Disturbed sleep associated with symptoms of long COVID, including dyspnea
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Key takeaways:
- Of study participants who had been admitted to the hospital for COVID-19, 62% reported poor sleep quality.
- Overall, 53% felt that their sleep quality had deteriorated following discharge.
Sleep disturbance was common among patients hospitalized for COVID-19 and was associated with symptoms of long COVID, including breathlessness and reduced lung function, a study found.
The findings were presented at the European Congress of Clinical Microbiology & Infectious Diseases and published simultaneously in The Lancet Respiratory Medicine.
“Tiredness is one of the commonest symptoms in long COVID,” John F. Blaikley, MBBS, PhD, clinician scientist at the University of Manchester, told Healio. “We therefore wanted to investigate whether sleep disturbance was common in long COVID, and if other long COVID symptoms are associated with sleep disturbance.”
To investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19, Blaikley and colleagues conducted a prospective multicenter cohort substudy called CircCOVID.
The study assessed a cohort of participants aged 18 years or older, admitted to the hospital for COVID-19 in the U.K. and discharged between March 2020 and October 2021, who were recruited from the Post-Hospitalization COVID-19 study (PHOSP-COVID).
Follow-up data were collected at 2 to 7 months after hospital discharge and again 10 to 14 months after hospital discharge. Sleep quality was assessed for all patients using the Pittsburgh Sleep Quality Index questionnaire, a numerical rating scale, and using an accelerometer worn on the patients’ wrist for 14 days.
In total, 2,320 of 2,468 participants in the PHOSP-COVID study attended an appointment at 2 to 7 months after discharge from 83 hospitals in the U.K. Data for their sleep quality was assessed by the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale for 638 participants at these visits, whereas sleep quality was assessed using the wrist device for 729 participants.
The data showed that 62% of participants who had been admitted to hospital for COVID-19 reported poor sleep quality after discharge using the Pittsburgh Sleep Quality Index questionnaire, whereas 53% of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, according to an assessment using the numerical rating scale.
Wrist device-based assessments were compared with an age-matched, sex-matched, BMI-matched and time from discharge-matched U.K. Biobank cohort who had recently been admitted to hospital. Compared with the recently hospitalized-matched U.K. Biobank cohort, participants in the study slept an average 65 minutes longer (95% CI, 59-71), had a lower sleep regularity index (–19%; 95% CI, –20 to –16) and a lower sleep efficiency (3.83 percentage points; 95% CI, 3.4-4.26).
Additionally, the study showed that sleep quality (unadjusted effect estimate = 3.94; 95% CI, 2.78-5.1), deterioration in sleep quality following hospital admission (unadjusted effect estimate = 3; 95% CI, 1.82-4.28), and sleep regularity (unadjusted effect estimate = 4.38; 95% CI, 2.1-6.65) were associated with higher dyspnea scores, whereas poor sleep quality, deterioration in sleep quality and sleep regularity were associated with impaired lung function, as assessed by forced vital capacity.
Although the study has assessed some aspects of sleep disturbance following COVID-19 recovery, continued research is needed, Blaikley said.
“[Sleep disturbance] is associated with several symptoms of long COVID,” Blaikley said. “What we now need to do is see whether this association is caused by sleep disturbance. If a causal link is established, then interventions targeting sleep may be able to improve both sleep disturbance as well as other long COVID symptoms.”
In a related commentary, W. Cameron McGuire, MD, MPH, associate physician diplomate at the University of California San Diego, and colleagues wrote that there are additional questions remaining for researchers and clinicians, including whether documented abnormalities in pulmonary microvasculature in previous studies are “contributing to elevated dead space, yielding a risk of dyspnea”; whether pulmonary functional abnormalities are obstructive, restrictive, vascular or mixed, and if they are clinically significant; and whether recovery from respiratory infection due to COVID-19 is worse than that for other viral respiratory illnesses.
“Although we feel systematic screening of sleep and respiratory abnormalities following recovery from COVID-19 is not yet indicated, we applaud Jackson and colleagues for their important contribution to this topic and welcome further research in this area,” they wrote.
References:
- Jackson C, et al. Lancet Respir Med. 2023;doi:10.1016/S2213-2600(23)00124-8.
- McGuire WC, et al. Lancet Respir Med. 2023;doi:10.1016/S2213-2600(23)00138-8.
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