Financial toxicity raises odds for sleep problems 1 year after COVID-19 hospitalization
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Key takeaways:
- One year after COVID-19 hospitalization, 31.4% of survivors had sleep disturbance, and 25.1% had sleep-related impairment.
- Three different measures of financial toxicity increased the odds for sleep problems.
HONOLULU — Experiencing financial toxicity 1 year after COVID-19 hospitalization contributed to elevated odds for sleep disturbance and sleep-related impairment, according to research presented at the CHEST Annual Meeting.
“This study drives home the importance of clinicians asking about a patient’s financial stress and sleep quality after they experience hospitalization from COVID-19,” Madeline McDougal, MPH, CPH, senior research coordinator in the Oregon Health & Science University (OHSU) pulmonary and critical care department, and Aluko A. Hope, MD, MSCE, associate professor of pulmonary and critical care medicine and medical director of the OHSU Long COVID-19 Program, told Healio in a statement.
Using the cohort from the Biology & Longitudinal Epidemiology of PETAL COVID-19 Observational (BLUE CORAL) study, McDougal, Hope and colleagues assessed 693 individuals 1 year after hospitalization for symptomatic COVID-19 between August 2020 and July 2021 to determine how financial toxicity is related to sleep disturbance and sleep-related impairment.
Researchers used PROMIS instruments to evaluate symptoms of both sleep disturbance and sleep-related impairment and descriptive analyses to find abnormalities in these scores. A symptom rating of 0.5 standard deviation over the population mean (T-score 55) signaled abnormality.
Of the total cohort, almost one-third (31.4%) of individuals had an abnormally high rating of sleep disturbance (mean score, 50.1 ± 10.4), whereas a quarter (25.1%) of individuals had abnormal scores on the sleep-related impairment questionnaire (mean score, 47.6 ± 11.8).
To find out each individual’s level of financial toxicity, researchers asked them if they lost a job in the past 6 months (9.7%), if they could not pay for necessities such as food, heat or housing (20.6%) and if they used up all/most of their savings (35.4%).
Among the three different indications of financial toxicity, those unable to pay for necessities had the highest odds for abnormally high sleep disturbance (adjusted OR = 3.12; 95% CI, 2.07-4.69) in multiple logistic regression models adjusted for age, sex and race/ethnicity.
Notably, researchers also observed heightened likelihoods for abnormal sleep disturbance ratings among individuals who used up their savings (aOR = 2.46; 95% CI, 1.71-3.53) and individuals who lost their job (aOR = 2.26; 95% CI, 1.32-3.89).
Similar to the findings above, the highest odds for abnormally high sleep-related impairment occurred among individuals who could not pay for necessities (aOR = 3.24; 95% CI, 2.13-4.92), followed by those who used up their savings (aOR = 3.06; 95% CI, 2.08-4.51) and those who lost their job (aOR = 2.98; 95% CI, 1.73-5.15).
“We found that COVID-19 survivors who experienced financial stress after COVID-19 hospitalization were more likely to experience sleep problems,” McDougal and Hope told Healio. “Additionally, both financial stress and sleep problems persisted 1 year after their hospitalization.
“Because the current study is from a specific cross-section in time, we cannot say if financial problems cause sleep problems after COVID-19 hospitalization,” McDougal and Hope added. “It would be interesting to use data for financial toxicity collected earlier in the BLUE CORAL study to assess if this is the case.”