1. In this prospective cohort study, a high prevalence of sleep symptoms were identified in a cohort of long COVID patients. This was especially the case for insomnia, with symptoms that persisted 18 weeks.

2. Patients also developed persistent excessive sleepiness and were found to have improvements with wakefulness promoters.

Evidence Rating Level: 2 (Good)

Long COVID is a persistence of symptoms related to a COVID-19 infection that last beyond 4 weeks. Often, these symptoms included fatigue and shortness of breath; however, it has been identified that sleep disorders may present with long COVID. Of the proposed mechanisms for this, a prolonged latent inflammation and glymphatic congestion have been postulated.  This study looked to quantify the prevalence of sleep disorders in a cohort of patients with post-COVID symptoms.

This prospective cohort study included 207patients with post-COVID symptoms at a neurology center in Ceará, Brazil. Patients were recruited via radio messaging and social media. Patients were included if they had a documented SARS-CoV-2 PCR assay and persistence of symptoms for longer than 4 weeks. Polysomnography and actigraphy were completed for objective sleep measures. Questionaries and structured psychiatric interviews were completed to collect sleep symptoms and establish sleep disorder diagnoses.

Overall, this study identified 48 long COVID (25.3%) patients to have sleep-related symptoms. Insomnia (22.2%) and excessive sleepiness (3.17%) were the most commonly identified sleep disorders in this patient group. Interestingly, most patients had these sleep disorder symptoms persist up to 18 weeks. In performing objective sleep measurements, two patients were identified with central hypersomnia and one with narcolepsy.  However, this study was limited by selection bias, as the recruitment method may have resulted in patients with more severe symptoms participating in the study. Nonetheless, this study provides evidence that chronic insomnia and hypersomnia are possible symptoms associated with long COVID.

Click to read the study in BMC Neurology

Image: PD

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