Poor sleep behavior burden and risk of COVID-19 mortality and hospitalization

Abstract: SLEEPJ, 2021, 1–3 doi: 10.1093/sleep/zsab138 Advance Access Publication Date: 18 June 2021 Letter to the Editor Letter to the Editor Peng Li1,2,*, , Xi Zheng1, Ma Cherrysse Ulsa1, Hui-Wen Yang1, Frank A. J. L. Scheer1,2,3, , Martin K. Rutter4, Kun Hu1,2,3,*,†, and Lei Gao1,2,5,*,†, Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA, 3Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA, 4Division of Diabetes, Endocrinology & Gastroenterology, University of Manchester, Manchester, UK and 5Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 1 Contributed equally. *Corresponding author. Peng Li, Kun Hu, or Lei Gao, Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115, USA. Email: pli9@bwh.harvard.edu; khu1@bwh.harvard.edu; lgao@mgh.harvard.edu. † Dear Editor, Despite the unprecedented efforts in vaccinations, the COVID19 pandemic will likely continue to affect those most vulnerable [1], and the need to identify modifiable risk factors remains [2]. Poor sleep behavior traits have been linked to multisystemic disruptions [3], but whether this is linked to COVID-19 severity remains unknown. Using, the UK Biobank, a population-based cohort of >500 000 participants recruited between 2006 and 2010 [4], we determined the associations of poor sleep behavior burden with mortality, and need for hospitalization after a positive COVID-19 result. This study was restricted to 46 535 participants tested between March and December 2020 (age: 69.4 ± 8.3 years [mean ± standard deviation]; female: 53.3%). Sleep behavior traits (duration, daytime sleepiness, insomnia, and chronotype) were assessed between 2006 and 2010. Scores of 0 (if sleep duration between 6 and 9 h, “never/rarely” daytime sleepiness/insomnia, or non-evening chronotype), 1 (if short <6 h, or long sleeper >9 h, “sometimes” experience daytime sleepiness/insomnia, or evening chronotype), and 2 (if “often/all the time” experience daytime sleepiness, or “usually” have insomnia) were assigned, and summed to obtain a sleep behavior score ranging from 0 to 6, where higher scores are indicative of multiple domains of poor sleep behavior traits. We used this to classify poor sleep behavior burden as follows: “none” (0), “mild” (1), “moderate” (2–3), and “significant” (4–6). 8422 participants tested positive (COVID+), defined as the earliest result from PCR tests, provided by Public Health England. If tested but never positive (COVID−; n = 38 113), the earliest test date was used. Primary outcome was 30-day mortality, matched to death registry dates. The interaction effect between sleep behavior burden and COVID positivity/negativity on mortality was also tested. Finally, hospitalization within 7 days of a positive test was extracted by matching dates with hospital admission data (7146 positive cases available). We included test results that were reported up to 4 days after death or hospitalization, per the UK Biobank’s guidance over testing-to-result time frames; thus, we excluded 11 participants with a date of death and/or hospitalization more than 4 days before test results were released. Logistic regression models were used to determine the..