<p>Reduced Sleep in the Week Prior to Diagnosis of COVID-19 is Associated with the Severity of COVID-19</p>
Baozhen Huang, Yanlin Niu, Weiguo Zhao, Pengtao Bao, Diangeng Li
Nature and Science of Sleep, doi:10.2147/nss.s263488
Background: The rapid outbreak of coronavirus disease 2019 (COVID-19) is a major health concern, in response to which widespread risk factor research is being carried out. Objective: To discover how physical activity and lifestyle affect the epidemic as well as the disease severity and prognosis of COVID-19 patients. Methods: This multicenter, retrospective cohort study included 203 adults infected with COVID-19 and 228 uninfected adults in three Chinese provinces, with 164 (80.7%) of the infected participants and 188 (82.5%) of the uninfected participants answering a doctoradministered telephone questionnaire on lifestyle. The binary logistic regression model and the ordinal logit model were used to observe relevance. Results: Comparing sick and non-sick patients, we found that irregular exercise (P=0.004), sedentary lifestyle (P=0.010), and overexertion (P<0.001) may be associated with the susceptibility to COVID-19. In symptomatic patients, using the recommended status as a reference, risk of severe infection increased with decreased sleep status, being 6.729 (95% CI=2.138-21.181) times higher for potentially appropriate sleep (P=0.001) and peaking at 8.612 (95% CI=1.913-38.760) times higher for lack of sleep (P=0.005). Reduction in average daily sleep time significantly increased the likely severity (P=0.002). Discussion: Through further examination of damage of external lung organs, we found that lack of sleep affected not only disease severity but also prognosis. Based on these findings, the public should prioritize a healthy lifestyle and get adequate sleep in response to the outbreak. The study of life habits may bring new ideas for the prevention and treatment of COVID-19.
Abbreviations COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; RT-PCR, real-time reverse-transcription polymerase-chainreaction; CT, computed tomography; IPAQ, International Physical Activity Questionnaire; NSF, National Sleep Foundation; OR, odds ratio; CI, confidence interval; BMI, body mass index; MET, metabolic equivalent of task.
Ethics Declarations The study complied with the Declaration of Helsinki and the ethical approval in this study was obtained from the Research and Ethics Committee of the Chinese PLA General Hospital (No. S2020-063-01). All patients involved in this study signed informed consent.
Author Contributions Baozhen Huang and Yanlin Niu contributed the same in this study. All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed on the journal to which the article will be submitted; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure The authors declare that they have no conflict of interest for this work.
Nature and Science of Sleep
Dovepress
References
Boon, Hamlin, Steel, Ross, Validation of the New Zealand Physical Activity Questionnaire (NZPAQ-LF) and the International Physical Activity Questionnaire (IPAQ-LF) with accelerometry, Br J Sports Med,
doi:10.1136/bjsm.2008.052167Bryant, Trinder, Curtis, Sick and tired: does sleep have a vital role in the immune system?, Nat Rev Immunol,
doi:10.1038/nri1369Fan, Hao, Yang, Clinical characteristics of COVID-19 and establishment of a disease risk prediction model, SSRN J,
doi:10.2139/ssrn.3556660Guan, Liang, Zhao, Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis, Eur Respir J,
doi:10.1183/13993003.00547-2020Iibarra-Coronado, Pantaleón-Martínez, Velazquéz-Moctezuma, The bidirectional relationship between sleep and immunity against infections, J Immunol Res,
doi:10.1155/2015/678164Irwin, Mcclintick, Costlow, Fortner, White et al., Partial night sleep deprivation reduces natural killer and cellular immune responses in humans, FASEB J,
doi:10.1096/fasebj.10.5.8621064Khair, Nwaneri, Damico, Kolb, Hassoun et al., The minimal important difference in borg dyspnea score in pulmonary arterial hypertension, Ann Am Thorac Soc,
