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0 0.5 1 1.5 2+ Severe case 19% Improvement Relative Risk Severe case (b) 26% Zhang et al. Sleep for COVID-19 Prophylaxis Is better sleep beneficial for COVID-19? Prospective study in China (January - March 2020) Lower severe cases with higher quality sleep (p=0.00089) Zhang et al., EXCLI J.; 20:Doc894; ISSN 1611-2156, doi:10.17179/excli2021-3451 Favors good sleep Favors control
Association of sleep quality before and after SARS-CoV-2 infection with clinical outcomes in hospitalized patients with COVID-19 in China
Zhang et al., EXCLI Journal; 20:Doc894; ISSN 1611-2156, doi:10.17179/excli2021-3451
Zhang et al., Association of sleep quality before and after SARS-CoV-2 infection with clinical outcomes in hospitalized.., EXCLI Journal; 20:Doc894; ISSN 1611-2156, doi:10.17179/excli2021-3451
May 2021   Source   PDF  
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Prospective study of 205 hospitalized COVID-19 patients in China, showing higher risk of severe cases with poor sleep quality. This study is excluded in meta analysis: results only provided with respect to continuous values.
risk of severe case, 18.7% lower, HR 0.81, p < 0.001, inverted to make HR<1 favor higher quality sleep, global PQSI before infection, Cox proportional hazards, model 3.
risk of severe case, 25.9% lower, HR 0.74, p = 0.007, inverted to make HR<1 favor higher quality sleep, global PQSI after infection, Cox proportional hazards, model 3.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zhang et al., 14 May 2021, prospective, China, peer-reviewed, survey, mean age 58.0, 15 authors, study period 6 January, 2020 - 9 March, 2020.
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MD a# Li Zhang, MD b # Tingting Li, PhD Liangkai Chen, MD a# Feng Wu, PhD Wenguang Xia, PhD Min Huang, MD Zhenli Guo, MD a ; Lin Song, MD Hongxiang Yin, MD Yangpu Zhang, MD Yongfei Yu, MD Sijie Cai, MD b ; Zijian Lu, MD, PhD Shuang Rong, MD Wei Bao
Sleep is believed to benefit the host defense against pathogens. We aimed to investigate the association of sleep quality with clinical outcomes among hospitalized patients with COVID-19. We conducted a prospective cohort study in 205 adult hospitalized patients with diagnosed moderate COVID-19, with follow-up until hospital discharge or death. Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality before and after infection. The primary outcome was the incidence of severe or critical pneumonia, and the secondary outcomes were duration of hospital stay and laboratory measurements during the follow up. Among the 205 included hospitalized patients, 185 (90.2 %) experienced poorer sleep quality after infection than before according to the PSQI score, and 25 (12.2 %) developed severe or critical pneumonia during follow-up. In Cox regression models, the adjusted hazard ratio of developing severe or critical pneumonia associated with each 1 score increment in the PSQI score before and after infection was 1.23 (95% CI: 1.09, 1.39) and 1.35 (95 % CI: 1.08, 1.67), respectively. Poorer sleep quality was also significantly associated with a prolonged hospital stay and more serious dysregulations in immune system indicated by several laboratory markers. Poorer sleep quality, either in the daily time or after infection with SARS-CoV-2, was associated with worse clinical outcomes. These findings highlight the importance of good sleep in confronting the emerging pandemic of COVID-19.
Contributors SR, LZ, and WB designed research. LZ, FW, WX, MH, ZG, LS, HY, YZ, and YY contributed to the acquisition, analysis, or interpretation of the data. All authors contributed to critically revise the manuscript for important intellectual content. SR has primary responsibility for final content and is the study guarantor. All authors read and approved the final manuscript. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding No funding was received for the present study. Competing interests The authors declare no conflict of interest.
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Huang, Berube, Mcnamara, Saksena, Hartman et al., Lymphocyte subset counts in COVID-19 patients: A meta-analysis, Cytometry A
Irwin, Cole, Reciprocal regulation of the neural and innate immune systems, Nat Rev Immunol
Irwin, Sleep and inflammation: Partners in sickness and in health, Nat Rev Immunol
Irwin, Thompson, Miller, Gillin, Ziegler et al., Sleep disturbance, sleep duration, and inflammation: A systematic review and meta-analysis of cohort studies and experimental sleep deprivation, J Clin Endocrinol Metab
Jiang, Zhu, Wang, Hu, Pang et al., Psychological distress and sleep quality of COVID-19 patients in Wuhan, a lockdown city as the epicenter of COVID-19, J Psychiatr Res
Kuo, Williams, Increased sleep promotes survival during a bacterial infection in Drosophila, Sleep
Liguori, Pierantozzi, Spanetta, Sarmati, Cesta et al., Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection, Brain Behav Immun
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