Sleep Disturbances Associated with COVID-19

Educational Objectives

The goal of this program is to improve treatment of sleep disturbances associated with COVID-19. After hearing and assimilating this program, the clinician will be better able to:

1. Analyze the association between sleep duration and antibody acquisition after COVID-19 vaccination.

Summary

Prevalence of sleep disorders in long COVID-19: Chinvararak et al (2023) — after COVID-19, 56% of the patients with sleep disturbance reported disruptions in sleep quality, 38% reported insomnia, and 14% reported hypersomnia; the prevalence of sleep disorders is significant in long COVID-19

The impact of acute respiratory distress syndrome (ARDS) on sleep and circadian rhythms in COVID-19 survivors: a prospective observational study by Henríquez-Beltrán et al (2023) found that post-COVID-19, 91% of patients had poor sleep quality, 59% had insomnia, 50% reported daytime sleepiness, and 37% had comorbid insomnia and obstructive sleep apnea (COMISA); sleep disorders were highly prevalent in long COVID-19 at 4 and 12 mo; though patients with ARDS did not have statistically higher rates of COMISA at 4 and 12 mo, there was a trend toward that; there were also no notable changes in symptoms or circadian rhythms measured by actigraphy between 4 and 12 mo; the symptoms persisted for longer durations

Obstructive sleep apnea (OSA) as a risk factor for post-acute sequelae of COVID-19 (PASC): Quan et al (2023) — the cross-sectional survey found that 22% of COVID-19 survivors reported PASC; the PASC symptoms were associated with OSA after adjusting for the demographic comorbidities and socioeconomic covariates; OSA is a risk factor for long COVID-19; the symptoms could be mitigated by OSA treatment

Associations between changes in habitual sleep duration (HSD) and lower self-rated health (SRH) among COVID-19 survivors: Matsui et al (2023) — conducted an online survey across 16 countries and found that a lower SRH score was associated with the COVID-19 infection (the worse the COVID-19, the lower the SRH); decreases and increases in HSD after infection were associated with SRH; the decrease in HSD was related to fatigue, shortness of breath, gastrointestinal symptoms, and hallucinations; an increase in HSD was associated with fatigue; they concluded that changes in HSD after COVID-19 were associated with lower perceived SRH scores

Insomnia and long COVID-19: Chen et al (2023) — found that patients with COVID-19 with pre-pandemic insomnia were at higher risk of developing long COVID-19 than those without pre-pandemic insomnia; incident insomnia was 24% for acute COVID-19 and 60% for long COVID-19

Prevalence of sleep disturbances in long COVID-19: Linh et al (2023) — found that the pooled prevalence of sleep disturbances in patients who were COVID-19-positive was ≈29%; severe COVID-19 infection and female sex were considered risk factors for sleep disturbances; the prevalence of sleep disturbance was higher in COVID-19 survivors

COVID-19 and brain changes: Qin et al (2023) — found that, regardless of sleep disturbances, those patients who had COVID-19 had widespread white matter microstructure abnormalities (at 1 and 3 mo); patients with sleep disturbances had higher interleukin-1β (IL-1β) and Pittsburgh Sleep Quality Index (PSQI) scores and specific patterns of white matter changes compared with those who did not have sleep disturbances; imaging, cytokines, and the PSQI scores showed a trend toward improvement at 3 mo; they concluded that COVID-19 infection is associated with neuroinflammation regardless of sleep symptoms; those who develop sleep symptoms might represent a different group and a different possible phenotype

Sleep duration and antibody response to vaccination: Izuhara et al (2023) found that actigraphy-measured sleep duration 3 and 7 days after the booster vaccination independently and significantly correlated with higher antibody titers even after controlling for covariates, including age, sex, the type of vaccine, and reactogenicity to the vaccination; sleeping longer was associated with enhanced antibody response

Readings

Chen SJ, Morin CM, Ivers H, et al. The association of insomnia with long COVID: An international collaborative study (ICOSS-II). Sleep Med. 2023;112:216-222. doi:10.1016/j.sleep.2023.09.034; Chinvararak C, Chalder T. Prevalence of sleep disturbances in patients with long COVID assessed by standardised questionnaires and diagnostic criteria: A systematic review and meta-analysis. J Psychosom Res. 2023;175:111535. doi:10.1016/j.jpsychores.2023.111535; Henríquez-Beltrán M, Benítez I, Belmonte T, et al. Association between Acute Respiratory Distress Syndrome Due to COVID-19 and Long-Term Sleep and Circadian Sleep-Wake Disorders. J Clin Med. 2023;12(20):6639. Published 2023 Oct 20. doi:10.3390/jcm12206639; Izuhara M, Matsui K, Yoshiike T, et al. Association between sleep duration and antibody acquisition after mRNA vaccination against SARS-CoV-2. Front Immunol. 2023;14:1242302. Published 2023 Dec 11. doi:10.3389/fimmu.2023.1242302; Linh TTD, Ho DKN, Nguyen NN, et al. Global prevalence of post-COVID-19 sleep disturbances in adults at different follow-up time points: A systematic review and meta-analysis. Sleep Med Rev. 2023;71:101833. doi:10.1016/j.smrv.2023.101833; Matsui K, Chung F, Bjelajac AK, et al. Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions. BMC Public Health. 2023;23(1):2352. Published 2023 Nov 28. doi:10.1186/s12889-023-17258-3; Meaklim H, Junge MF, Varma P, et al. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097. doi:10.5664/jcsm.9354; Qin H, Duan G, Zhou K, et al. Alteration of white matter microstructure in patients with sleep disorders after COVID-19 infection. Sleep Med. 2024;114:109-118. doi:10.1016/j.sleep.2023.12.024; Quan SF, Weaver MD, Czeisler Mé, et al. Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Preprint. medRxiv. 2023;2023.12.30.23300666. Published 2023 Dec 31. doi:10.1101/2023.12.30.23300666.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Sarmiento was recorded at the 29th Annual Advances in Diagnosis and Treatment of Sleep Apnea and Snoring, held February 16-17, 2024, in San Francisco, CA, and presented by the University of California, San Francisco. For information on upcoming CME activities from this presenter, please visit https://sleepapnea.ucsf.edu. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.25 CE contact hours.

Lecture ID:

OT572003

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.