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BackgroundSleep disturbance is common following hospitalisation both for COVID-19 and other causes. The clinical associations are poorly understood, despite it altering pathophysiology in other scenarios. We, therefore, investigated whether sleep disturbance is associated with dyspnoea along with relevant mediation pathways. MethodsSleep parameters were assessed in a prospective cohort of patients (n=2,468) hospitalised for COVID-19 in the United Kingdom in 39 centres using both subjective and device-based measures. Results were compared to a matched UK biobank cohort and associations were evaluated using multivariable linear regression. Findings64% (456/714) of participants reported poor sleep quality; 56% felt their sleep quality had deteriorated for at least 1-year following hospitalisation. Compared to the matched cohort, both sleep regularity (44.5 vs 59.2, p<0.001) and sleep efficiency (85.4% vs 88.5%, p<0.001) were lower whilst sleep period duration was longer (8.25h vs 7.32h, p<0.001). Overall sleep quality (effect estimate 4.2 (3.0-5.5)), deterioration in sleep quality following hospitalisation (effect estimate 3.2 (2.0-4.5)), and sleep regularity (effect estimate 5.9 (3.7-8.1)) were associated with both dyspnoea and impaired lung function (FEV1 and FVC). Depending on the sleep metric, anxiety mediated 13-42% of the effect of sleep disturbance on dyspnoea and muscle weakness mediated 29-43% of this effect. InterpretationSleep disturbance is associated with dyspnoea, anxiety and muscle weakness following COVID-19 hospitalisation. It could have similar effects for other causes of hospitalisation where sleep disturbance is prevalent. FundingUK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.
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ObjectivesTo assess how the early stages of National governments Coronavirus disease (COVID-19) containment strategies impacted upon the physical activity, mental health and well-being of adults in the UK, Ireland, New Zealand and Australia DesignObservational, cross-sectional SettingOnline survey disseminated in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government mandated COVID-19 restrictions ParticipantsAdults (n = 8,425; 44.5 {+/-} 14.8 y), [≥] 18 y who were residing in the surveyed countries Main outcome measuresStages of Change scale for exercise behaviour change, International Physical Activity Questionnaire (short-form), World Health Organisation-5 Well-being Index and the Depression Anxiety and Stress Scale-9 ResultsParticipants who reported a negative change in exercise behaviour between pre- and during the early COVID-19 restrictions demonstrated poorer mental health and well-being compared to those who had either a positive change- or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who engaged in more physical activity reported better mental health and well-being (p<0.001). Although there were no differences in physical activity between countries, individuals in New Zealand reported better mental health and well-being (p<0.001). ConclusionThe COVID-19 restrictions have differentially impacted upon the physical activity habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage physical activity should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation.
