Pre‐existing sleep problems as a predictor of post‐acute sequelae of COVID‐19

Abstract

SummarySeveral months after COVID‐19 many individuals still report persisting symptoms, the so‐called ‘post‐COVID‐19 syndrome’. An immunological dysfunction is one of the main pathophysiological hypotheses. As sleep is central to the functioning of the immune system, we investigated whether self‐reported pre‐existing sleep disturbance might be an independent risk factor for the development of post‐COVID‐19 syndrome. A total of 11,710 participants of a cross‐sectional survey (all tested positive for severe acute respiratory syndrome coronavirus‐2) were classified into probable post‐COVID‐19 syndrome, an intermediate group, and unaffected participants at an average of 8.5 months after infection. The case definition was based on newly occurring symptoms of at least moderate severity and ≥20% reduction in health status and/or working capacity. Unadjusted and adjusted odds ratios were calculated to investigate the association between pre‐existing sleep disturbances and subsequent development of post‐COVID‐19 syndrome while controlling for a variety of demographic, lifestyle, and health factors. Pre‐existing sleep disturbances were found to be an independent predictor of subsequent probable post‐COVID‐19 syndrome (adjusted odds ratio 2.7, 95% confidence interval 2.27–3.24). Sleep disturbances as part of the post‐COVID‐19 syndrome were reported by more than half of the participants and appeared to be a new symptom and to occur independent of a mood disorder in most cases. Recognition of disturbed sleep as an important risk factor for post‐COVID‐19 syndrome should promote improved clinical management of sleep disorders in the context of COVID‐19. Further, it may stimulate further research on the effect of improving sleep on the prognosis of COVID‐19 long‐term sequelae and other post‐viral conditions.

Wearable Data Reveals distinct Characteristics of Individuals with Persistent Symptoms after a SARS-CoV-2 Infection

“…Specifically we find a mean difference of 0 • 6/0 • 58 in mean well-being score and a mean difference of 0 • 76/0 • 73 between P S and P C/NC individuals. This is in line with recent findings, where individuals reporting persistent symptoms also reported poorer mental health in comparison to a control group [40], as well as a study reporting disturbed sleep as an important risk factor for PCC [41].…”

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][10][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.…”

“…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.…”

“…[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.…”

Applying Lessons From Rheumatology to Better Understand Long COVID

“…In a report of 1,581 adults from the United Kingdom, poor-quality sleep in the month before initial SARS-CoV-2 infection increased the risk of long COVID (odds ratio [OR] 3.5), as did average sleep quality (OR 2.5) (19). In a similar study, pre-existing sleep disturbances were an independent predictor of subsequent probable post-COVID-19 syndrome (20). Sleep disturbances were reported by more than half of the participants, were usually a new symptom, and were independent of a mood disorder in most cases.…”