Poor sleep quality, insomnia, and short sleep duration before infection predict long-term symptoms after COVID-19

Abstract

Study objectives: Millions of COVID-19 survivors experience a wide range of long-term symptoms after acute infection, giving rise to serious public health concerns. To date, few risk factors for post-COVID-19 conditions have been determined. This study evaluated the role of pre-infection sleep quality/duration and insomnia severity in the incidence of long-term symptoms after COVID-19. Methods: This prospective study involved two assessments (April 2020 and 2022). At baseline, sleep quality/duration and insomnia symptoms in participants without current/prior SARS-CoV-2 infection were measured using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). At follow-up, we evaluated the presence of twenty-one symptoms (psychiatric, neurological, cognitive, bodily, and respiratory) one month (n=713, infection in April 2020-February 2022) and three months after COVID-19 (n=333, infection in April 2020-December 2021). Zero-inflated negative binomial models were used to estimate the effect of previous sleep on the number of long-term symptoms. Binomial logistic regressions were performed to evaluate the association between sleep outcomes and the incidence of each post-COVID-19 symptom. Results: Analyses highlighted a significant effect of pre-infection sleep on the number of symptoms one/three months after COVID-19. Previous higher PSQI and ISI scores, and shorter sleep duration significantly increased the risk of almost every long-term symptom at one/three months from COVID-19. Conclusion: This study suggested a prospective dose-dependent association between pre-infection sleep quality/quantity and insomnia severity with the manifestation of post-COVID-19 symptoms. Promoting sleep health may represent an effective preventive approach to mitigate the COVID-19 sequelae, with substantial public health and societal implications.

Bidirectional relationship between sleep problems and long COVID: a longitudinal analysis of data from the COVIDENCE UK study

“…33 Our sleep quality measure combined the effects of both sleep efficiency and sleep duration, but exploratory analyses suggested that low and inconsistent sleep efficiency—which can reflect a range of sleep disturbances, such as increased sleep latency and fragmented sleep—was driving the relationship observed. This is in line with other studies, which have found increased risk of long COVID associated with pre-infection sleep disturbances, 9–11 whereas results on sleep duration are inconsistent 9,10 and do not always consider the simultaneous effect of sleep efficiency. 35 Together, these findings suggest short sleep duration, on its own, is unlikely to substantially increase the risk of long COVID; instead, the focus should be on ensuring consistently good-quality sleep to aid recovery from future infections.…”

“…Our use of prospectively collected, pre-infection sleep data strengthens our estimates of pre-infection sleep; most studies to date have relied on retrospectively reported pre-infection sleep data, 3,32,35,37,38 and research has shown that people asked to retrospectively recall their sleep before the pandemic estimated that they slept much better than they actually did. 6 Our extended follow-up enabled us to capture long COVID symptoms presenting at any point after infection, and to record sleep duration over the entire year after infection, in contrast with other studies that have relied on a cross-sectional approach, 32,37 infrequent assessments, 10 or shorter follow-up. 38 Monthly responses from our participants meant that we were able to track changes in sleep duration with detail that would have been missed if observations had been further apart, while simultaneously allowing us to adjust for time-varying factors that may affect people's sleep habits-particularly in the context of a pandemic that limited people's movement and employment.…”

“…8 Sleep quality has also been implicated in the development of long COVID among those infected, with studies finding a wide range of sleeprelated measures such as sleep quality, sleep duration, and pre-existing sleep disorders predicting the development of long COVID. [9][10][11][12] This research, however, is still in its infancy, with studies presenting conflicting findings on the associations with different sleep measures; 9,10 heterogeneity between study definitions of long COVID, ranging between symptoms lasting 4 weeks 9 and 6 months; 11 and reliance on retrospectively reported pre-infection sleep data. 11 More research is therefore needed to build our understanding of this relationship.…”

Sleep Quality mediates the association between Tea Consumption and Duration of COVID-19-related Symptoms in the Elderly

“…Lower sleep quality, more severe insomnia, and shorter sleep duration 1 to 3 months post-COVID-19 are associated with higher odds of developing a wide range of clinical manifestations. Our findings suggest that the impact of sleep loss on vaccination effectiveness may mediate the link between sleep and post-COVID-19 symptoms[11]. Moreover, studies have reported the efficacy of various tea ingredients in blocking COVID-19 infection[28].…”

Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions

“…Additionally, our results related to poor sleep quality are supported by data from the aforementioned Italian cohort study which showed that higher scores on the Pittsburgh Sleep Quality Index predicted a greater risk for developing symptoms associated with PASC. 25 Furthermore, in a study of 1,581 persons from the United Kingdom who were surveyed concerning their sleep quality one month before their COVID-19 infection, persons who reported average to very poor sleep quality were 2.4-3.5 times more likely to self-report having "Long COVID". 24 Our study extends these June 12, 2024 previous observations by using a more precise definition of poor sleep quality as well as a more formal definitions of PASC.…”