Angela Sohng , Ariana Rauch , Neoreet Braha , et. al., Sleep, Volume 48, Issue Supplement_1, May 2025, Page A605, https://doi.org/10.1093/sleep/zsaf090.1407
Abstract
Introduction
Millions globally suffer from long-term functional and cognitive impairment from post-acute-SARS-CoV-2 infection (PASC), or “Long COVID.” Sleep disturbances (SDs), either new or exacerbated, are common but under-researched in this population despite their impact on immune function, chronic organ illness, and quality of life.
Methods
Retrospective chart review of patients seen at Boston Medical Center’s Long COVID Clinic (01/2022-12/2023). SDs experienced during PASC were classified into four phenotypes: insomnia, hypersomnia, mixed, and other. Binomial and multinomial regression identified predictors, with no SD as the reference and Area Deprivation Index (ADI) as the covariate. P-values were adjusted for multiplicity using the Benjamini-Hochberg method.
Results
Among 452 PASC patients (median age 47, 70.4% Female, 46% White), 28.1% had no SD, while 34.7% reported insomnia, 9.3% hypersomnia, 20.8% mixed insomnia/hypersomnia, and 6.9% other SDs. ADI was the only significant demographic predictor of SD (p=.016); vaccination status, number of infections, and hospitalizations were not predictive. Comorbidities strongly linked to SD-Insomnia included pre-existing insomnia (OR=3.97, p<.01), chronic pain (OR=2.75, p<.01), anxiety (OR=2.24, p<.01), and depression (OR=1.98, p=.024). These also predicted SD-Mixed insomnia/hypersomnia. Additionally, chronic heart disease (OR=5.02, p=.024), OSA (OR=3.16, p=.022), and chronic pulmonary disease (OR=2.76, p<.01) were specifically associated with SD-Mixed. No comorbidities predicted hypersomnia. PASC symptom predictors (all p<.01) included fatigue, post-exertional malaise (PEM), brain fog, anxiety, depression, and POTS/dysautonomia. SD-Hypersomnia was notably associated with PEM (OR=10.39, p<.01), gait instability (OR=9.12, p=.012), and POTS/dysautonomia (OR=8.09, p<.01). SD-Mixed was especially defined by fatigue (OR=18.5, p<.01) and PEM (OR=10.93, p<.01). Notable medication risk factors for SD-Insomnia included benzodiazepines (OR=3.53, p<.01) and PPIs (OR=2.22, p=.033). Beta-blockers (OR=3.46, p=.024) and albuterol (OR=3.40, p<.01) were stronger predictors of SD-Mixed but also significant for SD-Insomnia.
Conclusion
SD-Insomnia and SD-Mixed were strongly linked to pre-existing comorbidities, PASC symptoms, and medications, while SD-Hypersomnia was primarily driven by PASC-related symptoms. Treatment strategies should be tailored based on SD phenotypes: addressing comorbidities and minimizing iatrogenic effects for SD-Insomnia and SD-Mixed, while targeting PASC symptoms of autonomic dysfunction, PEM, and gait instability for SD-Hypersomnia. Recognizing these distinct patterns may improve personalized management of sleep disturbances in PASC.