doi:10.1513/AnnalsATS.201512-824OCPatel, Malhotra, Gao, Hu, Neuman et al., A prospective study of sleep duration and pneumonia risk in women, Sleep,
doi:10.5665/sleep.1594Scholes, Bridges, Ng Fat, Mindell, Brucki, Comparison of the physical activity and sedentary behaviour assessment questionnaire and the short-form international physical activity questionnaire: an analysis of health survey for England data. Brucki S, PLoS One,
doi:10.1371/journal.pone.0151647Who, None
Zhao, Zhao, Wang, Zhou, Ma et al., Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2, Bioinformatics,
doi:10.1101/2020.01.26.919985Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3Zhu, Zhao, Lai, Dose-response association between risk factors and incidence of COVID-19 in 325 hospitalized patients: a Multicenter Retrospective Cohort Study,
doi:10.2139/ssrn.3562478{ 'indexed': {'date-parts': [[2022, 4, 29]], 'date-time': '2022-04-29T15:06:41Z', 'timestamp': 1651244801500},
'reference-count': 25,
'publisher': 'Informa UK Limited',
'license': [ { 'start': { 'date-parts': [[2020, 11, 1]],
'date-time': '2020-11-01T00:00:00Z',
'timestamp': 1604188800000},
'content-version': 'unspecified',
'delay-in-days': 0,
'URL': 'http://creativecommons.org/licenses/by-nc/3.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'DOI': '10.2147/nss.s263488',
'type': 'journal-article',
'created': { 'date-parts': [[2020, 11, 12]],
'date-time': '2020-11-12T02:46:14Z',
'timestamp': 1605149174000},
'page': '999-1007',
'source': 'Crossref',
'is-referenced-by-count': 11,
'title': '<p>Reduced Sleep in the Week Prior to Diagnosis of COVID-19 is Associated with the '
'Severity of COVID-19</p>',
'prefix': '10.2147',
'volume': 'Volume 12',
'author': [ {'given': 'Baozhen', 'family': 'Huang', 'sequence': 'first', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-4946-3028',
'authenticated-orcid': True,
'given': 'Yanlin',
'family': 'Niu',
'sequence': 'additional',
'affiliation': []},
{'given': 'Weiguo', 'family': 'Zhao', 'sequence': 'additional', 'affiliation': []},
{'given': 'Pengtao', 'family': 'Bao', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-8698-4746',
'authenticated-orcid': True,
'given': 'Diangeng',
'family': 'Li',
'sequence': 'additional',
'affiliation': []}],
'member': '301',
'published-online': {'date-parts': [[2020, 11]]},
'reference': [ { 'key': 'ref1',
'unstructured': 'WHO. Available from: https://www.who.int. Accessed March 31, 2020.'},
{ 'key': 'ref2',
'doi-asserted-by': 'publisher',
'author': 'Fan',
'year': '2020',
'journal-title': 'SSRN J',
'DOI': '10.2139/ssrn.3556660'},
{ 'key': 'ref3',
'doi-asserted-by': 'publisher',
'author': 'Zhu',
'year': '2020',
'journal-title': 'SSRN J',
'DOI': '10.2139/ssrn.3562478'},
{ 'key': 'ref4',
'doi-asserted-by': 'publisher',
'first-page': '1054',
'DOI': '10.1016/S0140-6736(20)30566-3',
'volume': '395',
'author': 'Zhou',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': 'ref5',
'doi-asserted-by': 'publisher',
'first-page': '1499',
'DOI': '10.1001/jama.2020.3633',
'volume': '323',
'author': 'Murthy',
'year': '2020',
'journal-title': 'JAMA'},
{ 'key': 'ref6',
'doi-asserted-by': 'publisher',
'first-page': 'e20',
'DOI': '10.1016/S2213-2600(20)30117-X',
'volume': '8',
'author': 'Cai',
'year': '2020',
'journal-title': 'Lancet Respir Med'},
{ 'key': 'ref7',
'doi-asserted-by': 'publisher',
'author': 'Zhao',
'year': '2020',
'journal-title': 'Bioinformatics',
'DOI': '10.1101/2020.01.26.919985'},
{ 'key': 'ref8',
'doi-asserted-by': 'publisher',
'first-page': '321',
'DOI': '10.1080/02640414.2011.627371',
'volume': '30',
'author': 'Gleeson',
'year': '2012',
'journal-title': 'J Sports Sci'},
{ 'key': 'ref9',
'doi-asserted-by': 'publisher',
'first-page': '377',
'DOI': '10.1016/j.bbi.2005.04.002',
'volume': '19',
'author': 'Lowder',
'year': '2005',
'journal-title': 'Brain Behav Immun'},
{ 'key': 'ref10',
'doi-asserted-by': 'publisher',
'first-page': '157',
'DOI': '10.1097/JES.0b013e3181b7b57b',
