Sleep quality and insomnia among patients recovered from COVID-19: implications for rehabilitation

ABSTRACT

Introduction: Changes in sleep patterns have been documented worldwide since the onset of the Covid-19 pandemic. Among people infected by the new coronavirus, sleep disturbances were detected even after the acute phase of the disease, becoming a prevalent problem in Post-Covid Syndrome. Objective: The present study evaluated the quality of sleep (QS) and prevalence of insomnia among Covid-19 survivors undergoing a physical rehabilitation program. Methods: This is a descriptive, observational and cross-sectional study using the Pittsburgh Sleep Quality Index (PSQI);Insomnia Severity Index (ISI);and the question “whether sleep was better before Covid-19”;approved by the research ethics committee. Results: Fortytwo patients were evaluated between May and August 2021, referred to the Post-Covid Rehabilitation section, aged 45.6±14.5 years, 23 women (55%), BMI of 29.8±5.5 kg/ m2, median Covid diagnosis time of 96 days (22-485) and 60% with mild functional limitation (grade II). Twenty-five patients were hospitalized (59%) for an average of 15 days (1-90), 12 in intensive care (2 to 30 days) and 20 in the ward (1 to 60 days). Overall, poor QS and sleep disturbance occurred for 34 patients (81%), with 19 (56%) reporting sleeping well before Covid-19. Only eight patients (19%) had good QS. Twenty-two patients had a positive insomnia score, at the lower limit (33%), moderate (17%) or severe (2%);of which nine said reported having good quality sleep before Covid. Prevalence of Insomnia was 25% among wards hospitalization and 33% of critical cases. QS was compromised among 95% of patients hospitalized in the ward and for 66% of those who were in intensive care. Fatigue was the most prevalent symptom among other sleep disruptors. Conclusion: QS was impaired for most patients, with insomnia for more than half, for which sleep also became poor after Covid-19. High prevalence of fatigue, obesity and repercussions of illness should be considered. In view of the negative impact and bidirectional relationship of impaired sleep and physical and mental recovery, a more accurate investigation of sleep, as well therapies for its interfering factors, should be incorporated into the rehabilitation program.