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Sleep for COVID-19: real-time meta analysis of 13 studies

@CovidAnalysis, September 2023
https://c19early.org/slmeta.html
 
0 0.5 1 1.5+ All studies 31% 13 354,908 Improvement, Studies, Patients Relative Risk Mortality 33% 3 313,843 Hospitalization 33% 2 46,535 Cases 14% 6 35,032 Peer-reviewed 29% 12 353,097 Sleep for COVID-19 c19early.org Sep 2023 Favorsgood sleep Favorscontrol
Statistically significant lower risk is seen for mortality, hospitalization, and cases. 10 studies from 10 independent teams in 4 countries show statistically significant improvements.
Meta analysis using the most serious outcome reported shows 31% [22‑40%] lower risk. Results are similar for peer-reviewed studies.
Results are robust — in exclusion sensitivity analysis 11 of 13 studies must be excluded to avoid finding statistically significant efficacy in pooled analysis.
Studies analyze sleep quality before infection, and use different definitions of sleep quality.
No treatment or intervention is 100% effective. All practical, effective, and safe means should be used based on risk/benefit analysis.
All data to reproduce this paper and sources are in the appendix.
Evolution of COVID-19 clinical evidence Sleep p=0.000000033 Acetaminophen p=0.0000018 2020 2021 2022 2023 Effective Harmful c19early.org September 2023 meta analysis results (pooled effects) 100% 50% 0% -50%
Highlights
Good quality sleep reduces risk for COVID-19 with very high confidence for mortality, cases, and in pooled analysis, and low confidence for hospitalization.
We show traditional outcome specific analyses and combined evidence from all studies.
Real-time updates and corrections, transparent analysis with all results in the same format, consistent protocol for 56 treatments.
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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Cloosterman 32% 0.68 [0.43-1.07] symp. case 31/201 222/2,385 Improvement, RR [CI] Treatment Control Gao 36% 0.64 [0.42-0.97] cases case control Kim 17% 0.83 [0.70-0.99] m/s case 2,884 (all patients) COVIDENCE UK Holt 12% 0.88 [0.61-1.27] cases 15,227 (all patients) Marcus 16% 0.84 [0.76-0.93] symp. case 14,335 (all patients) Li 43% 0.57 [0.35-0.90] death 46,535 (all patients) Ahmadi 3% 0.97 [0.59-1.61] death 189/252,788 17/14,520 Mohsin 38% 0.62 [0.49-0.77] severe case 327/948 273/552 Huang 81% 0.19 [0.05-0.66] severe case 12/127 4/9 Paul 67% 0.33 [0.19-0.55] PASC 1,811 (all patients) LONG COVID Jones 39% 0.61 [0.45-0.82] death n/a n/a Pływaczewska-J.. 17% 0.83 [0.68-1.01] m/s case 1,225 (n) 622 (n) Wang 36% 0.64 [0.50-0.82] PASC 559 (n) 180 (n) LONG COVID Tau​2 = 0.03, I​2 = 71.2%, p < 0.0001 Prophylaxis 31% 0.69 [0.60-0.78] 559/255,848 516/18,268 31% lower risk All studies 31% 0.69 [0.60-0.78] 559/255,848 516/18,268 31% lower risk 13 sleep COVID-19 studies c19early.org Sep 2023 Tau​2 = 0.03, I​2 = 71.2%, p < 0.0001 Effect extraction pre-specified(most serious outcome, see appendix) Favors good sleep Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Cloosterman 32% symp. case Improvement Relative Risk [CI] Gao 36% case Kim 17% mod./sev. case COVIDENCE UK Holt 12% case Marcus 16% symp. case Li 43% death Ahmadi 3% death Mohsin 38% severe case Huang 81% severe case Paul 67% PASC LONG COVID Jones 39% death Pływaczewska-.. 17% mod./sev. case Wang 36% PASC LONG COVID Tau​2 = 0.03, I​2 = 71.2%, p < 0.0001 Prophylaxis 31% 31% lower risk All studies 31% 31% lower risk 13 sleep C19 studies c19early.org Sep 2023 Tau​2 = 0.03, I​2 = 71.2%, p < 0.0001 Effect extraction pre-specifiedRotate device for details Favors good sleep Favors control
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Figure 1. A. Random effects meta-analysis. This plot shows pooled effects, see the specific outcome analyses for individual outcomes, and the heterogeneity section for discussion. Effect extraction is pre-specified, using the most serious outcome reported. For details of effect extraction see the appendix. B. Scatter plot showing the most serious outcome in all studies. The diamond shows the results of random effects meta-analysis. C. Results within the context of multiple COVID-19 treatments. 0.7% of 5,019 proposed treatments show efficacy c19early.org. D. Timeline of results in sleep studies. The marked dates indicate the time when efficacy was known with a statistically significant improvement of ≥10% from ≥3 studies for pooled outcomes and one or more specific outcome.
