Sleep disruption after COVID tied to dyspnoea, other post-acute sequelae

Sleep disruption following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness in the CircCOVID cohort sub-study presented at ECCMID 2023.

“Sleep disturbance is common and persisted for 12 months after discharge,” said study author Dr John Blaikley from the Division of Infection, Immunity & Respiratory Medicine, University of Manchester in Manchester, UK. “Due to its association with multiple symptoms, targeting sleep disturbance might be beneficial in treating post-COVID-19 conditions.”

The clinical association of sleep disturbance for recovery following hospital admission for COVID-19 is poorly understood. Baikley and team investigated the effects of circadian disruption and sleep disturbance after COVID-19 and whether there is any association with dyspnoea in a cohort of patients ≥18 years of age, who were admitted to 83 hospitals for COVID-19 in the UK, and discharged between March 2020, and October 2021. [Lancet Respir Med 2023;S2213-2600(23)00124-8]

Participants were recruited from the long-term follow-up Post-hospitalisation COVID-19 (PHOSP-COVID) study. [Lancet Respir Med 2021;9:1275-1287]

Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale at 2–7 months and at 10–14 months after discharge. Additionally, an accelerometer worn 24 hours for 14 days assessed for sleep quality.

“Polysomnography is the current gold standard in sleep monitoring,” said Blaikley. “However, it is technically challenging and only measures sleep quality over shorter timeframes. Here, we used actigraphy, which accurately identifies many of the sleep traits captured by polysomnography.”

More patients had poor sleep quality

After discharge, 62 percent (396 of 638 participants) reported poor sleep quality. Fifty-three percent (338 of 638 participants) felt their sleep quality had deteriorated following discharge. Actigraphy-based measurements were compared with matched UK Biobank cohort (nonhospitalized and recently hospitalized individuals).

Compared with the hospitalized UK Biobank cohort, the COVID-19 cohort slept on average 65 min longer but had a lower sleep regularity index (–19 percent), and a lower sleep efficiency (3.83 percentage points. Similar results were obtained when comparisons were made with the nonhospitalized UK Biobank cohort.

In aggregate, sleep quality (unadjusted effect estimate 3.94), deterioration in sleep quality following hospital admission (3.00), and sleep regularity (4.38) were associated with higher dyspnoea scores.

Poor sleep quality, deterioration of sleep quality, and sleep regularity were all associated with impaired lung function, as assessed by forced vital capacity.

Depending on the sleep metric, anxiety mediated 18–39 percent of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41 percent of this effect.

Device-based sleep metrics have been used in studies to assess sleep and circadian rest-activity pattern post-COVID-19 period. [Crit Care Med 2022;50: 945-954]

An effect of COVID?

“Our study extends these findings, revealing altered sleep-based metrics in patients who had been admitted to the hospital for COVID-19 regardless of critical care admission,” said Blaikley. “Comparison with the matched UK Biobank participants admitted for other causes suggested that sleep disturbance is likely a specific effect of COVID-19, given the comparatively modest effects seen with hospital admission for other causes. Additionally, sleep disturbance is associated with dyspnoea and other symptoms.”

Future research should assess whether interventions targeting sleep disturbance can improve dyspnoea by reducing anxiety and improving muscle strength in these patients, he added.