Insomnia and sleep characteristics in post COVID-19 related fatigue

Aims: Following COVID-19 a substantial number of patients report persistent fatigue and insomnia. As these symptoms have overlapping features, insomnia can be easily underdiagnosed in post COVID-19 related fatigue (PCRF). The main object of this study was to determine the prevalence of insomnia in patients with PCRF and investigate their sleep characteristics. Data of PCRF patients were compared with those of patients with chronic fatigue syndrome (CFS/ME), a condition also characterized by persistent fatigue. Method(s): In this cross-sectional study insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score >=10), were determined in patients with PCRF (n = 114) and compared with CFS/ME patients (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate if fatigue severity, concentration problems, pain, depressive symptoms and having PCRF or CFS/ME were associated with insomnia severity. Sleep characteristics assessed with sleep diary and accelerometer were determined in patients with PCRF and compared with CFS/ME patients using ANCOVA. Result(s): In PCRF patients the mean (SD) insomnia severity was 11.46 (5.7) and prevalence of clinical insomnia was 64%. Both did not differ significantly from CFS/ME. Insomnia severity was significantly associated with depressive symptoms (beta = 0.49, p = 0.006) and higher age (beta = -0.08, p = 0.04). In PCRF the mean subjective sleep duration in h was 7.39 (1.00), sleep onset latency 0.97 (0.62) and wake after sleep onset 1.24 (0.72). The PCRF group reported a significantly shorter sleep duration than the CFS/ME group (p = 0.002), with a moderate effect size (d = 0.59). Conclusion(s): Insomnia severity and prevalence of clinical insomnia is high in PCRF. Insomnia should be assessed and if present treated with insomnia focused therapy in patients reporting post COVID-19 related chronic fatigue.

Adherence to Preventive Measures Before and After Vaccination Against SARS-CoV-2 in Kidney Transplant Recipients

Background: At the start of the COVID-19 pandemic, kidney transplant recipients (KTR) were warned for a high risk of complications in case of infection. After SARSCoV-2 vaccination, KTR appeared to still be at risk of fatal COVID-19 disease, especially when they had limited or no antibody formation. The aim of this study was to describe the self-reported change in behavior of KTR before and after SARS-CoV-2 vaccination in groups with different antibody responses. Method(s): Questionnaires were sent to 2793 KTR, asking for adherence to preventive measures before vaccination, after vaccination and after receiving their level of antibody response. Adherence was reported on a 5-point Likert scale. From April till June 2021 blood samples were collected measuring anti-spike IgG by ELISA 28 days after full SARS-CoV-2 vaccination. Participants were categorized based on antibody response to vaccination as non-responder (<=50 BAU/mL), low-responder (>50 <=300 BAU/mL) or responder (>300 BAU/mL), which was shared with the participant as a correlate of protection. Adherence to preventive measures before vaccination was compared with the two time points after vaccination by the Wilcoxon signed rank sum test. The impact of category on adherence was measured by ordinal logistic regression, taking non-responder as reference. Result(s): The median antibody titer was 7 BAU/mL in the non-(N=1109), 122 BAU/mL in the low-(N=564) and 1751 BAU/mL in the responder cohort (N=1120). Of all preventive measures, adherence to 'keep 1.5 m distance', 'avoid supermarket or shops' and 'rules for visitors or visits' was significantly higher (p<0.001) before than after vaccination within all cohorts. Adherence was decreased among participants, with a dose response effect, who were informed of being a (low-) responder compared to KTR with no antibody response. Conclusion(s): SARS-CoV-2 vaccination in KTR leads to decreased adherence to some, but not all preventive measures, even when the antibody response was absent or low. A greater decrease in adherence was seen in (low)-responders to vaccination.

Early discharge of patients with COVID-19

Introduction: Recently, this journal published a study on the experiences of 49 stable Covid-19 patients who were discharged early from hospital. These patients self-administered oxygen at home and were supervised remotely by a pulmonologist or lung nurse. In October 2020, a project started in Amsterdam in which Covid-19 patients were discharged early, received oxygen supplementation at home and were supervised by their own GP. We report the safety of this approach and describe the expectations beforehand and satisfaction afterwards of all involved. MethodAdult patients admitted to Amsterdam UMC, OLVG or BovenIJ hospital because of covid-19 were eligible for early discharge if they were clinically stable for at least 48 hours and had an oxygen saturation of 94% on oxygen therapy at 3 l/min (figure). Before discharge, patients were taught how to use a pulse oximeter (ihealth P03M, CE/FDA certified) and oxygen equipment. Treatment with dexamethasone and thrombosis prophylaxis were continued in accordance with current treatment guidelines as long as there was an indication. The participants were transferred verbally and in writing from the hospital to their own GP who then took over the supervision. In the period January 18-March 26, 2021, patients could be prospectively included in this evaluation. All patients discharged from October 23, 2020 to January 18, 2021 were retrospectively included. We collected clinical data from the patients and completed questionnaires among patients, general practitioners and caregivers, before hospital discharge and 14 days after.

A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol.

BACKGROUND: Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2. METHOD: The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2. DISCUSSION: This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms. TRIAL REGISTRATION: Netherlands Trial Register NL8947 . Registered on 14 October 2020.

[Early hospital discharge for patients with COVID-19: evaluation of the transmural healthcare program in Amsterdam]

OBJECTIVE: Evaluation of an early discharge program for COVID-19-patients who still required additional oxygen support, supervised by their own general practitioner (GP) in a home setting. We evaluated safety and gathered experiences from patients, caregivers and GPs. DESIGN: Cohort study (prospective and retrospective inclusion) RESULTS: We included 113 patients, of whom 40 retrospectively . Median age was 58 years and median length of hospital stay 8 days. Four patients (3.7%) were readmitted within 14 days after discharge. Median duration of oxygen support at home was 8 days. Almost no home visits were conducted by GPs, but contact by telephone was regular (median 6 times in 2 weeks). All stakeholders reported feeling safe, able and confident while delivering the necessary (self) care. The program was graded by patients and GPs with an 8 (on a scale of 1 to 10). CONCLUSION: Early discharge for COVID-19-patients with a necessity for oxygen support, under supervision of the GP, is safe and was positively evaluated by all stakeholders involved.