We analyze all significant studies reporting COVID-19 outcomes as a function of sleep quality and providing adjusted results. Search methods, inclusion criteria, effect extraction criteria (more serious outcomes have priority), all individual study data, PRISMA answers, and statistical methods are detailed in Appendix 1. We present random effects meta-analysis results for all studies, individual outcomes, and peer-reviewed studies.
Table 1 summarizes the results for all studies, after exclusions, and for specific outcomes. Figure 2, 3, 4, 5, and 6 show forest plots for random effects meta-analysis of all studies with pooled effects, mortality results, hospitalization, cases, and peer reviewed studies.
Table 1. Random effects meta-analysis for all studies, after exclusions, and for specific outcomes. Results show the percentage improvement with good sleep quality and the 95% confidence interval. ** p<0.01  *** p<0.001  **** p<0.0001.
Improvement Studies Patients Authors
All studies31% [22‑40%]
****
13 354,908 122
Peer-reviewed studiesPeer-reviewed29% [20‑37%]
****
12 353,097 120
Mortality33% [11‑50%]
**
3 313,843 25
HospitalizationHosp.33% [21‑43%]
****
2 46,535 20
Cases14% [7‑20%]
***
6 35,032 81
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Figure 2. Random effects meta-analysis for all studies with pooled effects. This plot shows pooled effects, see the specific outcome analyses for individual outcomes, and the heterogeneity section for discussion. Effect extraction is pre-specified, using the most serious outcome reported. For details of effect extraction see the appendix.
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Figure 3. Random effects meta-analysis for mortality results.
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Figure 4. Random effects meta-analysis for hospitalization.
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Figure 5. Random effects meta-analysis for cases.
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Figure 6. Random effects meta-analysis for peer reviewed studies. Zeraatkar analyze 356 COVID-19 trials, finding no significant evidence that preprint results are inconsistent with peer-reviewed studies. They also show extremely long peer-review delays, with a median of 6 months to journal publication. A six month delay was equivalent to around 1.5 million deaths during the first two years of the pandemic. Authors recommend using preprint evidence, with appropriate checks for potential falsified data, which provides higher certainty much earlier. Effect extraction is pre-specified, using the most serious outcome reported, see the appendix for details.
Better sleep reduces risk for COVID-19. Statistically significant lower risk is seen for mortality, hospitalization, and cases. 10 studies from 10 independent teams in 4 countries show statistically significant improvements. Meta analysis using the most serious outcome reported shows 31% [22‑40%] lower risk. Results are similar for peer-reviewed studies. Results are robust — in exclusion sensitivity analysis 11 of 13 studies must be excluded to avoid finding statistically significant efficacy in pooled analysis.
Studies analyze sleep quality before infection, and use different definitions of sleep quality.
0 0.5 1 1.5 2+ Mortality 3% Improvement Relative Risk Sleep for COVID-19  Ahmadi et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 267,308 patients in the United Kingdom No significant difference in mortality c19early.org Ahmadi et al., Brain, Behavior, and Im.., Aug 2021 Favors good sleep Favors control
Ahmadi: Retrospective 468,569 adults in the UK, showing no significant difference in COVID-19 mortality based on sleep quality.
0 0.5 1 1.5 2+ Symp. case 32% Improvement Relative Risk Sleep for COVID-19  Cloosterman et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 2,586 patients in Netherlands Fewer symptomatic cases with higher quality sleep (not stat. sig., p=0.09) c19early.org Cloosterman et al., J. Science and Med.., Oct 2020 Favors good sleep Favors control
Cloosterman: Analysis of 2,586 participants of a running injury prevention RCT in the Netherlands, showing higher risk of COVID-19 symptoms with sleep disturbance.
