Sleep quality and efficiency in adults with post-acute sequelae of COVID-19.

Study objectives: Sleep disruptions are associated with adverse mental and physical health outcomes. Individuals with post-acute sequelae of COVID-19 (PASC) commonly report worsened sleep. This study examined sleep quality and efficiency and their associations with neuropsychiatric symptoms and fatigue in non-hospitalized individuals with PASC.

Methods: Sixty-one participants (73.8 percent female; - _age = 45.4) who reported being infected with COVID-19 ≥ 2 months before enrollment, non-hospitalized, and experiencing ≥3 symptoms since infection were eligible. The Pittsburgh Sleep Quality Index was used to measure self-reported sleep quality, and the Fitbit Charge-4 to assess sleep efficiency. Participants completed the Beck Anxiety Index, Beck Depression Index, Post-Traumatic Stress Disorder-Checklist Civilian Version, and the Fatigue Severity Scale. We conducted multivariable linear regressions to examine associations controlling for age, sex, time since first COVID-19 infection, pre-COVID sleep disorders, and sleep aids.

Results: Pittsburgh Sleep Quality Index scores were not associated with objective sleep efficiency. Nearly 97 percent of PASC participants reported poor sleep quality, 85 percent indicated that sleep difficulties interfered with their daily functioning, and 93.9 percent achieved optimal sleep efficiency. Higher Beck Depression Index scores were linked to worse sleep quality, while Beck Anxiety Index, Post-Traumatic Stress Disorder-Checklist Civilian Version, and Fatigue Severity Scale scores were not. However, Beck Anxiety Index and Fatigue Severity Scale scores were related to distinct Pittsburgh Sleep Quality Index components. None were associated with sleep efficiency.

Conclusion: Individuals with PASC experience significant sleep difficulties impacting daily functioning. Although they showed adequate sleep efficiency, most participants perceived their sleep as inefficient, which correlated with worse depressive symptoms. Therefore, sleep is a modifiable factor that could enhance the quality of life for patients with PASC.