Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy.
Brain Behav Immun. 2023 Aug;112:140-151. doi: 10.1016/j.bbi.2023.06.010. Epub 2023 Jun 9.
Millions of COVID-19 survivors experience a wide range of long-term symptoms after acute infection, giving rise to serious public health concerns. To date, few risk factors for post-COVID-19 conditions have been determined. This study evaluated the role of pre-infection sleep quality/duration and insomnia severity in the incidence of long-term symptoms after COVID-19.
This prospective study involved two assessments (April 2020 and 2022). At the baseline (April 2020), sleep quality/duration and insomnia symptoms in participants without current/prior SARS-CoV-2 infection were measured using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). At the follow-up (April 2022), we asked a group of COVID-19 survivors to retrospectively evaluate the presence of twenty-one symptoms (psychiatric, neurological, cognitive, bodily, and respiratory) that have been experienced one month (n = 713, infection in April 2020-February 2022) and three months after COVID-19 (n = 333, infection in April 2020-December 2021). In April 2022, participants also reported how many weeks passed to fully recover from COVID-19. Zero-inflated negative binomial models were used to estimate the effect of previous sleep on the number of long-term symptoms. Binomial logistic regressions were performed to evaluate the association between sleep variables, the incidence of each post-COVID-19 symptom, and the odds of recovery four/twelve weeks after infection.
Analyses highlighted a significant effect of pre-infection sleep on the number of symptoms one/three months after COVID-19. Previous higher PSQI and ISI scores, and shorter sleep duration significantly increased the risk of almost every long-term symptom at one/three months from COVID-19. Baseline sleep problems were also associated with longer recovery times to return to the pre-infection daily functioning level after COVID-19.
This study suggested a prospective dose-dependent association of pre-infection sleep quality/quantity and insomnia severity with the manifestation of post-COVID-19 symptoms. Further research is warranted to determine whether preventively promoting sleep health may mitigate the COVID-19 sequelae, with substantial public health and societal implications.
数百万 COVID-19 幸存者在急性感染后会经历广泛的长期症状，引发严重的公共卫生问题。迄今为止，确定 COVID-19 后疾病的危险因素很少。本研究评估了感染前睡眠质量/时长和失眠严重程度对 COVID-19 后长期症状发生的影响。
这是一项前瞻性研究，包括两次评估（2020 年 4 月和 2022 年）。在基线（2020 年 4 月）时，使用匹兹堡睡眠质量指数（PSQI）和失眠严重程度指数（ISI）测量无当前/既往 SARS-CoV-2 感染的参与者的睡眠质量/时长和失眠症状。在随访（2022 年 4 月）时，我们要求一组 COVID-19 幸存者回顾性评估一个月（n=713，2020 年 4 月至 2022 年 2 月感染）和 COVID-19 后三个月（n=333，2020 年 4 月至 2021 年 12 月感染）出现的 21 种症状（精神、神经、认知、身体和呼吸）。2022 年 4 月，参与者还报告了从 COVID-19 中完全康复所需的周数。零膨胀负二项式模型用于估计先前睡眠对长期症状数量的影响。二项逻辑回归用于评估睡眠变量与 COVID-19 后每种症状的发生以及感染后四周/十二周恢复的几率之间的关联。
分析强调了感染前睡眠对 COVID-19 后一个月/三个月症状数量的显著影响。先前较高的 PSQI 和 ISI 评分以及较短的睡眠时间显著增加了 COVID-19 后几乎所有长期症状的风险。基线睡眠问题也与感染后恢复到感染前日常功能水平的时间延长有关。
本研究表明，感染前睡眠质量/数量和失眠严重程度与 COVID-19 后症状表现之间存在前瞻性剂量依赖性关联。需要进一步研究以确定预防性促进睡眠健康是否可以减轻 COVID-19 的后遗症，这具有重大的公共卫生和社会意义。
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