Multidimensional Sleep Health Prior to SARS-CoV-2 Infection and Risk of Post-COVID-19 Condition
MD Siwen Wang, ScD Tianyi Huang, PhD, ScD Marc G Weisskopf, ScD Jae H Kang, MD, ScD Jorge E Chavarro, PhD Andrea L Roberts, Roberts Wang, Roberts Chavarro, Weisskopf, Chavarro Kang, Anthony Menor
doi:10.1001/jamanetworkopen.2023.15885
IMPORTANCE The association of multiple healthy sleep dimensions with post-COVID-19 condition (PCC), also known as long COVID, has not been investigated. OBJECTIVE To examine whether multidimensional sleep health before and during the COVID-19 pandemic, prior to SARS-CoV-2 infection, was associated with the risk of PCC. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study (2015-2021) included Nurses' Health Study II participants who reported testing positive (n = 2303) for SARS-CoV-2 infection in a substudy series of COVID-19-related surveys (n = 32 249) between April 2020 and November 2021. After exclusion for incomplete information about sleep health and nonresponse to a question about PCC, 1979 women were included in the analysis. EXPOSURES Sleep health was measured both before (June 1, 2015, to May 31, 2017) and early (April 1 to August 31, 2020) in the COVID-19 pandemic. Prepandemic sleep score was defined according to 5 dimensions: morning chronotype (assessed in 2015), 7 to 8 hours of sleep per day, low insomnia symptoms, no snoring, and no frequent daytime dysfunction (all assessed in 2017). On the first COVID-19 substudy survey (returned between April and August 2020), average daily sleep duration and sleep quality for the past 7 days were queried. MAIN OUTCOMES AND MEASURES SARS-CoV-2 infection and PCC (Ն4 weeks of symptoms) were self-reported during 1 year of follow-up. Comparisons were examined between June 8, 2022, and January 9, 2023, using Poisson regression models. RESULTS Of the 1979 participants reporting SARS-CoV-2 infection (mean [SD] age, 64.7 [4.6] years; 1979 [100%] female; and 1924 [97.2%] White vs 55 [2.8%] other races and ethnicities), 845 (42.7%) were frontline health care workers, and 870 (44.0%) developed PCC. Compared with women who had a prepandemic sleep score of 0 or 1 (least healthy), those who scored 5 (most healthy) had a 30% lower risk of developing PCC (multivariable-adjusted relative risk, 0.70; 95% CI, 0.52-0.94; P for trend <.001). Associations did not differ by health care worker status. No or little daytime dysfunction prepandemic and good sleep quality during the pandemic were independently associated with a lower risk of PCC (relative risk, 0.83 [95% CI, 0.71-0.98] and 0.82 [95% CI, 0.69-0.99], respectively). Results were similar when PCC was defined as having 8 or more weeks of symptoms or as having ongoing symptoms at the time of PCC assessment.
CONCLUSIONS AND RELEVANCE The findings indicate that healthy sleep measured prior to SARS-CoV-2 infection, both before and during the COVID-19 pandemic, may be protective against PCC. Future research should investigate whether interventions on sleep health may prevent PCC or improve PCC symptoms.
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'abstract': '<jats:sec id="ab-zoi230479-4"><jats:title>Importance</jats:title><jats:p>The association of '
'multiple healthy sleep dimensions with post–COVID-19 condition (PCC), also known as long '
'COVID, has not been investigated.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-5"><jats:title>Objective</jats:title><jats:p>To examine whether '
'multidimensional sleep health before and during the COVID-19 pandemic, prior to SARS-CoV-2 '
'infection, was associated with the risk of PCC.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This '
'prospective cohort study (2015-2021) included Nurses’ Health Study II participants who '
'reported testing positive (n\u2009=\u20092303) for SARS-CoV-2 infection in a substudy series '
'of COVID-19–related surveys (n\u2009=\u200932\u202f249) between April 2020 and November 2021. '
'After exclusion for incomplete information about sleep health and nonresponse to a question '
'about PCC, 1979 women were included in the analysis.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-7"><jats:title>Exposures</jats:title><jats:p>Sleep health was measured both '
'before (June 1, 2015, to May 31, 2017) and early (April 1 to August 31, 2020) in the COVID-19 '
'pandemic. Prepandemic sleep score was defined according to 5 dimensions: morning chronotype '
'(assessed in 2015), 7 to 8 hours of sleep per day, low insomnia symptoms, no snoring, and no '
'frequent daytime dysfunction (all assessed in 2017). On the first COVID-19 substudy survey '
'(returned between April and August 2020), average daily sleep duration and sleep quality for '
'the past 7 days were queried.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>SARS-CoV-2 '
'infection and PCC (≥4 weeks of symptoms) were self-reported during 1 year of follow-up. '
'Comparisons were examined between June 8, 2022, and January 9, 2023, using Poisson regression '
'models.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-9"><jats:title>Results</jats:title><jats:p>Of the 1979 participants '
'reporting SARS-CoV-2 infection (mean [SD] age, 64.7 [4.6] years; 1979 [100%] female; and 1924 '
'[97.2%] White vs 55 [2.8%] other races and ethnicities), 845 (42.7%) were frontline health '
'care workers, and 870 (44.0%) developed PCC. Compared with women who had a prepandemic sleep '
'score of 0 or 1 (least healthy), those who scored 5 (most healthy) had a 30% lower risk of '
'developing PCC (multivariable-adjusted relative risk, 0.70; 95% CI, 0.52-0.94; '
'<jats:italic>P</jats:italic> for trend &amp;lt;.001). Associations did not differ by '
'health care worker status. No or little daytime dysfunction prepandemic and good sleep '
'quality during the pandemic were independently associated with a lower risk of PCC (relative '
'risk, 0.83 [95% CI, 0.71-0.98] and 0.82 [95% CI, 0.69-0.99], respectively). Results were '
'similar when PCC was defined as having 8 or more weeks of symptoms or as having ongoing '
'symptoms at the time of PCC assessment.</jats:p></jats:sec><jats:sec '
'id="ab-zoi230479-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>The findings '
'indicate that healthy sleep measured prior to SARS-CoV-2 infection, both before and during '
'the COVID-19 pandemic, may be protective against PCC. Future research should investigate '
'whether interventions on sleep health may prevent PCC or improve PCC '
'symptoms.</jats:p></jats:sec>',
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