Exploring the Associations Between Self-Reported Sleep Disturbance and Cognitive Impairment Among Survivors of COVID-19 Hospitalization

Cognitive impairment following COVID-19 infection is common and risk factors remain poorly understood. Sleep disturbance increases risk of cognitive impairment in the general population, and sleep disturbance is common after COVID-19. While prior literature has extensively explored the relationship between sleep and cognition, few studies have addressed the temporality of this association and how one may contribute to the other over time. This study assessed whether new sleep disturbance at 1-month is associated with risk of cognitive impairment at 6-months after COVID-19 hospitalization. English-speaking adults aged ≥ 18 years at the University of Washington Medical Center who survived to 1-month post-COVID-19 hospitalization were enrolled. Self-reported sleep disturbance, cognitive function, cognitive abilities, and fatigue severity at 1- and 6-months after discharge were assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. Linear and logistic regression models analyzed associations of new sleep disturbance at 1-month with cognitive function, cognitive abilities, and fatigue severity outcomes at 6-months. Participants (n = 120) had mean age of 56.5 ± 15.7 years, and 35% developed new sleep disturbance at 1-month. Among those with versus without new sleep disturbance at 1-month, 74% versus 40%, 76% versus 37%, and 64% versus 50% developed significant worsening in cognitive function, cognitive abilities, and fatigue severity at 6 months, respectively. In this single-center observational cohort, new sleep disturbance at 1-month post-COVID-19 hospitalization was associated with subsequent significant worsening in cognitive function, cognitive abilities, and fatigue severity at 6-months. Thus, new sleep disturbance may be a risk factor for persistent neurocognitive impairment after COVID-19. Additional studies should validate these relationships and examine whether improving sleep quality may reduce the risk of cognitive impairment in these patients.