Sleep disturbance in Covid-19 patients associated with dyspnea, anxiety and muscular weakness

Sleep disruption during COVID-19 hospitalization is related with dyspnea, anxiety, and muscular weakness, says an article published in The Lancet Respiratory medicine.

Sleep disruption is prevalent after hospitalization for COVID-19 and other reasons. Despite sleep disruption contributing to morbidity in other circumstances, the clinical consequences of this for recovery after hospitalization are little recognized. As a result, Callum Jackson and colleagues sought to determine the prevalence and form of sleep disruption after release during COVID-19 hospitalization, as well as if it was linked with dyspnea.

A prospective multicenter cohort substudy called CircCOVID was created to examine the effects of circadian rhythm disruption and difficulty sleeping on recovery following COVID-19 in a cohort of participants 18 years of age or older who were hospitalized in the UK for COVID-19 and released between March 2020 and October 2021. The Post-hospitalization COVID-19 study (PHOSP-COVID) was used to find participants. Two timepoints were used to gather the follow-up data: the first was 2–7 months following hospital release, and the second was 10–14 months. Using a numerical rating scale and the Pittsburgh Sleep Quality Index questionnaire, the subjective quality of sleep was evaluated.

The effectiveness of sleep was also evaluated using an accelerometer (actigraphy) worn for 14 days on the wrist. At the first time point after discharge, participants were also clinically phenotyped, including symptom evaluation. Actigraphy results were also contrasted with a matched UK Biobank cohort of people who had recently been hospitalized and those who had not. The primary outcome of breathlessness and the other clinical symptoms were defined as relationships of sleep disruption with multivariable linear regression.

The key findings of this study were as follows:

1. In the PHOSP-COVID project, 2320 of 2468 patients showed up for an early time point research visit a median of 5 months (IQR 4-6) after leaving 83 hospitals in the UK.

2. At the early time point, 638 participants' subjective ratings of their sleep quality were recorded.

3. Following hospital discharge, 729 individuals had their sleep quality evaluated using device-based measurements (actigraphy) a median of 7 months (IQR 5-8 months) later.

4. 396 (62% of 638) of the individuals who had been hospitalized to the hospital for COVID-19 reported having poor sleep quality on the Pittsburgh Sleep Quality Index questionnaire after being released from the hospital.

5. According to the numerical rating scale, a similar percentage (338 [53%] of 638) of individuals believed their sleep quality had declined after being discharged from COVID-19 admission.

6. Device-based measures were compared to a UK Biobank cohort of patients who had just been admitted to the hospital and were age-, sex-, BMI-, and time from discharge-matched.

7. Participants in our research slept on average 65 minutes longer than the recently hospitalized matched UK Biobank group, had a lower sleep regularity score, and had less efficient sleep.

8. When comparisons were performed with the non-hospitalized UK Biobank sample, similar outcomes were observed. Higher dyspnoea scores were related to poorer overall sleep quality, decline in sleep quality after hospital admission, and sleep regularity (4.38; 2.10 to 6.65).

9. When measured by forced vital capacity, reduced lung function was likewise linked to poor sleep, worsening sleep, and irregular sleep.

10. Depending on the sleep metric, anxiety mediates 18–39% and muscular weakness mediates 27–41% of the effect of sleep disruption on dyspnea.

Reference:

Jackson, C., Stewart, I. D., Plekhanova, T., Cunningham, P. S., Hazel, A. L., Al-Sheklly, B., Aul, R., Bolton, C. E., Chalder, T., Chalmers, J. D., Chaudhuri, N., Docherty, A. B., Hanley, N. A., Harris, V. C., Harrison, E. M., … Zongo, O. (2023). Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study. In The Lancet Respiratory Medicine. Elsevier BV. https://doi.org/10.1016/s2213-2600(23)00124-8