Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: 2023 authors incl. Chalder

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Summary
Background
Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea.
Methods
CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107).
Findings
2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect.
Interpretation
Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition.
Funding
UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00124-8/fulltext?rss=yes

 

Well, if it's caused by SOB, then it's the SOB that should be targeted, not its consequence. You find an object obstructing a stream, and the only thing you can think is to address the consequences of the blockage? Not the blockage? That's just a weird conclusion. As if thinking in root causes is... forbidden? Almost feels that way. It's like they're working with all the wrong tools. Using screwdrivers to hammer nails, and electric hammers to paint.

This is also a common problem with patients who never get hospitalized. Except they usually don't have impaired lung function as assessed this way. So they are reflexively told that it must be, MUST be, anxiety. By numbers it's far greater.

And still this study tells us nothing about this. This is a very expensive and slow process for such mediocre results. But I guess things must continue to be done the same way, because it's the way things are done that matters, not outcomes. I guess? I don't know anymore.

 

Sleep disturbances, dyspnoea, and anxiety in long COVID

This study is an important addition to the literature, but a few potential limitations are noteworthy. First, since fewer than 50% of participants with COVID-19 provided follow-up data, a concern exists for participation bias, ascertainment bias, and recall bias (given that pre-existing abnormalities would be difficult to assess). Although the demographics of the participants resemble the overall CircCOVID cohort of more than 2000 participants, the findings clearly pertain only to the CircCOVID subcohorts studied. In theory, the most severely affected patients would be least likely to present for follow-up. Conversely, patients who are sometimes labelled as having psychosomatic complaints might be those most likely to seek follow-up care. Second, further data are required to investigate the degree of objective versus subjective abnormality in patients who have recovered from COVID-19. Although some patients might be labelled as having functional complaints, the observation of objective brain abnormalities after COVID-19 in previous studies might suggest an important neurological role in mediating symptoms. 6 Third, given the nature of this epidemiological study, the findings represent correlation rather than causation. For example, it is unclear whether sleep disturbance is causing anxiety or whether anxiety is contributing to poor sleep. Interventional studies are required to define the underlying causal pathways. Fourth, although some objective testing was available, gold standard polysomnography and full plethysmography were not provided. For the sleep disturbances, increased BMI in the cohort reporting poor sleep compared with those reporting good sleep might suggest underlying obstructive sleep apnoea, although this assertion is speculative. Thus, further mechanistic work is required to draw definitive conclusions.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00138-8/fulltext

 

Where on earth did they get that idea from 'in theory'?

Well yes if you made it inaccessible to them - and I don't see how that can still be allowed to be a pat statement where noone made any attempt to see what might be possible there. Did they look at whether what they were offering would have any benefit at all vs the risks for such patients?

Or it is something else... like how your heart rate raises when you overdo it in ME/CFS, which isn't actually 'anxiety' but sadly too much of the literature seems to be trying to make it confused that way. It could trigger anxiety though (anxiety is actually physiological happens first normally even according to its own models, not the 'thought patterns') and could therefore be responsible for both.

 

What a weird framing. Obviously sick people being denied proper care will continue seeking health care. This is literally what's expected. But it has nothing to do with psychosomatic, it's the denial of care, whatever form or nature it takes.

And of course this basically ignores reality. They wouldn't have to work hard to find how common it is for chronically ill patients to give up entirely, getting the message that we don't actually have a right to competent medical care.

This is really a failure of object permanence. As if not seeing the illness makes it never have existed in the first place. What a weird bunch of people with old ideas.