Sleep Quality and Efficiency in Adults with Post-Acute Sequelae of COVID-19

Study Objectives Sleep disruptions are associated with adverse mental and physical health outcomes. Individuals with post-acute sequelae of COVID-19 (PASC) commonly report worsened sleep. This study examined sleep quality and efficiency and their associations with neuropsychiatric symptoms and fatigue in non-hospitalized individuals with PASC. Methods Sixty-one participants (73.8% female; x-age=45.4) who reported being infected with COVID-19 ≥2 months before enrollment, non-hospitalized, and experiencing >3 symptoms since infection were eligible. The Pittsburgh Sleep Quality Index (PSQI) was used to measure self-reported sleep quality, and the Fitbit Charge-4 to assess sleep efficiency. Participants completed the Beck Anxiety Index (BAI), Beck Depression Index (BDI), Post-Traumatic Stress Disorder-Checklist Civilian Version (PCL-C), and the Fatigue Severity Scale (FSS). We conducted multivariable linear regressions to examine associations controlling for age, sex, time since first COVID-19 infection, pre-COVID sleep disorders, and sleep aids. Results PSQI scores were not associated with objective sleep efficiency. Nearly 97% of PASC participants reported poor sleep quality, 85% indicated that sleep difficulties interfered with their daily functioning, and 93.9% achieved optimal sleep efficiency. Higher BDI scores were linked to worse sleep quality, while BAI, PCL-C and FSS scores were not. However, BAI and FSS were related to distinct PSQI components. None were associated with sleep efficiency. Conclusion Individuals with PASC experience significant sleep difficulties impacting daily functioning. Although they showed adequate sleep efficiency, most participants perceived their sleep as inefficient, which correlated with worse depressive symptoms. Therefore, sleep is a modifiable factor that could enhance the quality of life for PASC patients.