Sleep quality after COVID-19 infection

Introduction: As the COVID-19 pandemic continues to worsen our understanding of the disease remains in its infancy, and the repercussions of acute COVID-19 infection are yet to be fully appreciated. Of the various morbidities suffered by survivors of this acute illness, the effects on mental health, quality of life, and changes in cognition have been of recent interest. These changes have long been associated with sleep fragmentation and disruption;moreover, significant cytokine storm and inflammatory response is a hallmark of acute COVID-19 infection, and previous studies have linked inflammatory pathways with the sleep dysregulation. We examined the change in sleep quality after severe acute COVID-19 infections requiring hospitalization. Methods: We performed a retrospective, single-center follow-up study of 20 patients with acute COVID-19 infection confirmed by PCR testing who had previously required hospital admission and deemed to have moderate to severe infection. Patients with a previous history of any diagnosed sleep disorder, including OSA, or those hospitalized within the last 30 days were excluded. Eligible patients were called and completed a telephone survey of the Pittsburgh Sleep Quality Index (PSQI) prior to and one month after COVID infection, with a score of 5 or above indicative of poor sleep quality. Secondary data from EMR including demographics, comorbid medical conditions, inflammatory markers, disease severity, measures of hypoxia and oxygenation and hospital length of stay were collected. ResultsThe mean PSQI prior to COVID-19 infection was 6.1, worsening to 10.3 one month after acute infection, denoting a delta-PSQI of 4.2 (p = 0.0004) as shown in Figure 1A. There were 6 out of 20 patients in whom sleep quality either improved or remained completely unchanged following COVID infection;these patients had poorer initial sleep quality (indicated by PSQI >5) than the 14 patients whose PSQI worsened (pre-infection PSQI 9.67 vs 4.57, p = 0.009). In the 14 patients whose sleep worsened after infection, on average they did not have sleep disturbances prior to COVID infection, and had a statistically significant increase in PSQI postinfection from 4.57 to 10.93 (p < 0.001) [Figure 1B]. There were no difference between groups in age, sex, BMI, hospital length of stay, mean PaO2/FiO2 ratio, rates of intubation, or inflammatory markers. Conclusions: In our study of patients with moderate-severe COVID-19 infections, those who had poor baseline sleep quality remained poor sleepers, while those without previous sleep disturbances had a significant worsening of sleep quality.