Impaired Sleep in Patients with Post-COVID-19 Syndrome Compared to Healthy Controls: A Cross-Sectional Trial, 2024, Jarosch et al.

SNT Gatchaman

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Impaired Sleep in Patients with Post-COVID-19 Syndrome Compared to Healthy Controls: A Cross-Sectional Trial
Jarosch, Inga; Schneeberger, Tessa; Stegemann, Antje; Gloeckl, Rainer; Leitl, Daniela; Dennis, Clancy; Hitzl, Wolfgang; Schoen, Christopher; Koczulla, Andreas Rembert

INTRODUCTION
To objectify self-reported sleep disorders in individuals with post-COVID-syndrome (PCS), we aimed to investigate the prevalence and nature of sleep disturbances by polysomnography (PSG) in PCS compared to healthy individuals.

METHODS
People with PCS (n = 21) and healthy controls (CON, n = 10) were included in this prospective trial. At baseline, clinical and social anamnesis, lung function, 1 min sit-to-stand test (STST) and Pittsburgh Sleep Quality Index (PSQI) were assessed. For a single-night, sleep health was evaluated by video-PSG. The apnoea/hypopnea index (AHI) was used as the primary outcome.

RESULTS
Twenty patients with PCS (50 ± 11 y, BMI 27.1 m2/kg, SARS-CoV-2 infection 8.5 ± 4.5 months ago) and 10 CON participants (46 ± 10 y, BMI 23.0 m2/kg, no SARS-CoV-2 infection in the history) completed the study. Forced vital capacity (p = 0.018), STST repetitions (p < 0.001), and symptoms of dyspnoea (at rest: p = 0.002, exertion: p < 0.001) were worse in PCS compared to CON. PSQI score (PCS: 7.5 ± 4.7 points) was higher in PCS compared to CON (Δ = 3.7 points, 95% CI [0.4–7.1] p = 0.015), indicating poor sleep in 80% of patients with PCS. Although PSG showed comparable sleep stage distributions in both groups, AHI (Δ = 9.0 n/h, 95% CI [3.3–14.8], p = 0.002), PLM index (Δ = 5.1 n/h, 95% CI [0.4–9.8], p = 0.017), and the prevalence of sleep apnoea (60% vs. 10%, p = 0.028) was significantly higher in PCS compared to CON.

CONCLUSIONS
Quantifiable subjective limitations of sleep have been revealed by PSG data in this PCS cohort. More than half of PCS patients had signs of sleep apnoea, highlighting the importance of sleep screening in PCS.

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Limitations
Firstly, the majority of patients with PCS reported weight gain since COVID-19. As an elevated BMI is an important risk factor for sleep apnoea which was only observed in PCS, this might indicate a higher risk for sleep apnoea in PCS patients, independently of PCS. Nevertheless, BMI did not correlate to AHI in PCS (r = 0.011, p = 0.964) leaving open the possibility that elevated BMI and diagnosis of sleep apnoea do not indicate causality. Secondly, as we included PCS patients during pulmonary rehabilitation, these patients have a history of respiratory issues which is not generalized to the whole PCS cohort.
 
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