Fatigue, sleepiness and sleep quality are SARS-CoV-2 variant independent in patients with long COVID symptoms

Abstract

Acute infections with SARS-CoV-2 variants of concerns (VOCs) differ in clinical presentation. Discrepancies in their long-term sequelae, commonly referred to as long COVID, however, remain to be explored. We retrospectively analyzed data of 287 patients presented at the post-COVID care of the Pulmonology Department, Semmelweis University, Budapest, Hungary, and infected with SARS-CoV-2 during a period of 3 major epidemic waves in Hungary (February–July 2021, VOC: B.1.1.7, Alpha, N = 135; August–December 2021, VOC: B.1.617.2, Delta, N = 89; and January–June 2022, VOC: B.1.1.529, Omicron; N = 63), > 4 weeks after acute COVID-19. Overall, the ratio of long COVID symptomatic (LC) and asymptomatic (NS) patients was 2:1. Self-reported questionnaires on fatigue (Fatigue Severity Scale, FSS), sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) showed higher scores for LC (4.79 ± 0.12, 7.45 ± 0.33 and 7.46 ± 0.27, respectively) than NS patients (2.85 ± 0.16, 5.23 ± 0.32 and 4.26 ± 0.29, respectively; p < 0.05 for all vs. LC). By comparing data of the three waves, mean FSS and PSQI scores of LC patients, but not ESS scores, exceeded the normal range in all, with no significant inter-wave differences. Considering FSS ≥ 4 and PSQI > 5 cutoff values, LC patients commonly exhibited problematic fatigue (≥ 70%) and poor sleep quality (> 60%) in all three waves. Comparative analysis of PSQI component scores of LC patients identified no significant differences between the three waves. Our findings highlight the importance of concerted efforts to manage both fatigue and sleep disturbances in long COVID patient care. This multifaceted approach should be followed in all cases infected with either VOCs of SARS-CoV-2.

The Impact of Long COVID on Cognitive Performance and Sleep Quality: An Analysis of the Rancagua Chilean Study (RACHIS)

“…Long COVID patients commonly exhibit fatigue (61.3%), insomnia symptoms (49.6%), and excessive daytime sleepiness (35.8%), with compromised sleep quality [22]. Cognitive function in roughly 70% of patients with sleep disorders, including insomnia, hypersomnia, and daytime sleepiness, may be affected [23].…”

“…Cognitive function in roughly 70% of patients with sleep disorders, including insomnia, hypersomnia, and daytime sleepiness, may be affected [23]. The etiology is linked to neuroinflammation [4,22] and the potential involvement of immune mediators. Sleep deprivation exacerbates neuroinflammation by compromising the blood-brain barrier, facilitating the entry of viral antigens into the brain, and promoting inflammation [4,22].…”

“…The etiology is linked to neuroinflammation [4,22] and the potential involvement of immune mediators. Sleep deprivation exacerbates neuroinflammation by compromising the blood-brain barrier, facilitating the entry of viral antigens into the brain, and promoting inflammation [4,22]. However, it remains unclear whether inflammatory processes occur in brain regions associated with cognition and sleep, such as the prefrontal cortex or lateral hypothalamic area, post-COVID-19 diagnosis [22,23].…”

“…Sleep deprivation also heightens vulnerability to the virus by weakening the immune system [22]. The magnitude of sleep quality impairment seems consistent across different viral variants [22]. Sleep disorders are closely linked to the high prevalence of anxiety and depression [23].…”

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study

“…Additionally, several studies have highlighted the presence of uctuations and relapses in post-COVID-19 fatigue over time[48,70]. The interplay between fatigue and insomnia can create a vicious cycle, particularly among patients with long-term COVID[71]. Fatigue can contribute to increased sleep di culties, while insomnia can exacerbate feelings of fatigue and prolong recovery.…”