Post-Hospitalized COVID-19 Patients Fare Worse in Sleep Quality, Daytime Fatigue Scores

Parth Sitashia, MBBS

Patients previously hospitalized from COVID-19 are at a significantly greater risk of sleep disturbance and daytime sleepiness than the general population, according to new data from the Mayo Clinic – Jacksonville.

In research presented at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting this week, a team of investigators reported that patients to have survived hospitalization due to COVID-19 complications were more likely to report significantly worse sleep impairment, regardless of factors including age or body mass index (BMI), than those who were COVID-naïve. The findings highlight another clinical burden associated with severe disease from the pandemic virus.

A group led by Parth Satashia, MBBS, a research fellow with Mayo Clinic, sought to identify and define sleep disturbance, fatigue and daytime sleepiness burden among a group of post-hospitalized COVID-19 patients. While the virus has generally impacted patients’ respiratory systems, the investigators noted that a “number of clinical sequela have emerged” among those who have recovered from COVID-19.

“Besides the most commonly reported symptoms of fatigue and dyspnea, early studies have found that sleep disturbance is also a common complaint,” they wrote.

Satashia and colleagues recruited patients discharged from Mayo Clinic hospitals after hospitalization for COVID-19 for this study. Exclusion criteria included those with existing diagnoses of sleep apnea or other sleep disorders, while patients without a history of COVID-19 infection nor sleep disorders were recruited as control participants.

Trial participants completed a trio of questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and the Fatigue Severity Scale (FSS). The PSQI is a self-rated questionnaire reviewing a person’s sleep quality and disturbances over the last month, with scores >5 indicating poor sleep quality. The ESS is an 8-item questionnaire that scores chance of sleepiness between 0-24. The FSS is a 9-item scale measuring fatigue severity and its impact on persons, with ≥36 indicating the subject is suffering from fatigue.

Investigators used Wilcoxon rank sum test to evaluate differences between cases and controls across multiple variables, as well as Fisher’s exact test to compare categorical variables.

The final assessment included 62 patients who completed the questionnaires, 33 of whom had been hospitalized with COVID-19. Investigators noted patients with COVID-19 were significantly older than control, and reported a greater mean BMI.

Patients with COVID-19 fared significantly worse in each of median PSQI (10 vs 6; P = .015), ESS (8 vs 5; P = .018) and FSS (30 vs 22; P = .009) versus control. Even after adjusting for the baseline differences in age and BMI, the worse scores remained statistically significant.

After control, mean difference between COVID-19 patents and control were 2.7 for PSQI (95% CI, 0.2 – 5.2; P = .038), 2.93 for ESS (95% CI, 0.66 – 5.2; P = .014), and 12.62 for FSS (95% CI, 5.22 – 20.03; P = .001).

“Preliminary results showed that sleep disturbance per PSQI and daytime symptoms measured by ESS and FSS are found to be significantly higher among post COVID-19 hospitalized patients compared to controls,” Satashia and colleagues concluded.

The study, “Sleep Disturbance Among COVID-19 Posthospitalized Patients,” was presented at SLEEP 2022.