Cleveland Clinic Study: Long COVID Shows Link to Sleep Disturbances

Approximately 41% of individuals with long COVID had moderate-to-severe sleep disturbances, according to the results of a study published in Journal of General Internal Medicine.¹

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“Sleep difficulties and fatigue are widely reported by people with long COVID, but little is known about the severity and factors associated with these symptoms,” Cinthya Pena Orbea, MD, an assistant professor of medicine at Cleveland Clinic’s Sleep Disorders Center, said in a statement. “We leveraged data from Cleveland Clinic’s reCOVer Clinic for people with long COVID to better understand these associations.”¹

Investigators from the Cleveland Clinic conducted a retrospective analysis to identify risk factors for moderate-to-severe sleep disturbances, which include anxiety, fatigue, hospitalization for COVID-19, and race.¹

They found that Black individuals were 3 times more likely to develop these sleep disturbances, after adjusting for demographics.¹

Additionally, greater anxiety severity, hospitalization for COVID-19, and moderate-to-severe fatigue were significantly associated with moderate to severe sleep disturbance.²

The interaction of anxiety severity to moderate-to-severe fatigue were not significant, according to investiagtors.²

Approximately 67.2% of individuals reported moderate-to-severe fatigue, while 21.8% reported severe fatigue. Also, 58% reported normal to mild disturbances of sleep, while 41.3% reported moderate-to-severe disturbances of sleep.¹

Investigators also determined that there was no association between objective sleep study measures of antecedent sleep apnea and hypoxia.²

“Our findings not only emphasize the importance of identification of sleep disturbance in long COVID considering its impact on patients’ quality of life, daytime functioning, and medical health status, but they also draw the attention to the persistent inequities seen throughout the COVID-19 pandemic,” Pena Orbea said.¹

Data were collected from 962 adults with log COVID in the Cleveland Clinic’s reCOVer Clinic between February 2021 and April 2022.¹

The individuals recovered from COVID-19 and completed the sleep disturbance and fatigue questionnaires for the Patient-Reported Outcomes Measurement Information System.¹

“There is an unmet need to understand the neurobiological mechanisms or pathways behind the association of sleep disturbances with long COVID and, per our findings, investigate the reasons for the increased vulnerability of [post-acute sequelae of COVID-19]-related sleep disturbance in the Black population so that we can develop race-specific interventions to overcome disparities,” Reena Mehra, MD, director of Sleep Disorders Research at the Cleveland Clinic, said in the statement.¹

There is a need for further studies to investigate mental and sleep disturbances from long COVID physiologic pathways, investigators said.²

Limitations of their study could include small sample size, testing indication biases, or limitations of sleep study type, including home sleep apnea tests, investigators said.²

They also noted that the study could suffer from selection bias, but among the Black individuals who did not complete the Patient-Reported Outcomes Measurement Information System Sleep Disturbance, 60% completed the mood and fatigue questionnaires, which could indicate a greater associations between those who are Black and moderate-to-severe sleep disturbances.

References

1. Cleveland Clinic researchers find sleep disturbances prevalent in long COVID. News release. EurekAlert. April 5, 2023. Accessed April 7, 2023. https://www.eurekalert.org/news-releases/985197

2. Pena-Orbea C, Lapin B, Li Y, Englund K, et al. Sleep disturbance severity and correlates in post-acute sequelae of COVID-19 (PASC). J Gen Intern Med. 2023;1-3. doi:10.1007/s11606-023-08187-3