COVID-19 related worries and sleep disturbances in patients previously hospitalized with COVID-19 illness

ABSTRACT

Introduction: In patients hospitalized for COVID-19 illness, sleep disturbances after discharge may impact quality of life and prognosis. We examined the relationship of COVID-19-related worries with sleep disturbances in patients three months after COVID-19 hospitalization. Methods: Patients hospitalized for COVID-19 illness completed a survey three months post-discharge (n=153). We measured COVID- 19-related worry along two domains worry directly related to the disease (COVID-illness worry) and worry related to the socioeconomic impact of the pandemic (COVID-impact worry). COVID-illness worry included worry regarding 1) getting COVID again, 2) dying from COVID, 3) family members getting COVID, 4) losing a loved one to COVID, 5) unknowingly infecting others with COVID, 6) having significant financial burdens because of COVID. COVID-impact included worry regarding 1) employment loss, 2) not having enough food, 3) not having access to medical care/medications, 4) not having access to mental health care/medications, 5) reduction in interactions with other people, 6) separation from family members, 7) being lonely. Patients rated how much they worried about each item on a 4-point scale (not at all, a little, moderately, extremely). Scores on each domain were summed to reflect overall severity. Past month sleep was assessed for insomnia symptoms (none, mild, moderate, severe, very severe) and self-reported sleep duration. Binary logistic regression was used to evaluate the association of COVID-illness worry and COVID-impact worry, separately, with sleep measures, adjusting for age, sex, race/ethnicity, and presence of persistent COVID-related symptoms. Results: The prevalence of insomnia (moderate, severe, or very severe symptoms) and short sleep duration (<6 h/day) was 47.0% and 39.2%, respectively. COVID-illness worry severity was significantly associated with presence of insomnia (OR 1.91, 95% CI 1.13-3.23, p=0.016) and short sleep (OR 2.20, 95% CI 1.25-3.86, p=0.006). In a separate model, COVID-impact worry severity was significantly associated with presence of insomnia (OR 1.98, 95% CI 1.23-3.19, p=0.005) and short sleep (OR 2.11, 95% CI 1.26-3.55, p=0.005). Conclusion: Sleep disturbances are common among patients previously hospitalized with COVID-19 illness, and COVID-19 related worries are associated with insomnia and short sleep. Additional research is needed to determine whether addressing COVID-19 related worries reduces sleep disturbance, which in turn may promote post- COVID recovery.