Sleep and long COVID: preexisting sleep issues and the risk of post-acute sequelae of SARS-CoV-2 infection in a large general population using 3 different model definitions

Study Objectives: Insomnia, poor sleep quality, and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to post-acute sequelae of SARS-CoV-2 infection (PASC). Methods: Cross-sectional survey of a general population of 24,803 United States adults to determine the association of insomnia, poor sleep quality, and sleep duration with PASC. Three definitions of PASC were used based on post COVID-19 clinical features: COVID-19 Outbreak Public Evaluation Initiative (COPE) (≥ 3), National Institute for Health and Care Excellence (NICE) (≥ 1), and Researching COVID to Enhance Recovery (RECOVER) (scoring algorithm). Results: Prevalence rates of PASC were 21.9%, 38.9%, and 15.5% for COPE, NICE, and RECOVER PASC definitions, respectively. PASC was associated with insomnia in all 3 models after full adjustment with odds ratios and 95% confidence intervals (CIs) ranging from 1.30 (95% CI: 1.11–1.52, P ≤ .05, RECOVER PASC score) to 1.52 (95% CI: 1.34–1.71, P ≤ .001, NICE). Poor sleep quality was related to PASC in all models with adjusted odds ratios ranging from 1.77 (95% CI: 1.60–1.97, P ≤ .001, NICE) to 2.00 (95% CI: 1.77–2.26, P ≤ .001, COPE). Sleep < 6 hours was associated with PASC with adjusted odds ratios between 1.59 (95% CI: 1.40–1.80, P ≤ .001, RECOVER PASC score) and 1.70 (95% CI: 1.53–1.89, P ≤ .001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality, and short sleep duration with PASC in any of the models. Conclusions: Insomnia, poor sleep quality, and short sleep duration are cross-sectionally associated with PASC and may be potential risk factors. Further longitudinal studies should be conducted.