Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions

Abstract

AbstractStudy ObjectivesInsomnia, poor sleep quality and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to Post-Acute Sequelae of SARS-CoV-2 infection (PASC).MethodsCross-sectional survey of a general population of 24,803 U.S. adults to determine the association of insomnia, poor sleep quality and sleep duration with PASC.ResultsPrevalence rates of PASC among previously COVID-19 infected participants for three definitions of PASC were COPE (21.9%), NICE (38.9%) and RECOVER PASC Score (15.3%). PASC was associated with insomnia in all 3 models in fully adjusted models with adjusted odds ratios (aORs) and 95% confidence intervals (CI) ranging from 1.30 (95% CI: 1.11-1.52, p≤0.05, PASC Score) to 1.52 (95% CI: 1.34-1.71, p≤0.001, (NICE). Poor sleep quality was related to PASC in all models with aORs ranging from 1.77 (95% CI: 1.60-1.97, p≤0.001, NICE) to 2.00 (95% CI: 1.77-2.26, p≤0.001, COPE). Sleep <6 hours was associated with PASC with aORs between 1.59 (95% CI: 1.40-1.80, p≤0.001, PASC Score) to 1.70 (95% CI: 1.53-1.89, p≤0.001, COPE). Sleep>9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality and short sleep duration with PASC in any of the models.ConclusionsInsomnia, poor sleep quality and short sleep duration are potential risk factors for PASC. Interventions to improve sleep may decrease the development of PASC.Brief SummaryCurrent Knowledge/Study RationaleInsomnia, poor sleep quality, and extremes of sleep duration have been associated with a higher likelihood of COVID-19 infection. However, evidence implicating an association with the development of Post-Acute Sequelae of SARS-CoV-2 infection (PASC) is scant.Study ImpactResults indicate that insomnia, poor sleep quality and sleep duration<6 hours are associated with an increase in the prevalence of PASC among persons who have previously had a COVID-19 infection. The findings provide support for employing interventions to improve sleep as a means to decrease the development of PASC.