Association of Prior COVID-19 Infection with Restorative Sleep Quality Using REST-Q Scores: Findings from the COPE Initiative

Objectives: The COVID –19 pandemic has disrupted sleep health globally. However, the relationship between prior SARS –COV –2 infection and subjective restorative sleep, measured using validated instruments, remains underexplored. This study evaluated the association between prior SARS –CoV –2 infection and restorative sleep quality using Restorative Sleep Questionnaire (REST –Q) scores in a large, nationally representative U.S. sample. Methods: Data were obtained from the September –October 2022 wave of the COVID –19 Outbreak Public Evaluation (COPE) Initiative, a cross sectional online survey of 4982 adults approximating the U.S. population by age, sex, race, and ethnicity. Restorative sleep was measured using the 9 & [ndash]item REST – Q. COVID –19 infection status was self reported and categorized as never infected, one infection, or &ge 2 infections. General linear models and ordinal logistic regression assessed associations between infection status and REST –Q scores, adjusting for demographic, socioeconomic, comorbidity, sleep related, and mental health variables (Patient Health Questionnaire 4). Results: Participants with prior COVID–19 infection had significantly lower REST –Q scores compared with those without infection (52.1±22.5 vs. 57.9 ±24.4, p<0.001). Prior COVID –19 infection was also associated with higher odds of reporting low restorative sleep (adjusted OR=1.15, 95% CI: 1.02 – 1.30, p=0.019). REST –Q scores decreased with increasing number of infections. In fully adjusted models including anxiety and depression, the association attenuated (p=0.078) but remained significant in sensitivity analyses accounting for infection recency. Conclusions: Prior COVID –19 infection is associated with reduced restorative sleep quality as measured by REST –Q scores, independent of multiple confounders. The association persists although is partly attenuated when adjusted for anxiety and depression. These findings suggest a potential long term impact of COVID –19 on self reported restorative sleep and highlight the need for mechanistic and interventional research to address post-COVID sleep impairment.