'volume': '37',
'author': 'Martin',
'year': '2009',
'journal-title': 'Exerc Sport Sci Rev'},
{ 'key': 'ref11',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1155/2015/678164',
'volume': '2015',
'author': 'IIbarra-Coronado',
'year': '2015',
'journal-title': 'J Immunol Res'},
{ 'key': 'ref12',
'doi-asserted-by': 'publisher',
'first-page': '3',
'DOI': '10.2807/1560-7917.ES.2020.25.3.2000045',
'volume': '25',
'author': 'Corman',
'year': '2020',
'journal-title': 'Eurosurveillance'},
{ 'key': 'ref13',
'doi-asserted-by': 'publisher',
'first-page': '842',
'DOI': '10.1513/AnnalsATS.201512-824OC',
'volume': '13',
'author': 'Khair',
'year': '2016',
'journal-title': 'Ann Am Thorac Soc'},
{ 'key': 'ref14',
'doi-asserted-by': 'crossref',
'unstructured': 'Diagnosis and treatment plan for COVID-19 (trial version 6). Chin Med J. '
'2020.',
'DOI': '10.4103/2311-8571.281609'},
{ 'key': 'ref15',
'doi-asserted-by': 'publisher',
'first-page': '2000547',
'DOI': '10.1183/13993003.00547-2020',
'volume': '55',
'author': 'Guan',
'year': '2020',
'journal-title': 'Eur Respir J'},
{ 'key': 'ref16',
'unstructured': 'US Department of Health and Human Services, & National Institutes of '
'Health. Your Guide to Physical Activity and Your Heart (No. 06-5714). '
'NIH Publication; 2006.'},
{ 'key': 'ref17',
'doi-asserted-by': 'publisher',
'first-page': '741',
'DOI': '10.1136/bjsm.2008.052167',
'volume': '44',
'author': 'Boon',
'year': '2010',
'journal-title': 'Br J Sports Med'},
{ 'key': 'ref18',
'unstructured': 'IPAQ committee. Guidelines for data processing and analysis of the '
'International Physical Activity Questionnaire (IPAQ). November, 2005. '
'Available from: http://www.ipaq.ki.se/scoring.html. Accessed September '
'23, 2020.'},
{ 'key': 'ref19',
'doi-asserted-by': 'publisher',
'first-page': 'e0151647',
'DOI': '10.1371/journal.pone.0151647',
'volume': '11',
'author': 'Scholes',
'year': '2016',
'journal-title': 'PLoS One'},
{ 'key': 'ref20',
'unstructured': 'National Sleep Foundation. National sleep foundation recommends new '
'sleep times. February 2, 2015. Available from: '
'https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times. '
'Accessed September 23, 2020.'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'first-page': '457',
'DOI': '10.1038/nri1369',
'volume': '4',
'author': 'Bryant',
'year': '2004',
'journal-title': 'Nat Rev Immunol'},
{ 'key': 'ref22',
'doi-asserted-by': 'publisher',
'first-page': '3408',
'DOI': '10.2174/138161208786549281',
'volume': '14',
'author': 'Krueger',
'year': '2008',
'journal-title': 'CPD'},
{ 'key': 'ref23',
'doi-asserted-by': 'publisher',
'first-page': '643',
'DOI': '10.1096/fasebj.10.5.8621064',
'volume': '10',
'author': 'Irwin',
'year': '1996',
'journal-title': 'FASEB J'},
{ 'key': 'ref24',
'doi-asserted-by': 'publisher',
'first-page': '97',
'DOI': '10.5665/sleep.1594',
'volume': '35',
'author': 'Patel',
'year': '2012',
'journal-title': 'Sleep'},
{ 'key': 'ref25',
'doi-asserted-by': 'publisher',
'first-page': '850',
'DOI': '10.1001/jamainternmed.2016.0787',
'volume': '176',
'author': 'Prather',
'year': '2016',
'journal-title': 'JAMA Intern Med'}],
'container-title': 'Nature and Science of Sleep',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.dovepress.com/getfile.php?fileID=63655',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://www.dovepress.com/getfile.php?fileID=63655',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2020, 11, 12]],
'date-time': '2020-11-12T02:46:24Z',
'timestamp': 1605149184000},
'score': 1,
'resource': { 'primary': { 'URL': 'https://www.dovepress.com/reduced-sleep-in-the-week-prior-to-diagnosis-of-covid-19-is-associated-peer-reviewed-article-NSS'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2020, 11]]},
'references-count': 25,
'URL': 'http://dx.doi.org/10.2147/NSS.S263488',
'relation': {},
'ISSN': ['1179-1608'],
'subject': ['Behavioral Neuroscience', 'Applied Psychology'],
'container-title-short': 'NSS',
'published': {'date-parts': [[2020, 11]]}}
