. In 2022, Tanushree Shivaswamy et al. conducted a study on ‘Vagus Nerve Stimulation as a Treatment for Fear and Anxiety in Individuals with Autism Spectrum Disorder. He stated that for ASD patients who have significant anxiety and for those who already have an implant for epilepsy or depression, vagus nerve stimulation may be a desirable complement to exposure-based therapy [28]. In 2014, Hofmann et al. conducted a study on ‘Cognitive Enhancers for the Treatment of Anxiety Disorders. He stated that cognitive behavioural therapy and anxiolytic drugs are common treatments for anxiety conditions. Even though these treatments are more successful than placebos, there is still much room for advancement [29]. These are the anxiety and sleep disorder treatments that are now accessible. Finally, we started looking at the benefits of vagal nerve stimulation for lowering anxiety and sleep disorders. The majority of the research included invasive techniques. In order to find out whether transcutaneous vagus nerve stimulation at the auricular concha is effective for treating insomnia, Yue Jiao et al. undertook a randomised clinical trial in 2020. This study evaluated the efficacy and security of ta-VNS for patients who reported sleeplessness. They found that ta-VNS effectively reduced insomnia over the course of a 4-week treatment period. He also came to the conclusion that there were no discernible differences in the reduction of anxiety, sadness, and sleeplessness, as well as the improvement of QOL, between the ta-VNS group and the tn-VNS group. The electrodes that are attached to the concha and scapha of the auricle, on the other hand, may be the most likely suspect [30]. In the view of exploring the effect of non-invasive vagal nerve stimulation on reducing nervousness and sleep, this study was conducted with 42 participants, of whom 21 underwent taVNS for 30 minutes. The taVNS parameters used were frequency (20 Hz) and pulse width (80 s). With the above-mentioned method of application, the study revealed a significant effect in reducing anxiety and sleep disturbances among the elderly health care workers. The patient also received the Jacobson relaxation techniques for the control group. Thus, this study has ended up concluding that the non-invasive method of vagal Nerve stimulation is more reliable and safe than the invasive method, and it has a greater significance in reducing anxiety and sleep disorders among elderly health care workers. The experiences shared by senior medical professionals show the pandemic’s wide-ranging effects on individuals and the workplace, which have a negative impact on mental health. Since Anxiety and sleep disturbances are most common in the COVID-19 pandemic for elderly health care workers, further studies can be carried out on the patients with anxiety-associated sleep disturbances with more samples.

4.1 Limitations and suggestions

Since this project is self-funded, we did not do any quantitative analysis, such as a parametric test; instead, we simply used scales to analyse the data and included senior doctors and nurses as the population of study participants. The COVID-19 pandemic has significantly impacted elderly health care workers, as this report details. It’s critical to detect the hazards of mental health conditions like insomnia, anxiety, and uneasiness in health care workers working in both public and private hospitals. The results also raise serious concerns regarding the availability and standard of patient care as well as the growing gender disparity in the workplace, therefore more research is required to determine the implications of the COVID-19 pandemic on senior doctors’ mental health. Most importantly, our research enables senior physicians and nurses to overcome anxiety and sleep issues. It is crucial to use tactics that lessen the stigma associated with mental illness and provide wellness support for all health care workers. Other psychological issues faced by other medical professionals should be addressed. The future viability of the healthcare system depends on the health and welfare of the workforce. The population will be studied more closely in the future so that we can determine the prevalence of anxiety and sleep disorders among the general population.

5 Conclusion

taVNS plays a significant role in reducing anxiety and sleep disturbances by providing a significant improvement with the application of taVNS for 4 weeks. In summary, the results indicate that the taVNS treatment in Group A-taVNS therapy group (Experimental) led to a significant improvement in the measured outcome, while Group B-Progressive muscle relaxation therapy group (Control) showed a change in means that requires further investigation. These findings suggest that taVNS may be a promising intervention for addressing anxiety and sleep-related issues among elderly health care workers, but further research is necessary to confirm and better understand these effects.

Ethical considerations

By adhering to all relevant rules and regulations this human population study intervention proposal received approval from the Institutional Ethics committee of Saveetha Medical College & Hospital with the approval number 004/06/2021/IEC/SMCH. The study followed the ethical prospects according to the Declaration of Helsinki 1964.

Informed consent

Participants from the private hospital were selected following a comprehensive explanation of the procedure. The intervention protocols were explained in detail to the participants in their native language and a detailed Information sheet was given to the participants who volunteered for this study. The written Informed consent was obtained and the documents were confidentially maintained.