0 0.5 1 1.5 2+ Case 36% Improvement Relative Risk Sleep for COVID-19  Gao et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 315 patients in China (February - March 2020) Fewer cases with higher quality sleep (p=0.038) c19early.org Gao et al., PLOS ONE, November 2020 Favors good sleep Favors control
Gao: Case control study in China with 105 cases and 210 matched controls, showing COVID-19 cases associated with lack of sleep.
0 0.5 1 1.5 2+ Case 12% Improvement Relative Risk Case (b) 12% Case (c) 22% Sleep for COVID-19  COVIDENCE UK  Prophylaxis Is better sleep beneficial for COVID-19? Prospective study of 15,227 patients in the United Kingdom (May 2020 - Feb 2021) Fewer cases with higher quality sleep (not stat. sig., p=0.5) c19early.org Holt et al., Thorax, March 2021 Favors good sleep Favors control
Holt: Prospective survey-based study with 15,227 people in the UK, showing reduced risk of COVID-19 cases with 8 hours sleep, with statistical significance when compared with ≥9 hours. NCT04330599. COVIDENCE UK.
0 0.5 1 1.5 2+ Severe case 81% Improvement Relative Risk Sleep for COVID-19  Huang et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 136 patients in China (February - March 2020) Lower severe cases with higher quality sleep (p=0.015) c19early.org Huang et al., Nature and Science of Sl.., Nov 2021 Favors good sleep Favors control
Huang: Retrospective 164 COVID-19 patients and 188 controls in China, showing the risk of severe cases associated with lack of sleep.
0 0.5 1 1.5 2+ Mortality 39% Improvement Relative Risk Hospitalization 32% Case 7% Sleep for COVID-19  Jones et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective study in multiple countries Lower mortality (p=0.001) and hospitalization (p<0.0001) c19early.org Jones et al., Sleep Medicine, July 2022 Favors good sleep Favors control
Jones: FinnGen Mendelian randomization study showing higher risk of COVID-19 mortality, hospitalization, and infection with insomnia.
0 0.5 1 1.5 2+ Moderate/severe case 17% Improvement Relative Risk Case 11% Sleep for COVID-19  Kim et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 2,884 patients in multiple countries (Jul - Sep 2020) Fewer moderate/severe cases (p=0.035) and cases (p=0.003) c19early.org Kim et al., BMJ Nutrition, Prevention .., Mar 2021 Favors good sleep Favors control
Kim: Retrospective 2,884 high-risk healthcare workers in France, Germany, Italy, Spain, UK, and the USA, showing shorter sleep duration associated with increased risk of COVID-19 cases and severity.
0 0.5 1 1.5 2+ Mortality 43% Improvement Relative Risk Hospitalization 36% Hospitalization (b) 21% Sleep for COVID-19  Li et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 46,535 patients in the USA (March - December 2020) Lower mortality (p=0.017) and hospitalization (p=0.008) c19early.org Li et al., Sleep, June 2021 Favors good sleep Favors control
Li: UK Biobank retrospective, 46,535 participants with sleep behavior assessed between 2006 and 2010, showing higher risk of hospitalization and mortality with poor sleep.
0 0.5 1 1.5 2+ Symp. case 16% Improvement Relative Risk Sleep for COVID-19  Marcus et al.  Prophylaxis Is better sleep beneficial for COVID-19? Prospective study of 14,335 patients in multiple countries (Mar - May 2020) Fewer symptomatic cases with higher quality sleep (p=0.00075) c19early.org Marcus et al., PLOS ONE, June 2021 Favors good sleep Favors control
Marcus: Prospective survey based study with 14,335 participants, showing risk of viral symptoms associated with shorter sleep duration.
0 0.5 1 1.5 2+ Severe case 38% Improvement Relative Risk Sleep for COVID-19  Mohsin et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 1,500 patients in Bangladesh (November 2020 - April 2021) Lower severe cases with higher quality sleep (p=0.000031) c19early.org Mohsin et al., Infection and Drug Resi.., Sep 2021 Favors good sleep Favors control
Mohsin: Retrospective 1,500 COVID+ patients in Bangladesh, showing lower risk of severe cases with good sleep.
