Sleep disturbance increases the risk of severity and acquisition of COVID-19: a systematic review and meta-analysis

Abstract

Background Understanding the association between sleep quality and COVID-19 outcomes is crucial for effective preventive strategies and patient management. This systematic review aims to evaluate the impact of sleep quality as a risk factor for acquiring COVID-19 infection and the severity of the disease. Methods A comprehensive search of electronic databases was conducted to identify relevant studies published from the inception of the COVID-19 pandemic which was 31st of December 2019 until 30 April 2023. Studies investigating the relationship between sleep quality and COVID-19 infection, or disease severity were included. Random effect meta-analysis was performed with odds ratios (OR) and their 95% confidence intervals (95% CI) as effect measures. Results Out of the initial 1,132 articles identified, 12 studies met the inclusion criteria. All studies were observational studies (cohort, case–control, and cross-sectional). The association between sleep quality and COVID-19 infection risk was examined in 6 studies, The results of our meta-analysis showed that participants with poor sleep quality showed a 16% increase regarding the risk of COVID-19 acquisition (OR 1.16; 95% CI 1.03, 1.32; I2 = 65.2%, p = 0.02). Our results showed that participants with poor sleep quality showed a 51% increase in the incidence of primary composite outcome (OR 1.51; 95% CI 1.25, 1.81; I2 = 57.85%, p < 0.001). The result of our subgroup analysis also showed significantly increased risk of mortality (RR 0.67; 95% CI 0.50, 0.90; I2 = 31%, p = 0.008), and disease severity (OR 1.47; 95% CI 1.19, 1.80; I2 = 3.21%, p < 0.001) when comparing poor sleep group to those with good sleep quality. Conclusion This study highlights a significant association between poor sleep quality and an increased risk of COVID-19 infection as well as worse disease clinical outcomes.

Bidirectional relationship between sleep problems and long COVID: a longitudinal analysis of data from the COVIDENCE UK study

“…Short sleep duration and sleep disturbances have been found to be associated with increased incidence of upper respiratory tract infections, including COVID-19, 8,30,31 as well as poorer outcomes from these infections. 8,31 Our longitudinal analysis extends these findings to show the bidirectional nature of the relationship between sleep and COVID-19 within the same cohort.…”

“…Short sleep duration and sleep disturbances have been found to be associated with increased incidence of upper respiratory tract infections, including COVID-19, 8,30,31 as well as poorer outcomes from these infections. 8,31 Our longitudinal analysis extends these findings to show the bidirectional nature of the relationship between sleep and COVID-19 within the same cohort. A large cross-sectional study 32 of both community and hospitalised COVID-19 cases has previously shown a bidirectional relationship between insomnia and long COVID, reporting increased risk of long COVID among people with pre-pandemic insomnia and a higher prevalence of post-infection insomnia among people with long COVID.…”

No evidence linking sleep traits with white blood cell counts: Multivariable‐adjusted and Mendelian randomization analyses

“…Sleep is a high‐dimensional phenotype, 1 is different for men and women, and is changing with increasing age 2 . Disturbances in single dimensions of habitual sleep are increasingly recognized as important risk factors contributing to the onset of age‐related diseases, including metabolic, cardiovascular and neurodegenerative diseases, 3–7 COVID‐19 and influenza susceptibility, 8,9 some types of cancer, 10–12 and mortality 13 . Mendelian randomization, which uses genetic variants associated with the exposure of interest as instrumental variable, 14–17 indicated that short self‐reported sleep duration and poor sleep quality play a causal role in the risk of cardiometabolic disease and dementia, 16,18–20 and susceptibility to some infectious diseases, 9 thus making sleep of particular interest as target for disease prevention.…”

Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions

“… 2 , 5 Recently, obstructive sleep apnea (OSA) has been demonstrated in two large studies to be associated with the development of PASC. 6 , 7 Although poor sleep quality and short sleep duration are associated with an increased risk of acute COVID-19 infection, 8 , 9 it is uncertain whether they also are related to a higher likelihood of PASC.…”