The effects of sleep disturbance on dyspnoea and impaired lung function following COVID-19 hospitalisation: a prospective multi-centre cohort study

Abstract

Background Sleep disturbance is common following hospitalisation both for COVID-19 and other causes. The clinical associations are poorly understood, despite it altering pathophysiology in other scenarios. We, therefore, investigated whether sleep disturbance is associated with dyspnoea along with relevant mediation pathways. Methods Sleep parameters were assessed in a prospective cohort of patients (n=2,468) hospitalised for COVID-19 in the United Kingdom in 39 centres using both subjective and device-based measures. Results were compared to a matched UK biobank cohort and associations were evaluated using multivariable linear regression. Findings 64% (456/714) of participants reported poor sleep quality; 56% felt their sleep quality had deteriorated for at least 1-year following hospitalisation. Compared to the matched cohort, both sleep regularity (44.5 vs 59.2, p<0.001) and sleep efficiency (85.4% vs 88.5%, p<0.001) were lower whilst sleep period duration was longer (8.25h vs 7.32h, p<0.001). Overall sleep quality (effect estimate 4.2 (3.0-5.5)), deterioration in sleep quality following hospitalisation (effect estimate 3.2 (2.0-4.5)), and sleep regularity (effect estimate 5.9 (3.7-8.1)) were associated with both dyspnoea and impaired lung function (FEV1 and FVC). Depending on the sleep metric, anxiety mediated 13-42% of the effect of sleep disturbance on dyspnoea and muscle weakness mediated 29-43% of this effect. Interpretation Sleep disturbance is associated with dyspnoea, anxiety and muscle weakness following COVID-19 hospitalisation. It could have similar effects for other causes of hospitalisation where sleep disturbance is prevalent.

Impaired Sleep in Patients with Post-COVID-19 Syndrome Compared to Healthy Controls: A Cross-Sectional Trial

“…Patients with newly diagnosed sleep apnoea have been shown to be at higher risk to develop a lower respiratory tract infection [16]. Further, sleep disturbances are discussed as a potential cause of impaired lung function (FVC) and dyspnoea in PCS [5], which might have contributed to a reduced FVC and elevated dyspnoea levels in our PCS cohort.…”

“…Symptoms of fatigue, muscle weakness (37–63%), and sleep difficulties (26–31%) have been shown to be the most common consequences of post-COVID-19 syndrome (PCS) [1‒4]. Hospitalization due to COVID-19 increases the prevalence of sleep disturbances to 62%, which can persist for at least 1 year [5]. The consequences of poor sleep are multifaceted and can result in daytime sleepiness, reduced concentration and performance, and poor quality of life have.…”