More than 40% of patients with long COVID report mild to severe sleep disturbances

Key takeaways:

• Black patients with long COVID were significantly more likely to experience sleep disturbances than white patients.
• Other risk factors included COVID-19 hospitalization and greater anxiety severity.

More than 40% of patients with long COVID reported having mild to severe sleep disturbances, with Black individuals and those hospitalized for COVID-19 at greater risk for worsened sleep, a recent study found.

Cinthya Pena-Orbea, MD, an assistant professor of medicine at the Cleveland Clinic, and colleagues wrote that sleep disturbance has been reported by 34% to 50% of patients with long COVID — also known as post-acute sequelae of COVID-19 (PASC) — but “only a few studies have identified associated risk factors, and these have primarily described sleep quality and not symptom severity.”

“Likewise, studies to date have not investigated the interaction of mood disorders and fatigue with sleep disturbance severity or the association of objective sleep study indices in PASC,” they wrote in the Journal of General Internal Medicine.

To determine potential associations, the researchers prospectively examined 962 patients with long COVID who had completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance instrument at the Cleveland Clinic’s ReCOver Clinic between February 2021 to April 2022. Patients had a mean age of 49 years, 74.9% were women and 81.9% were white.

Overall, 58.7% of patients had normal to mild sleep disturbance, while 41.3% had moderate to severe sleep disturbance. Additionally, 67.2% reported moderate to severe fatigue, while 21.8% had severe fatigue.

Pena-Orbea and colleagues found several factors were significantly associated with moderate to severe sleep disturbance, which included:

• being Black (OR=1.84; 95% CI, 1.1-3.08);
• being hospitalized for COVID-19 (OR=1.59; 95% CI, 1.1-2.32);
• having greater anxiety severity (OR = 1.31; 95% CI, 1.18-1.45); and
• having moderate to severe fatigue (OR = 2.03; 95% CI, 1.33-3.11).

Based on the data of 48 patients who had pre-COVID-19 sleep testing done 2 years before their ReCOver Clinic appointment, neither obstructive sleep apnea severity nor hypoxia measures were significantly different between normal to mild and mild to severe sleep disturbance.

There was no statistically significant interaction between anxiety severity and moderate to severe fatigue, so “further studies are needed to investigate the interplay between mental and sleep disturbances in PASC physiologic pathways,” the researchers wrote.

They additionally noted that 60% of Black patients who did not complete the PROMIS survey completed mood and fatigue assessments.

“As such, it is possible that the magnitude of association between Black race and moderate to severe sleep disturbances is even stronger,” Pena-Orbea and colleagues wrote.

They concluded that the study findings demonstrate the importance of identifying sleep disturbance in long COVID cases due to its impact on patients’ quality of life and health status, and “highlight the need to elucidate contributions of structural racism and socioeconomic inequities to PASC-related sleep disturbances with the goal of developing interventions to reduce PASC disparities.”

References:

• Cleveland Clinic researchers find sleep disturbances prevalent in long COVID. https://newsroom.clevelandclinic.org/2023/04/05/cleveland-clinic-researchers-find-sleep-disturbances-prevalent-in-long-covid/. Published April 5, 2023. Accessed April 7, 2023.
• Pena-Orbea C, et al. J Gen Intern Med. 2023;doi:10.1007/s11606-023-08187-3.