Reporting guidelines

The EQUATOR Network for Reporting Guidelines-CONSORT statement for reporting randomised trials was followed for reporting the current study.

Footnotes

Acknowledgment

The authors would like to express their sincere gratitude to the individuals who took part in the study, the authors whose works are referenced and cited in our paper, and the authors of the GAD and ESS scales.

Conflict of interest

The authors report no conflict of interest with regards to this study.

Funding

No specific funding was received for this work. It has been carried out for the benefit of the society to bring significant importance on this intervention.

References

Cascella

, Rajnik

, Aleem

, Dulebohn

, Di Napoli

Features, evaluation, and treatment of coronavirus (COVID-19). Statpearls [internet]. 2022, Feb. 5.

Ciotti

, Ciccozzi

, Terrinoni

, Jiang

, Wang

, Bernardini

. The COVID-19 pandemic. Critical Reviews in Clinical Laboratory Sciences. 2020;57(6):365–88.

Malesza

, Kaczmarek

. Predictors of anxiety during the COVID-19 pandemic in Poland. Personality and Individual Differences. 2021;170, 110419.

Hyland

, Shevlin

, McBride

, Murphy

, Karatzias

, Bentall

, Martinez

, Vallières

. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. ActaPsychiatricaScandinavica. 2020;142(3):249–56.

Stein

, Sareen

. Generalised anxiety disorder. New England Journal of Medicine. 2015;373(21):2059–68.

Jahrami

, BaHammam

, Bragazzi

, Saif

, Faris

, Vitiello

. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. Journal of Clinical Sleep Medicine. 2021;17(2):299–313.

Tran

, Willis

, Kay

, Hutt

, Smallwood

. The workplace and psychosocial experiences of Australian senior doctors during the COVID-19 pandemic: a qualitative study. International Journal of Environmental Research and Public Health. 2022;19(5):3079.

Letvak

, Ruhm

, McCoy

. Depression in hospital-employed nurses. Clinical Nurse Specialist. . 2012;26(3):177–82.

Spoorthy

, Pratapa

, Mahant

. Mental health problems faced by healthcare workers due to the COVID-19 pandemic: a review. Asian Journal of Psychiatry. 2020;51, 102119.

10.

Girdhar

, Srivastava

, Sethi

. Managing mental health issues among the elderly during the COVID-19 pandemic. Journal of Geriatric Care and Research. 2020;7(1):32–5.

11.

El Haj

, Allain

, Annweiler

, Boutoleau-Bretonnière

, Chapelet

, Gallouj

, Kapogiannis

, Roche

, Boudoukha

. High exhaustion in geriatric healthcare professionals during the COVID-19 second lockdown. Journal of Alzheimer’s Disease. 2021;83(4):1841–8.

12.

Uyarolu

, Basaran

, Ozisik

, Karahan

, Tanriover

, Guven

, Oz

. Evaluation of the effect of the COVID-19 pandemic onthe anxiety severity of physicians working in the internal medicinedepartment of a tertiary care hospital: a cross-sectional survey. Internal Medicine Journal. 2020;50(11):1350–8.

13.

Ning

, Yu

, Huang

, Li

, Luo

, Huang

, Chen

. The mental health of neurological doctors and nurses in Hunan Province, China, during the initial stages of the COVID-19 outbreak. BMC Psychiatry. 2020;20(1):1–9.

14.

Jahrami

, BaHammam

, AlGahtani

, Ebrahim

, Faris

, AlEid

, Saif

, Haji

, Dhahi

, Marzooq

, Hubail

. The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19. Sleep and Breathing. 2021;25:503–11.

15.

C , Pérez

, de Lorena

, Hermosilla-Grijalbo

, Sáenz-Jalón

, Fernández-Rodrguez

, Alconero-Camarero

. Experiences of geriatric nurses in nursing home settings acrossfour countries in the face of the COVID-19 pandemic. Journal ofAdvanced Nursing. 2021;77(2):869–78.

16.

Johnson

, Roth

, Breslau

. The association of insomnia withanxiety disorders and depression: exploration of the direction ofrisk. J Psychiatr Res.. 2006;40(8):700–8. doi: 10.1016/j.jpsychires.2006.07.008. Epub 2006 Sep 15. PMID: 16978649

17.

Staner

. Sleep and anxiety disorders. Dialogues ClinNeurosci.. 2003;5(3):249–58. doi: 10.31887/DCNS.2003.5.3/lstaner. PMID:22033804; PMCID: PMC3181635

18.

