Public health impact of poor sleep on COVID-19, influenza and upper respiratory infections

Jones, Samuel; Maisha, Fahrisa I.; Strausz, Satu; Cade, Brian E.; Tervi, Anniina; Helaakoski, Viola; Broberg, Martin; Lammi, Vilma; Lane, Jacqueline M.; Redline, Susan; Saxena, Richa; Ollila, Hanna

doi:10.1016/j.sleep.2022.05.369

Cited by 8 publications

(10 citation statements)

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“…19–21 Furthermore, the main findings were confirmed after controlling for the COVID-19 severity, which is an established predictor of long COVID conditions, 2,19,20,27 but also a documented outcome of previous sleep problems. 77,78 Third, the results were replicated in the same sample by using a different baseline assessment in December 2020. Finally, our findings were confirmed after controlling for the time elapsed from the baseline sleep assessment to the infection, suggesting a predictive role of sleep features even after several months.…”

Section: Discussionmentioning

confidence: 96%

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

Salfi

Amicucci

Corigliano

et al. 2023

Preprint

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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.

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Section: Discussionmentioning

confidence: 96%

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

Salfi

Amicucci

Corigliano

et al. 2023

Preprint

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“…Subjectively good sleep quality, on the other hand, protects young adults from respiratory infection risk in the case of sleep deprivation (Walsh et al, 2022). With respect to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections, it has been shown that poor or reduced sleep as well as sleep-wake rhythm disturbance due to shift work are associated with an increased risk of contracting COVID-19 (Jones et al, 2022;Loef et al, 2022;Peng et al, 2022) and with an increased risk of a severe disease course (Huang et al, 2020;Jones et al, 2022). Savard et al, 2003).…”

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confidence: 99%

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

Schilling

Nieters

Schredl

et al. 2023

Journal of Sleep Research

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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.

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“…Short sleep duration and sleep disturbances have been found to be associated with increased incidence of upper respiratory tract infections, including COVID-19, 8,30,31 as well as poorer outcomes from these infections. 8,31 Our longitudinal analysis extends these findings to show the bidirectional nature of the relationship between sleep and COVID-19 within the same cohort. A large cross-sectional study 32 of both community and hospitalised COVID-19 cases has previously shown a bidirectional relationship between insomnia and long COVID, reporting increased risk of long COVID among people with pre-pandemic insomnia and a higher prevalence of post-infection insomnia among people with long COVID.…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies in hospitalised people have been published; 5,39 as long COVID occurs across all severities of the initial disease, 1 it is important to assess its impact in the community as well as in those hospitalised. Fourth, as the severity of the acute infection may also be associated with pre-infection sleep, 8 including people with symptomatic COVID-19 in our reference group may have underestimated the impact of pre-infection sleep on long COVID risk. However, we had too few asymptomatic participants to exclude symptomatic participants from the reference group.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-existing sleep problems have been shown to increase the risk of upper respiratory infections, including influenza and SARS-CoV-2, as well as hospitalisation with COVID-19. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Vivaldi,

Talaei,

Blaikley

et al. 2024

Preprint

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Summary Background: Studies into the bidirectional relationship between sleep and long COVID have been limited by retrospective pre-infection sleep data and infrequent post-infection follow-up. We therefore used prospectively collected monthly data to evaluate how pre-infection sleep characteristics affect risk of long COVID, and to track changes in sleep duration during the year after SARS-CoV-2 infection. Methods: COVIDENCE UK is a prospective, population-based UK study of COVID-19 in adults. We included non-hospitalised participants with evidence of SARS-CoV-2 infection, and estimated odds ratios (ORs) for the association between pre-infection sleep characteristics and long COVID using logistic regression, adjusting for potential confounders. We assessed changes in sleep duration after infection using multilevel mixed models. We defined long COVID as unresolved symptoms at least 12 weeks after infection. We defined sleep quality according to age-dependent combinations of sleep duration and efficiency. COVIDENCE UK is registered with ClinicalTrials.gov,NCT04330599. Findings: We included 3994 participants in our long COVID risk analysis, of whom 327 (8.2%) reported long COVID. We found an inverse relationship between pre-infection sleep quality and risk of long COVID (medium vs good quality: OR 1.37[95% CI 1.04-1.81]; medium–low vs good: 1.55 [1.12-2.16]; low vs good: 1.94 [1.11–3.38]). Greater variability in pre-infection sleep efficiency was also associated with long COVID (OR per percentage-point increase 1.06 [1.01–1.11]). We assessed post-infection sleep duration in 6860 participants, observing a 0.11 h (95% CI 0.08–0.13) increase in the first month after infection compared with pre-infection, with larger increases for more severe infections. After 1 month, sleep duration largely returned to pre-infection levels, although fluctuations in duration lasted up to 6 months after infection among people reporting long COVID. Interpretation: Our findings highlight the bidirectional relationship between sleep and long COVID. While poor-quality sleep before SARS-CoV-2 infection associates with increased risk of long COVID thereafter, changes in sleep duration after infection in these non-hospitalised cases were modest and generally quick to resolve.

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Public health impact of poor sleep on COVID-19, influenza and upper respiratory infections

Cited by 8 publications

References 0 publications

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

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

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

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

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