Sleep alterations following COVID-19 are associated with both neuroinflammation and psychological disorders, although at different times

Abstract

IntroductionBy the end of 2019, severe acute respiratory syndrome coronavirus 2 rapidly spread all over the world impacting mental health and sleep habits. Insomnia, impaired sleep quality, and circadian rhythm alterations were all observed during the pandemic, especially among healthcare workers and in patients with acute and post-acute COVID-19. Sleep disruption may induce a pro-inflammatory state associated with an impairment of immune system function.ObjectiveWe investigated the relationship between sleep alterations, psychological disorders, and inflammatory blood biomarkers in patients with post-acute COVID-19.MethodsWe enrolled 47 subjects diagnosed with COVID-19 pneumonia at Santa Maria della Misericordia University Hospital (Udine, Italy) between March and May 2020. Selected patients were evaluated at 2 months (T1) and 10 months (T2) after discharge. Each time, we collected clinical interviews, neurological examinations, and self-administered questionnaires to assess sleep and life quality, anxiety, depression, and post-traumatic stress disorder. Blood biomarkers of endothelial activation, neuroinflammation, and inflammatory cytokines were also measured at each follow-up. Collected variables were analyzed using comparisons between groups and linear regression models.ResultsPrevalence of insomnia increased from 10.6% up to 27.3% after COVID-19. Poor sleep quality was found in 41.5% of patients at both study visits. At T1 follow-up, poor sleepers showed higher levels of neurofilament light chain, vascular cell adhesion molecule 1, and interleukin 10; no significant associations were found between sleep quality and psychological disorders. At T2 follow-up, lower sleep quality was associated with higher levels of vascular cell adhesion molecule 1 and interleukin 8, but also with higher scores for anxiety, depression, and post-traumatic stress disorder.ConclusionOur results suggest an association of poor sleep quality with both psychological disorders and neuroinflammation, although at different times, in previously hospitalized patients with moderate-to-critical COVID-19.

Sleep disturbance in post COVID-19 conditions: Prevalence and quality of life

“…Global PSQI score of post COVID-19 conditions also showed a statistically significant positive correlation with various domains of the SF-36 QoL scale ( 4 ). Another study also indicated that poor sleepers based on PSQI examination significantly underperformed in several SF-36 areas relating to subjective physical and mental health indicators when compared to good ones ( 29 ).…”

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

“…First, the hypothesised directionality of effects in the directed acyclic graph ( appendix pp 28–29, 32 ), used to identify the covariates in our models, cannot be confirmed by the data in this study. Other studies do support the hypothesised directions; 36 , 37 however, bidirectionality relationships have been reported in other settings. 16 Second, quantification of sleep quality deterioration based on the numerical rating scale relied upon participant recall and therefore could be affected by recall bias, also known as reporting bias.…”

Insomnia among coronavirus disease 2019 survivors: A single-center cross-sectional study

“…COVID-19 rehabilitation patients with poor sleep quality had higher levels of neurofilament light chain, vascular cell adhesion molecule 1, IL-10, and IL-8 in the blood, which were considered to be correlated with insomnia. [ 36 ] The activation of hypothalamic-pituitary-adrenal (HPA) axis by stressors and cortisol secretion may be related to sleep disorders caused by COVID-19. [ 37 ] Stressors in the context of the COVID-19 pandemic include changes in the work environment, financial concerns, and health risks.…”