Persistent Sleep Disturbance Following Pandemic Lockdowns: Longitudinal Findings From the UK COVID-19 Symptom Study Biobank.

Abstract

Sleep disturbance and fatigue were highly prevalent during the COVID-19 pandemic, in both infected and non-infected individuals, though mostly assessed cross-sectionally. To assess these symptoms after lockdown cessation, we conducted a prospective longitudinal study in a large UK cohort. Validated questionnaires assessing sleep disturbances, fatigue, depression, and anxiety were administered to COVID Symptom Study Biobank participants at two time periods-Autumn 2021 and Spring 2022 equinoxes-corresponding to lockdown and lifting of restrictions, respectively. After adjusting for differential participation using inverse probability weighting, data from 2390 participants were analysed. Generalised linear models examined SARS-CoV-2 infection, post-COVID-19 syndrome [PCS], and longitudinal changes of sleep disturbances and fatigue, adjusting for potential confounders. Despite lifting of lockdown, high levels of sleep disturbance and fatigue persisted, with no significant improvement over time, independently of baseline or new SARS-CoV-2 infection or PCS. De novo SARS-CoV-2 marginally worsened STOP-Bang scores although below clinical significance. There was a trend for interaction between baseline SARS-CoV-2 status and Chalder Fatigue scores on follow-up fatigue (B = 0.19, 95% CI = -0.01 to 0.39, p = 0.057). Receipt of booster vaccination lowered Epworth Sleepiness Scale scores (B = -0.53, 95% CI = -0.96 to -0.10, p = 0.016) but doubled likelihood of restless legs syndrome symptoms (OR = 2.45, 95% CI = 1.38 to 4.37, p = 0.002). Overall, the high rates of sleep disturbances and fatigue observed during lockdown persisted after restrictions were lifted, independent of SARS-CoV-2 infection. Sleep disruption reported during lockdown may endure unless actively addressed. Given the high prevalence of both sleep disturbance and fatigue, routine assessment of sleep is recommended for individuals presenting with persistent post-pandemic fatigue, including PCS.