Studying the Effect of Long COVID-19 Infection on Sleep Quality Using Wearable Health Devices: Observational Study (Preprint)

Abstract

BACKGROUND Patients with COVID-19 have increased sleep disturbances and decreased sleep quality during and after the infection. The current published literature focuses mainly on qualitative analyses based on surveys and subjective measurements rather than quantitative data. OBJECTIVE In this paper, we assessed the long-term effects of COVID-19 through sleep patterns from continuous signals collected via wearable wristbands. METHODS Patients with a history of COVID-19 were compared to a control arm of individuals who never had COVID-19. Baseline demographics were collected for each subject. Linear correlations among the mean duration of each sleep phase and the mean daily biometrics were performed. The average duration for each subject’s total sleep time and sleep phases per night was calculated and compared between the 2 groups. RESULTS This study includes 122 patients with COVID-19 and 588 controls (N=710). Total sleep time was positively correlated with respiratory rate (RR) and oxygen saturation (SpO<sub>2</sub>). Increased awake sleep phase was correlated with increased heart rate, decreased RR, heart rate variability (HRV), and SpO<sub>2</sub>. Increased light sleep time was correlated with increased RR and SpO<sub>2</sub> in the group with COVID-19. Deep sleep duration was correlated with decreased heart rate as well as increased RR and SpO<sub>2</sub>. When comparing different sleep phases, patients with long COVID-19 had decreased light sleep (244, SD 67 vs 258, SD 67; <i>P</i>=.003) and decreased deep sleep time (123, SD 66 vs 128, SD 58; <i>P</i>=.02). CONCLUSIONS Regardless of the demographic background and symptom levels, patients with a history of COVID-19 infection demonstrated altered sleep architecture when compared to matched controls. The sleep of patients with COVID-19 was characterized by decreased total sleep and deep sleep.

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

“…This population-based study has several strengths. 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.…”

“…Wearable devices have been used to objectively record sleep duration, showing different results in community and hospitalised cohorts. At 6 months after infection, a cohort of mostly non-hospitalised participants had a mean sleep duration that was 17 minutes shorter than that of uninfected controls, 38 whereas hospitalised participants from the PHOSP cohort reported sleeping for an hour longer at 7 months after infection than a cohort of nonhospitalised controls. 3 Our findings may reflect a quicker recovery among less severe cases of COVID-19, as well as the benefit of comparing post-infection sleep duration with prospectively collected pre-infection sleep data; indeed, another study in the PHOSP cohort showed no difference in sleep duration at 8 months after discharge when compared with a different control cohort.…”

“…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.…”

A Review of Neurological Symptoms in Long COVID and Clinical Management

“…69 There is limited evidence at this time on the prevalence of primary sleep disorders in long COVID, but disruption in sleep architecture that may not meet criteria for a specific diagnosis may still have effects and can provide a focus for management strategies. 70 Seizures do not appear to be a frequent finding in long COVID, but electroencephalogram should be performed if concerning symptoms are present. 9 Lumbar puncture and cerebrospinal fluid (CSF) testing are likely not needed in most cases unless there is a concern for an alternative, treatable process.…”