The association of insomnia with long COVID: An international collaborative study (ICOSS-II) 2023 Chen et al

[Andy]

Objective
There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection.

Methods
Data were collected cross-sectionally (May–Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18–99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety.

Results
COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07–1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50–2.66).

Conclusions
The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S1389945723003672

 

[Peter T]

Having red hair is associated with sun burn so it is obvious we need to manage ‘red hairness’ in order to prevent sun burn. Perhaps if people with red hair dyed their hair black all would be resolved.

Although association is necessary in demonstrating causation, when will these people recognise it is not sufficient.

 

[Amw66]

Objective
There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection.

Methods
Data were collected cross-sectionally (May–Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18–99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety.

Results
COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07–1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50–2.66).

Conclusions
The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S1389945723003672

Just demonstrates how little we know about sleep.

 

[rvallee]

They're arguing that pre-COVID insomnia leading to an increase in post-COVID insomnia means that they can improve the post-COVID by addressing the insomnia?

Wow. I guess they think that insomnia is just a thing people have without any underlying explanation. Obviously they did not show a bidirectional relationship, but it didn't stop them from saying so anyway.

Were medieval alchemists ever this weird? This is just weird. It's not as if it was widely known that medicine doesn't have a clue about sleep and doesn't know how to deal with insomnia. Surprised they didn't simply assert CBT would do it, it's the standard go-to.

 

[SNT Gatchaman]

They almost get the possibility that insomnia might result from immune/inflammatory pathology, but then appear to settle on insomnia -> LC.

Insomnia may lead to increased risk of developing long COVID for several reasons. First, long COVID may result from changes in immune system caused by insomnia, as previous studies have shown that insomnia is associated with elevated levels of cytokines, such as interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-a), which were also found in patients with long COVID.

Second, the increased risk of developing long-term COVID-19 symptoms may be related to various medical problems that are often comorbid with insomnia. Prior study* has demonstrated significant overlaps between insomnia and multiple medical problems, including breathing, urinary, and gastrointestinal conditions, and chronic pain, which have been identified as risk factors for long COVID. Third, a previous episode of insomnia (pre-pandemic insomnia) may predispose individuals to increased risks of having a more severe disease and a prolonged COVID-19 duration.

Consistent with previous studies, we found a relatively high rate of newly developed insomnia symptoms after infection, especially among long COVID cases. The occurrence of insomnia symptoms after infection may result from the neuroinflammation potential of the coronavirus, given that sleep impairment is one of the common neuropsychiatric symptoms. In addition, the extensive neuroinflammation in long COVID patients may partly explain the higher risk of developing insomnia symptoms for long COVID cases than short COVID cases. Other factors, such as impaired immune response, corticosteroids use during treatment, elevated stress responses, disrupted circadian rhythm and altered sleep architecture, may also be associated with the sleep consequences of infection. Furthermore, the increased risk of developing insomnia symptoms in long COVID cases may also result from other long COVID symptoms, such as bodily pain and urinary problems, which have been associated with comorbid insomnia.

These findings indicate the need for routine assessment and management of insomnia in order to facilitate prevention and treatment of long COVID.

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* Comorbidity of Chronic Insomnia With Medical Problems (2007, Sleep)

See also —

The Association Between Insomnia and Atherosclerosis: A Brief Report (2022, Nature and Science of Sleep) which concludes "Insomnia correlated with increased arterial stiffness and carotid atherosclerosis, and as the duration of insomnia prolongs, the correlation between them became more obvious."