Covid-19 mediated sleeping disorders elevate anxiety and depression: Lancet

A new study by Callum Jackson and team showed that after being admitted to the hospital with COVID-19, sleep disturbance is linked to anxiety, dyspnea, and muscle weakness. The findings of this study were published in The Lancet Respiratory Medicine.

Following hospital admission, sleep disturbances are frequent due to COVID-19 and other factors. Despite sleep disturbance contributing to morbidity in other situations, the clinical consequences of this for recovery following hospital admission are poorly recognized. Therefore, the purpose of this study was to ascertain the prevalence and type of sleep disturbance following hospitalization for COVID-19 and determine whether it was linked to dyspnea.

The objective of CircCOVID, a prospective multicenter cohort substudy, was to examine the impact of circadian disruption and sleep disturbance on recovery following COVID-19 in a cohort of patients aged 18 or older who had been hospitalized in the UK for COVID-19 and were 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 key findings of this study were:

1. A median of 5 months (IQR 4-6) after being discharged from 83 hospitals in the UK, 2320 of 2468 patients in the PHOSP-COVID trial went to an early time point research visit.

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 65 minutes longer on average (95% CI 59 to 71) on average, had a lower sleep regularity score, and had worse sleep efficiency compared to the recently hospitalized matched UK Biobank group.

8. When comparisons were performed with the non-hospitalized UK Biobank sample, similar outcomes were observed.

9. Higher dyspnea scores were linked with worse overall sleep quality, poorer sleep after hospital admission (300; 182 to 428), and irregular sleep (438; 210 to 665).

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

11. 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., Chaudhuri, N., 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