The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections

Abstract

Background Poor sleep is associated with an increased risk of infections and all-cause mortality, and acute sleep loss and disruption have been linked with inflammation and poorer immune control. Previous studies, however, have been unable to evidence causality between the chronic effects of poor sleep and respiratory infection risk. In light of the ongoing COVID-19 pandemic and potential future disease outbreaks, understanding the risk factors for these infections is of great importance. Aim Our goal was to understand if chronic poor sleep could be identified as a causal risk factor for respiratory infections including influenza, upper respiratory infections and COVID-19. Methods We used population cohorts from the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 327,000) with ICD-10 based electronic health records and obtained diagnoses of insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital settings. We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and used summary statistics from genome-wide association studies of insomnia, influenza, URI and COVID-19 to perform Mendelian randomization analyses and assess causality. Findings Utilizing 23 years of registry data and follow-up, we saw that insomnia diagnosis associated with increased risk for infections in FinnGen and in UK Biobank (FinnGen influenza HR = 5.32 [4.09, 6.92], P = 1.02×10-35, UK Biobank influenza HR = 1.54 [1.37, 1.73], P = 2.49×10-13). Mendelian randomization indicated that insomnia causally predisposed to influenza (OR = 1.59, P = 6.23×10-4), upper respiratory infections (OR = 1.71, P = 7.60×10-13), COVID-19 infection (OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (OR = 1.47, P = 4.96×10-5). Conclusions Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens as suggested by earlier work. As the current COVID-19 pandemic has increased the number of people suffering from poor sleep, safe interventions such as sleep management and treating individuals with insomnia could be promoted to reduce infections and save lives.

Kognitive Störungen und Schlafstörungen bei Long-COVID

“…Eine retrospektive Kohortenstudie basierend auf subjektiven Schlafdaten von über 200 SARS-CoV-2-infizierten Teilnehmenden fand bei solchen mit unzureichendem Schlaf während der der COVID-19-Infektion vorausgehenden Woche Hinweise auf ein 6‑ bis 8‑fach erhöhtes Risiko für einen schwereren Verlauf im Vergleich zu Teilnehmenden mit ausreichendem Schlaf [ 31 ]. Passend dazu zeigt eine zum Zeitpunkt dieses Reviews als Preprint vorliegende Studie an über 500.000 Menschen zweier bevölkerungsbasierter Kohorten (UK Biobank und FinnGen), dass eine vorbestehende Insomnie einen kausalen Risikofaktor für eine Erkrankung an einem respiratorischen Infekt einschließlich COVID-19 und einen schweren COVID-19-Verlauf darstellt [ 32 ]. Auch eine chronische Schlafstörung in Form eines Schlafapnoesyndroms stellt gemäß einer quantitativen Metaanalyse einen unabhängigen Risikofaktor für einen fatalen Ausgang einer COVID-19-Infektion dar [ 33 ].…”

The association between self-reported sleep problems, infection, and antibiotic use in patients in general practice

“…In a Japanese study including 39 524 adults without any serious medical conditions who underwent a medical health checkup, those who slept 5 h or less had higher odds of self-reported predisposition to the common cold compared to those who slept 7 h (14). More recently, a large longitudinal registry-based study found that a prior diagnosis of insomnia was associated with an increased risk of later being diagnosed with upper respiratory infections (17). This study included data from two population-based cohorts-the UK Biobank and FinnGen-with up to 23 years of follow-up data from primary care and/or hospitals.…”

“…Cognitive behavioral therapy for insomnia (CBT-I) has been found to be highly effective in a primary care setting (39), and there is also suggestive evidence that such treatment can reduce the level of CRP in the blood (40). Recently, a more direct link between insomnia and risk of infection was demonstrated in a Mendelian randomization study with genetic data from a large Finnish cohort (17). By using genetic variants strongly associated with insomnia, the authors were able to assess the causal effect of insomnia on respiratory infections.…”

“…The prevalence varies according to factors such as sex, age, socioeconomic status and circadian preference-evening types are reported to be more susceptible (2, 7). There is emerging evidence, both from controlled laboratory and epidemiological observational studies, that sleep disturbances and short sleep duration increase the risk of infection (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The underlying mechanisms behind this association are unclear and is further complicated by the bidirectional relationship between the two (1).…”

Insomnia, Poor Sleep Quality and Sleep Duration, and Risk for COVID-19 Infection and Hospitalization

“…However, with the exception of several studies implicating obstructive sleep apnea (OSA) to higher rates of COVID-19 infection, 4 , 5 , 6 morbidity, 7 and mortality, 8 there have been relatively few investigations of dysfunctional sleep as a potential risk for developing COVID-19. 9 , 10 , 11 , 12 …”