Cleveland, OH—Significant sleep disturbance afflicts more than one-third of long COVID patients, with black patients being especially affected, according to a new study.

The retrospective analysis published in the Journal of General Internal Medicine reports that race, hospitalization for COVID-19, greater anxiety severity, and fatigue were all risk factors for moderate-to-severe sleep disturbances.

In fact, after adjusting for demographics, Cleveland Clinic–led researchers determined that black patients were three times more likely to develop sleep problems.

“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,” said lead author Cinthya Pena Orbea, MD, assistant professor of medicine at the Cleveland Clinic Sleep Disorders Center. “We leveraged data from Cleveland Clinic’s reCOVer Clinic for people with long COVID to better understand these associations.”

Background information in the articles explained that postacute COVID-19 syndrome (PASC)—also known as “long COVID”—“is a global public health crisis in which patients experience lingering and debilitating symptoms beyond 4 weeks after the acute onset of SARS-CoV-2 infection. Sleep disturbance has a reported prevalence of 34–50% in PASC, but only a few studies have identified associated risk factors, and these have primarily described sleep quality and not symptom severity.”

They added that past studies have not examined whether mood disorders and fatigue are linked with sleep disturbance severity or the association of objective sleep study indices in PASC.

Adult patients with PASC were evaluated at the Cleveland Clinic ReCOver Clinic between February 2021 and April 2022. Prospectively examined were patients who completed Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance within 90 days or during their initial ReCOver clinic visit. The researchers extracted demographics and clinical characteristics were extracted from the COVID-19 Cleveland Clinic Registry.

Apnea Hypopnea Index (AHI) and hypoxia measures (mean oxygen saturation [SaO2%] and percentage of time spent <90% oxygen saturation [T90]) were recorded for a subset with pre-infection sleep studies available.

During the initial ReCOver clinic visit, the study team collected patient-reported outcomes from the electronic medical record, including PROMIS Sleep Disturbance, Fatigue, and Global Health v1.2, generalized anxiety disorder-2, patient health questionnaire-2, and the Quality of Life in Neurological Disorders v1.0 Cognitive Function.

Among 962 of 1,660 patients who completed the PROMIS Sleep Disturbance, 565 (58.7%) had normal-to-mild sleep disturbance and 397 (41.3%) had moderate-to-severe sleep disturbance. After adjustment, the researchers found that the following were significantly associated with moderate to severe sleep disturbance:

• Black race (odds ratio [OR] = 1.84; 95% CI, 1.10-3.08, P = .020)
• Hospitalization for COVID-19 (OR = 1.59; 95% CI, 1.10-2.32, P <.015),
• Greater anxiety severity (OR = 1.31; 95% CI: 1.18-1.45, P <.001), and
• Moderate-to-severe fatigue (OR = 2.03, 95% CI: 1.33-3.11, P = .001).

The study noted that more than two-thirds of patients (67.2%) reported moderate-to-severe fatigue, while 21.8% reported severe fatigue. In addition, more than one-half of the patients (58%) reported normal-to-mild disturbances, but 41.3% indicated moderate-to-severe sleep disturbances.

“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, MD, noted.

 “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 PASC-related sleep disturbance in the Black population so that we can develop race-specific interventions to overcome disparities,” added senior author Reene Mehra, MD, director of the Sleep Disorders Clinic at Cleveland Clinic.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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