Moderate-to-Severe Post-COVID-19 Sleep Disturbances Common, Especially in Black Individuals


Patients with moderate-severe compared with normal-to-mild sleep disturbances had worse GAD-2 questionnaire scores, PHQ-2 scores, and PROMIS fatigue scores with no difference in age, sex, or hospitalization due to COVID-19.

Cinthya Pena Orbea, MD

Cinthya Pena Orbea, MD

In one of the first studies of its kind, investigators found a very high prevalence of moderate-to-severe sleep disturbances in individuals who had post-acute sequelae (PASC) of COVID-19, including 3-fold higher odds for Black individuals. The study, presented at the 2022 SLEEP Annual Meeting, June 4-8, in Charlotte, North Carolina, also identified several predictors of these disturbances such as obesity and mood symptoms.1

"There is a lack of data characterizing the sleep disturbances among patients with PASC," Lead investigator Cinthya Pena Orbea, MD, assistant professor of medicine, Cleveland Clinic, told NeurologyLive®. “Most of the data available is just describing the prevalence of sleep disturbances among these patients. Our research wanted to go one step ahead and look at how severe these sleep disorders are."

Pena Orbea and colleagues analyzed the severity of PASC-related sleep disturbance in a cohort of 1321 individuals who completed the Patient-Reported Outcomes Measurement (PROMIS) Sleep Disturbance and PROMIS Fatigue questionnaires. PROMIS scores were standardized to the general US population on a T-scale with mean score of 50 (±10).

Of the cohort, 682 patients completed the PROMIS Sleep Disturbance questionnaire with average T-scores of 57.7 (±8.1). T-scores greater than 60, which indicated at least moderate disturbance, were reported in 41.2% of the cohort. Additionally, 7.3% of patients reported severe sleep disturbances, indicated by scores of at least 70. The average PROMIS fatigue T-score was 63.0 (±9.2), with 68.6% of patients reporting at least moderate fatigue and 22.6% who reported severe fatigue.

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T-test and Chi-square tests were used to examine cross-group differences. Here, investigators showed that a higher body mass index (BMI) was associated with more moderate-severe sleep disturbances compared with normal-to-mild (32.3 [±8.7] vs 30.9 [±7.5]; P = 0.049). Additionally, those who were more prone to moderate-severe sleep disturbances vs normal-to-mild were more likely of Black race (40.0 [±10.0] vs 41.0 [±15.7]; P = 0.010) and had worse General Anxiety Disorder (GAD)-2 questionnaire score (2.8 [±2.1] vs 1.6 [±1.7]; P <.001), Patient Health Questionnaire (PHQ)-2 scores (2.8 [±2.0]; vs 1.6 [±1.7]; P <.001), and PROMIS fatigue scores (66.7 [±7.8] vs 60.4 [±9.1]; P <.001), with no difference in age, sex, or hospitalization due to COVID-19. In the adjusted model, Black race was associated with moderate-severe sleep disturbance (odds ratio [OR], 3.42 [95% CI, 1.64-7.13]).

"Little is known about the underlying mechanisms of how COVID-19 cause sleep disorders,” Pena Orbea added. "There are several hypotheses that either viral replication, autoimmune response, or inflammatory response might be causing this. There are other hypotheses that mood disorders or PTSD related to COVID19 may result in these sleep disorders. Further investigation is needed to try to understand the basis of this."

Click here for more coverage of SLEEP 2022.

1. Pena Orbea C, Lapin B, Katzan I, Englund K, Folvary-Schaefer N, Mehra R. Sleep disturbances in post-acute sequelae of COVID-19 (PASC). Presented at: SLEEP Annual Meeting, 2022; June 4-8; Charlotte, NC. Abstract 0735
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