0 0.5 1 1.5 2+ Long COVID 67% Improvement Relative Risk Long COVID (b) 54% Sleep  Paul et al.  Prophylaxis  LONG COVID Does better sleep reduce the risk of Long COVID (PASC)? Retrospective 1,811 patients in the United Kingdom Lower PASC with higher quality sleep (p=0.000039) c19early.org Paul et al., medRxiv, April 2022 Favors good sleep Favors control
Paul: Retrospective 1,811 COVID-19 patients in the UK, showing lower risk of self-reported long COVID with good sleep quality in the month before infection.
0 0.5 1 1.5 2+ Moderate/severe case 17% Improvement Relative Risk PASC 7% Sleep  Pływaczewska-Jakubowska et al.  Prophylaxis Is better sleep beneficial for COVID-19? Retrospective 1,847 patients in Poland (May 2020 - January 2022) Fewer moderate/severe cases with higher quality sleep (not stat. sig., p=0.063) c19early.org Pływaczewska-Jakubowska et al., Fronti.., Oct 2022 Favors good sleep Favors control
Pływaczewska-Jakubowska: Retrospective 1,847 COVID+ patients in Poland, showing lower moderate/severe cases with improved sleep, without statistical significance. Hospitalized patients were excluded.
0 0.5 1 1.5 2+ PASC, before and during 36% Improvement Relative Risk PASC, during pandemic 18% PASC, before pandemic 30% Sleep  Wang et al.  Prophylaxis  LONG COVID Does better sleep reduce the risk of Long COVID (PASC)? Retrospective 1,979 patients in the USA Lower PASC with higher quality sleep (p=0.00044) c19early.org Wang et al., JAMA Network Open, May 2023 Favors good sleep Favors control
Wang: Retrospective 1,979 nurses in the USA, showing lower risk of long COVID with better sleep quality.
We performed ongoing searches of PubMed, medRxiv, ClinicalTrials.gov, The Cochrane Library, Google Scholar, Collabovid, Research Square, ScienceDirect, Oxford University Press, the reference lists of other studies and meta-analyses, and submissions to the site c19early.org. Search terms were sleep AND COVID-19. Automated searches are performed every few hours with notification of new matches. All studies regarding the use of sleep for COVID-19 that report a comparison with a control group are included in the main analysis. This is a living analysis and is updated regularly.
We extracted effect sizes and associated data from all studies. If studies report multiple kinds of effects then the most serious outcome is used in pooled analysis, while other outcomes are included in the outcome specific analyses. For example, if effects for mortality and cases are both reported, the effect for mortality is used, this may be different to the effect that a study focused on. If symptomatic results are reported at multiple times, we used the latest time, for example if mortality results are provided at 14 days and 28 days, the results at 28 days are used. Mortality alone is preferred over combined outcomes. Outcomes with zero events in both arms were not used (the next most serious outcome is used — no studies were excluded). For example, in low-risk populations with no mortality, a reduction in mortality with treatment is not possible, however a reduction in hospitalization, for example, is still valuable. Clinical outcome is considered more important than PCR testing status. When basically all patients recover in both treatment and control groups, preference for viral clearance and recovery is given to results mid-recovery where available (after most or all patients have recovered there is no room for an effective treatment to do better). If only individual symptom data is available, the most serious symptom has priority, for example difficulty breathing or low SpO2 is more important than cough. When results provide an odds ratio, we computed the relative risk when possible, or converted to a relative risk according to Zhang. Reported confidence intervals and p-values were used when available, using adjusted values when provided. If multiple types of adjustments are reported including propensity score matching (PSM), the PSM results are used. Adjusted primary outcome results have preference over unadjusted results for a more serious outcome when the adjustments significantly alter results. When needed, conversion between reported p-values and confidence intervals followed Altman, Altman (B), and Fisher's exact test was used to calculate p-values for event data. If continuity correction for zero values is required, we use the reciprocal of the opposite arm with the sum of the correction factors equal to 1 Sweeting. Results are expressed with RR < 1.0 favoring treatment, and using the risk of a negative outcome when applicable (for example, the risk of death rather than the risk of survival). If studies only report relative continuous values such as relative times, the ratio of the time for the treatment group versus the time for the control group is used. Calculations are done in Python (3.11.4) with scipy (1.11.1), pythonmeta (1.26), numpy (1.25.0), statsmodels (0.14.0), and plotly (5.15.0).
