To characterize risk factors of Long COVID sleep disturbance at a city hospital. 

Millions globally suffer from long-term functional and cognitive impairment from post-acute SARS-CoV-2 infection (PASC), or “Long COVID.” Sleep disturbances (SDs), either new or exacerbated, are common but under-researched in this population despite their impact on immune function, chronic organ illness, and quality of life. 

Retrospective chart review of patients seen at a hospital-based Long COVID Clinic (01/2022-12/2023). SDs experienced during PASC were classified into four phenotypes: insomnia, hypersomnia, mixed, and other. Binomial and multinomial regression identified predictors, with no SD as the reference and Area Deprivation Index (ADI) as the covariate. P-values were adjusted for multiplicity using the Benjamini-Hochberg method.

Of 452 patients (median age 47, 70.4% Female, 46% White), 71.9% reported SDs, of which 34.5% experienced new-onset and 23.2% reported exacerbation of prior disturbances. ADI was the only demographic predictor (p=.016) of SD. Vaccination status, number of infections, and hospitalization were not predictive.

Key PASC risk factors for SDs (all p<.01 unless specified) included post-exertional malaise (OR=7.98), fatigue (OR=6.39), dysautonomia/POTS (OR=5.96), gait instability (OR=5.36, p=.019), depression (OR=4.95), brain fog (OR=3.85), myalgias/arthralgias (OR=3.19), anxiety (OR=3.06), SOB/DOE (OR=2.17). Key prescription risk factors included antidepressants, albuterol, and benzodiazepines (OR>2.0, p<.01).

PASC neurologic symptoms of paresthesia, weakness, dizziness, and migraines predicted insomnia (OR>2.39, p<.027). Insomnia was also associated with pre-existing pain, anxiety, and depression. Benzodiazepines were stronger predictors of insomnia than anxiety (OR=3.53 vs. 2.96, p< .01). Beta blockers and PPIs predicted insomnia, while stimulants did not. Muscle relaxants predicted insomnia (OR=5.30, p=.016), while opioids predicted hypersomnia (OR=11.16, p=.018). Sleep aids like melatonin, mirtazapine, trazodone, doxepin, and zolpidem were protective, unlike antihistamines. 

PASC symptoms, comorbidities, and medications predicted sleep disturbances, revealing distinct patterns for insomnia and hypersomnia. Identifying these risk factors could enable earlier interventions and inform future treatment strategies.