Sleep problems before COVID and the risk of long COVID in a large population using three different models
Updated
Abstract
The prevalence rates of post-acute sequelae of SARS-CoV-2 infection (PASC) were 21.9%, 38.9%, and 15.5% based on three different definitions.
- Insomnia was associated with PASC across all three definitions, with odds ratios ranging from 1.30 to 1.52.
- Poor sleep quality was linked to PASC in all models, showing adjusted odds ratios from 1.77 to 2.00.
- Short sleep duration (less than 6 hours) was associated with PASC, with odds ratios between 1.59 and 1.70.
- Sleeping 9 hours or more was not related to PASC in any of the models.
- Vaccination with a COVID-19 booster reduced the likelihood of developing PASC, but did not weaken the associations of insomnia, poor sleep quality, and short sleep duration with PASC.
Simplified
Funding
Competing interests
All authors have seen and approved the manuscript. Conflicts of Interest: M.D.W. reports institutional support from the United States Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, and Delta Airlines as well as consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. L.K.B. reports institutional support from the United States Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots as well as honorariums from the National Institutes of Occupational Safety and Health, University of Arizona, and University of British Columbia. M.É.C. reported personal fees from Vanda Pharmaceuticals Inc., research grants or gifts to Monash University from WHOOP, Inc., Hopelab, Inc., CDC Foundation, and the Centers for Disease Control and Prevention. S.M.W.R. reported receiving grants and personal fees from Cooperative Research Centre for Alertness, Safety, and Productivity, receiving grants and institutional consultancy fees from Teva Pharma Australia and institutional consultancy fees from Vanda Pharmaceuticals, Circadian Therapeutics, BHP Billiton, and Herbert Smith Freehills. S.F.Q. has served as a consultant for Best Doctors, Bryte Foundation, Jazz Pharmaceuticals, Apnimed, and Whispersom. R.R. reports personal fees from SleepCycle AB; Rituals Cosmetics BV; Sonesta Hotels International, LLC; Ouraring Ltd; AdventHealth; and With Deep, LLC. C.A.C. serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc. and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc., Philips Respironics, Inc., Optum, and ResMed, Inc.; research support to Brigham and Women’s Hospital from Axome Therapeutics, Inc., Dayzz Ltd., Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc., Takeda Pharmaceutical Co., Ltd., Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc., Teva Pharmaceuticals Industries, Ltd., and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc.; personal consulting fees from Axome, Inc., Bryte Foundation, With Deep, Inc., and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd. and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the United Kingdom Biotechnology and Biological Sciences Research Council. C.A.C. has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc.; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc./Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc.; Puget Sound Pilots; and the San Francisco Sheriff’s Department; Schlumberger Technology Corp.; Union Pacific Railroad; United Parcel Service; Vanda Pharmaceuticals. C.A.C. has received travel support from the Stanley Ho Medical Development Foundation for travel to Macao and Hong Kong; equity interest in Vanda Pharmaceuticals, With Deep, Inc., and Signos, Inc.; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc., Harmony Biosciences LLC, Eisai Co., LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp., Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F. and Diana L. Quan Charitable Fund. Dr. Czeisler’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict of interest policies. No other disclosures were reported. Preprint Information: A preprint of this manuscript has posted on medRxiv. Funding Information: This work was supported by the Centers for Disease Control and Prevention. Dr. M. Czeisler was supported by an Australian-American Fulbright Fellowship, with funding from The Kinghorn Foundation. The salaries of Dr. Barger, Dr. Czeisler, Dr. Robbins, and Dr. Weaver were supported, in part, by National Institute for Occupational Safety and Health R01 OH011773 and National Heart, Lung, and Blood Institute (NHLBI) R56 HL151637. Dr. Robbins also was supported in part by NHLBI K01 HL150339.
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