Forest plots are computed using PythonMeta Deng with the DerSimonian and Laird random effects model (the fixed effect assumption is not plausible in this case) and inverse variance weighting. Mixed-effects meta-regression results are computed with R (4.1.2) using the metafor (3.0-2) and rms (6.2-0) packages, and using the most serious sufficiently powered outcome.
We received no funding, this research is done in our spare time. We have no affiliations with any pharmaceutical companies or political parties.
We have classified studies as early treatment if most patients are not already at a severe stage at the time of treatment (for example based on oxygen status or lung involvement), and treatment started within 5 days of the onset of symptoms. If studies contain a mix of early treatment and late treatment patients, we consider the treatment time of patients contributing most to the events (for example, consider a study where most patients are treated early but late treatment patients are included, and all mortality events were observed with late treatment patients). We note that a shorter time may be preferable. Antivirals are typically only considered effective when used within a shorter timeframe, for example 0-36 or 0-48 hours for oseltamivir, with longer delays not being effective McLean, Treanor.
A summary of study results is below. Please submit updates and corrections at the bottom of this page.
A summary of study results is below. Please submit updates and corrections at https://c19early.org/slmeta.html.
Effect extraction follows pre-specified rules as detailed above and gives priority to more serious outcomes. For pooled analyses, the first (most serious) outcome is used, which may differ from the effect a paper focuses on. Other outcomes are used in outcome specific analyses.
Ahmadi, 8/31/2021, retrospective, United Kingdom, peer-reviewed, 5 authors. risk of death, 3.0% lower, RR 0.97, p = 0.91, adjusted per study, good vs. poor, model 2, multivariable.
Cloosterman, 10/21/2020, retrospective, Netherlands, peer-reviewed, 4 authors. risk of symptomatic case, 31.6% lower, RR 0.68, p = 0.09, higher quality sleep 31 of 201 (15.4%), lower quality sleep 222 of 2,385 (9.3%), inverted to make RR<1 favor higher quality sleep, odds ratio converted to relative risk.
Gao, 11/5/2020, retrospective, China, peer-reviewed, survey, median age 55.0, 11 authors, study period 10 February, 2020 - 1 March, 2020. risk of case, 35.9% lower, HR 0.64, p = 0.04, higher quality sleep 73 of 105 (69.5%) cases, 179 of 210 (85.2%) controls, NNT 4.6, inverted to make HR<1 favor higher quality sleep, case control OR, Cox proportional hazards.
Holt, 3/30/2021, prospective, United Kingdom, peer-reviewed, 34 authors, study period 1 May, 2020 - 5 February, 2021, trial NCT04330599 (history) (COVIDENCE UK). risk of case, 12.3% lower, OR 0.88, p = 0.50, adjusted per study, inverted to make OR<1 favor higher quality sleep, fully adjusted, 8 hours vs. ≤6 hours, RR approximated with OR.
risk of case, 12.3% lower, OR 0.88, p = 0.33, adjusted per study, inverted to make OR<1 favor higher quality sleep, fully adjusted, 8 hours vs. 7 hours, RR approximated with OR.
risk of case, 22.5% lower, OR 0.78, p = 0.04, adjusted per study, inverted to make OR<1 favor higher quality sleep, fully adjusted, 8 hours vs. ≥9 hours, RR approximated with OR.
Huang, 11/30/2021, retrospective, China, peer-reviewed, survey, 5 authors, study period 10 February, 2020 - 28 March, 2020. risk of severe case, 80.9% lower, RR 0.19, p = 0.02, higher quality sleep 12 of 127 (9.4%), lower quality sleep 4 of 9 (44.4%), NNT 2.9, adjusted per study, inverted to make RR<1 favor higher quality sleep, odds ratio converted to relative risk, recommended vs. lack of sleep, multivariable.
Jones, 7/21/2022, retrospective, multiple countries, peer-reviewed, 12 authors. risk of death, 39.0% lower, OR 0.61, p = 0.001, inverted to make OR<1 favor higher quality sleep, RR approximated with OR.
risk of hospitalization, 32.0% lower, OR 0.68, p < 0.001, inverted to make OR<1 favor higher quality sleep, RR approximated with OR.
risk of case, 7.4% lower, OR 0.93, p = 0.04, inverted to make OR<1 favor higher quality sleep, RR approximated with OR.
