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

Stuart F Quan; Matthew D Weaver; Mark É Czeisler; Laura K Barger; Lauren A Booker; Mark E Howard; Melinda L Jackson; Rashon I Lane; Christine F McDonald; Anna Ridgers; Rebecca Robbins; Prerna Varma; Joshua F Wiley; Shantha M W Rajaratnam; Charles A Czeisler

doi:10.5664/jcsm.11322

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

J Clin Sleep Med. 2024 Sep 26. doi: 10.5664/jcsm.11322. Online ahead of print.

Authors

Stuart F Quan^{1

2}, Matthew D Weaver^{1

2}, Mark É Czeisler^{3

4

5}, Laura K Barger^{1

2}, Lauren A Booker^{5

6}, Mark E Howard^{5

7

8}, Melinda L Jackson^{4

5}, Rashon I Lane¹, Christine F McDonald^{5

8

9

10}, Anna Ridgers^{5

8

9}, Rebecca Robbins^{1

2}, Prerna Varma⁴, Joshua F Wiley⁴, Shantha M W Rajaratnam^{1

2

4

5}, Charles A Czeisler^{1

2}

Affiliations

¹ Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.
² Division of Sleep Medicine, Harvard Medical School, Boston, MA.
³ Francis Weld Peabody Society, Harvard Medical School, Boston, MA.
⁴ School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
⁵ Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.
⁶ University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
⁷ Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
⁸ Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
⁹ Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.
¹⁰ Faculty of Medicine, Monash University, Melbourne Australia.

PMID: 39324686
DOI: 10.5664/jcsm.11322

Abstract

Study objectives: Insomnia, 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).

Methods: Cross-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. Three definitions of PASC were used based on post COVID-19 clinical features: COPE (≥3), NICE (≥1), and RECOVER (scoring algorithm).

Results: Prevalence rates of PASC were 21.9%, 38.9%, 15.5% for COPE, NICE and RECOVER PASC definitions, respectively. PASC was associated with insomnia in all 3 models after full adjustment with 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.

Conclusions: Insomnia, poor sleep quality and short sleep duration are cross-sectionally associated with PASC and may be potential risk factors. Further longitudinal studies should be conducted.

Keywords: PASC; Post-Acute Sequelae of SARS-CoV-2 infection; insomnia; long COVID; poor sleep quality; sleep duration.