Pre‐existing sleep problems as a predictor of post‐acute sequelae of COVID‐19

Abstract

SummarySeveral months after COVID‐19 many individuals still report persisting symptoms, the so‐called ‘post‐COVID‐19 syndrome’. An immunological dysfunction is one of the main pathophysiological hypotheses. As sleep is central to the functioning of the immune system, we investigated whether self‐reported pre‐existing sleep disturbance might be an independent risk factor for the development of post‐COVID‐19 syndrome. A total of 11,710 participants of a cross‐sectional survey (all tested positive for severe acute respiratory syndrome coronavirus‐2) were classified into probable post‐COVID‐19 syndrome, an intermediate group, and unaffected participants at an average of 8.5 months after infection. The case definition was based on newly occurring symptoms of at least moderate severity and ≥20% reduction in health status and/or working capacity. Unadjusted and adjusted odds ratios were calculated to investigate the association between pre‐existing sleep disturbances and subsequent development of post‐COVID‐19 syndrome while controlling for a variety of demographic, lifestyle, and health factors. Pre‐existing sleep disturbances were found to be an independent predictor of subsequent probable post‐COVID‐19 syndrome (adjusted odds ratio 2.7, 95% confidence interval 2.27–3.24). Sleep disturbances as part of the post‐COVID‐19 syndrome were reported by more than half of the participants and appeared to be a new symptom and to occur independent of a mood disorder in most cases. Recognition of disturbed sleep as an important risk factor for post‐COVID‐19 syndrome should promote improved clinical management of sleep disorders in the context of COVID‐19. Further, it may stimulate further research on the effect of improving sleep on the prognosis of COVID‐19 long‐term sequelae and other post‐viral conditions.