Kim, 3/22/2021, retrospective, multiple countries, peer-reviewed, survey, mean age 48.0, 8 authors, study period 17 July, 2020 - 25 September, 2020. risk of moderate/severe case, 17.0% lower, OR 0.83, p = 0.03, per extra hour of sleep, RR approximated with OR.
risk of case, 11.0% lower, OR 0.89, p = 0.003, per extra hour of sleep, model 3, RR approximated with OR.
Li, 6/18/2021, retrospective, USA, peer-reviewed, mean age 69.4, 8 authors, study period March 2020 - December 2020. risk of death, 43.2% lower, OR 0.57, p = 0.02, inverted to make OR<1 favor higher quality sleep, fully adjusted model C, significant poor sleep burden, RR approximated with OR.
risk of hospitalization, 35.9% lower, OR 0.64, p = 0.008, inverted to make OR<1 favor higher quality sleep, fully adjusted model C, significant poor sleep burden, RR approximated with OR.
risk of hospitalization, 21.3% lower, OR 0.79, p = 0.02, inverted to make OR<1 favor higher quality sleep, fully adjusted model C, moderate poor sleep burden, RR approximated with OR.
Marcus, 6/17/2021, prospective, multiple countries, peer-reviewed, survey, 12 authors, study period 26 March, 2020 - 3 May, 2020. risk of symptomatic case, 16.0% lower, OR 0.84, p < 0.001, adjusted per study, per extra hour sleep, multivariable, RR approximated with OR.
Mohsin, 9/30/2021, retrospective, Bangladesh, peer-reviewed, survey, 10 authors, study period November 2020 - April 2021. risk of severe case, 37.9% lower, RR 0.62, p < 0.001, higher quality sleep 327 of 948 (34.5%), lower quality sleep 273 of 552 (49.5%), NNT 6.7, adjusted per study, inverted to make RR<1 favor higher quality sleep, odds ratio converted to relative risk, sleep disturbance, multivariable.
Paul, 4/13/2022, retrospective, United Kingdom, preprint, survey, 2 authors. risk of long COVID, 67.3% lower, RR 0.33, p < 0.001, adjusted per study, inverted to make RR<1 favor higher quality sleep, odds ratio converted to relative risk, very good/good vs. not good/very poor, multivariable, model 4, control prevalance approximated with overall prevalence.
risk of long COVID, 54.0% lower, RR 0.46, p = 0.002, adjusted per study, inverted to make RR<1 favor higher quality sleep, odds ratio converted to relative risk, very good/good vs. average, multivariable, model 4, control prevalance approximated with overall prevalence.
Pływaczewska-Jakubowska, 10/24/2022, retrospective, Poland, peer-reviewed, median age 51.0, 5 authors, study period May 2020 - January 2022. risk of moderate/severe case, 17.4% lower, OR 0.83, p = 0.06, higher quality sleep 1,225, lower quality sleep 622, adjusted per study, inverted to make OR<1 favor higher quality sleep, higher quality sleep vs. insomnia or falling asleep after midnight or nightshifts, multivariable, model 3, RR approximated with OR.
risk of PASC, 7.4% lower, OR 0.93, p = 0.51, higher quality sleep 1,015, lower quality sleep 502, adjusted per study, inverted to make OR<1 favor higher quality sleep, higher quality sleep vs. insomnia or falling asleep after midnight or nightshifts, multivariable, model 3, RR approximated with OR.
Wang, 5/30/2023, retrospective, USA, peer-reviewed, 6 authors. risk of PASC, 36.0% lower, RR 0.64, p < 0.001, higher quality sleep 559, lower quality sleep 180, adjusted per study, healthy sleep before and during the pandemic, multivariable.
risk of PASC, 18.0% lower, RR 0.82, p = 0.03, adjusted per study, healthy sleep during the pandemic, multivariable.
risk of PASC, 30.0% lower, RR 0.70, p = 0.02, higher quality sleep 238, lower quality sleep 166, adjusted per study, healthy sleep before the pandemic, sleep score 5 vs. score 0 or 1, multivariable.
Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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