Abstract Study Objectives The relationship between Coronavirus disease 2019 (COVID-19) and sleep health is unclear; therefore, we examined the association between SARS-CoV-2 infection and sleep impairment in Military Health System (MHS) beneficiaries. Methods The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infections of Pandemic Potential study enrolled MHS beneficiaries through Military Treatment Facilities and an online pathway. Eligibility criteria included those who were Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or negative. A subset of participants completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire in addition to the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) instruments. Bivariate analyses of PSQI score with COVID-19 history were extended by multivariable regression models to adjust for confounders. Sensitivity analyses adjusted for GAD-7, PHQ-9, and prior sleep disorders. Results A total of 1228 Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential participants completed a PSQI questionnaire. Over half were males (64%), white (77%), and Active-Duty Service Members (ADSM) (80%). The median age was 37 years, and 41% of the participants had a history of SARS-CoV-2 infection prior to completing the PSQI. Those with prior infection were more likely to have poor sleep health (PSQI 10) compared to those without (32% vs 21%, p .001). After adjusting for sex, race, age, BMI, and history of obstructive sleep apnea, those with a history of SARS-CoV-2 infection had higher risk of poor sleep PSQI 10: RR = 1.41, p .001. Results were similar across all sensitivity analyses. Conclusions Prior SARS-CoV-2 infection is associated with poor sleep in ADSM and MHS beneficiaries. Further prospective and mechanistic studies are required to further understand this association. Statement of Significance Insufficient sleep and associated health risks are highly prevalent in the military population. We examined the role of sleep quality and risk for SARS-CoV-2 infection during the COVID-19 pandemic in a military beneficiary population. Our study analyzed data from participants in a prospective study and included 1228 participants who completed the Pittsburgh Sleep Quality Index. We found significant risk for prior SARS-CoV-2 infection in those with poor sleep quality, even when adjusting for previous sleep disorders and other confounders, suggesting that SARS-CoV-2 infection is a risk factor for subsequent sleep impairment. Further studies are needed to understand the potential bidirectional relationship between sleep quality and risk for infection, severity of infection, post-acute sequelae of infection and SARS-CoV-2 immunity.
Pollett et al. (2025) studied this question.