Teker

, Luleci

. Sleep quality and anxiety level in employees. North Clin. Istanb. 2018;5(1):31–36. doi: 10.14744/nci.2017.58855. PMID: 29607429; PMCID: PMC5864704

19.

Bandelow

, Michaelis

, Wedekind

Treatment of anxiety disorders. Dialogues in clinical neuroscience 2022, April 1.

20.

Johnsonlson

. A review of vagus nerve stimulation as a therapeuticintervention. Journal of Inflammation Research. 2018;16:203–13.

21.

Shivaswamy

, Souza

, Engineer

, McIntyre

. Vagus nervestimulation as a treatment for fear and anxiety in individuals withautism spectrum disorder. Journal of Psychiatry and Brain Science. 2022;7(4).

22.

Bell

Va gus Nerve Stimulation and Anxiety iUniverse; 2010 Aug 5.

23.

Trevizol

, Shiozawa

, Taiar

, Soares

, Gomes

, Barros

, Liquidato

, Cordeiro

. Transcutaneous vagus nerve stimulation(taVNS) for major depressive disorder: an open labelproof-of-concept trial. Brain Stimulation. 2016;9(3):453–4.

24.

Doherty

, Colleran

, Durcan

, Irvine

, Barrett

A pilot study of burnout and long-term COVID in senior specialist doctors. Irish Journal of Medical Science (1971-) 2021 Mar 13:1-5.

25.

Urooj

, Ansari

, Siraj

, Khan

, Tariq

. Expectations,fears, and perceptions of doctors during the COVID-19 pandemic. Pakistan Journal of Medical Sciences. 2020May;36(COVID19-S4):S37.

26.

Dogru-Huzmeli , Esra et al. ‘Burnout and Anxiety Level of Healthcare Professionals During the COVID-19 Pandemic in Turkey’. 1 Jan. 2021:21-29.

27.

Suryavanshi

, Kadam

, Dhumal

, Nimkar

, Mave

, Gupta

, Cox

, Gupte

. Mental health and quality of life among healthcareprofessionals during the COVID-19 pandemic in India. Brain andBehaviour. 2020;10(11):e01837.

28.

George

, Ward

Jr. , Ninan

, Pollack

, Nahas

, Anderson

, Kose

, Howland

, Goodman

, Ballenger

. A pilot study of vagusnerve stimulation (VNS) for treatment-resistant anxiety disorders. Brain Stimulation. 2008;1(2):112–21.

29.

Shivaswamy

, Souza

, Engineer

, McIntyre

. Vagus nervestimulation as a treatment for fear and anxiety in individuals withautism spectrum disorder. Journal of Psychiatry and Brain Science. 2022;7(4).

30.

Hofmann , Stefan

, Fang , Angela , Gutner , Cassidy

‘CognitiveEnhancers for the Treatment of Anxiety Disorders’. 1 Jan. 2014:183-195.

31.

Jiao

, Guo

, Luo

, Li

, Liu

, Zhao

, Wang

, Li

, Zheng

, Wu

, Rong

Effect of Transcutaneous Vagus Nerve Stimulation at Auricular Concha for Insomnia: A Randomised Clinical Trial Evid Based Complement Alternat Med. 2020;2020:6049891. doi: 10.1155/2020/6049891. Erratum in: Evid Based Complement Alternat Med. 2020 Nov 22;2020:2536573. PMID: 32831871; PMCID: PMC7429019.

Effect of vagus nerve stimulation (taVNS) on anxiety and sleep disturbances among elderly health care workers in the post COVID-19 pandemic

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1 Introduction

2 Method

2.1 Study design and setting

2.2 Participants and selection criteria

2.3 Procedure

2.4 Outcome measures

2.4.1 GAD

2.4.2 ESS

2.5 Data analysis

3 Results

Table 1 Baseline characteristics of population included Characteristics Group A Group B Age (mean±SD) 62.23±2.90 61.27±2.72 No. of. males 10 12 No. of. females 11 9 GAD 15.6±1.58 15.19±2.87 ESS 19.6±2.31 19.1±2.93

4.1 Limitations and suggestions

5 Conclusion

Ethical considerations

Informed consent

Reporting guidelines

Footnotes

Acknowledgment

Conflict of interest

Funding

References

Table 1
Baseline characteristics of population included

Characteristics Group A Group B

Age (mean±SD) 62.23±2.90 61.27±2.72

No. of. males 10 12

No. of. females 11 9

GAD 15.6±1.58 15.19±2.87

ESS 19.6±2.31 19.1±2.93