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Observational Study
. 2022 Jun 1;50(6):945-954.
doi: 10.1097/CCM.0000000000005476. Epub 2022 Feb 18.

Sleep and Circadian Health of Critical COVID-19 Survivors 3 Months After Hospital Discharge

Iván D Benítez  1   2 , Anna Moncusí-Moix  1   2 , Rafaela Vaca  1 , Clara Gort-Paniello  1   2 , Olga Minguez  1 , Sally Santisteve  1 , Paola Carmona  1 , Gerard Torres  1   2 , Juliane Fagotti  3 , Gonzalo Labarca  4   5 , Antoni Torres  2   6 , Jessica González  1   2 , David de Gonzalo-Calvo  1 , Ferran Barbé  1   2 , Adriano D S Targa  1   2
Affiliations
Observational Study

Sleep and Circadian Health of Critical COVID-19 Survivors 3 Months After Hospital Discharge

Iván D Benítez et al. Crit Care Med. .

Abstract

Objectives: To evaluate the sleep and circadian rest-activity pattern of critical COVID-19 survivors 3 months after hospital discharge.

Design: Observational, prospective study.

Setting: Single-center study.

Patients: One hundred seventy-two consecutive COVID-19 survivors admitted to the ICU with acute respiratory distress syndrome.

Interventions: Seven days of actigraphy for sleep and circadian rest-activity pattern assessment; validated questionnaires; respiratory tests at the 3-month follow-up.

Measurements and main results: The cohort included 172 patients, mostly males (67.4%) with a median (25th-75th percentile) age of 61.0 years (52.8-67.0 yr). The median number of days at the ICU was 11.0 (6.00-24.0), and 51.7% of the patients received invasive mechanical ventilation (IMV). According to the Pittsburgh Sleep Quality Index (PSQI), 60.5% presented poor sleep quality 3 months after hospital discharge, which was further confirmed by actigraphy. Female sex was associated with an increased score in the PSQI (p < 0.05) and IMV during ICU stay was able to predict a higher fragmentation of the rest-activity rhythm at the 3-month follow-up (p < 0.001). Furthermore, compromised mental health measured by the Hospital Anxiety and Depression Scale was associated with poor sleep quality (p < 0.001).

Conclusions: Our findings highlight the importance of considering sleep and circadian health after hospital discharge. Within this context, IMV during the ICU stay could aid in predicting an increased fragmentation of the rest-activity rhythm at the 3-month follow-up. Furthermore, compromised mental health could be a marker for sleep disruption at the post-COVID period.

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Conflict of interest statement

Dr. Labarca has received financial support from Agencia Nacional de Investigacion y Desarrollo, Chile, grant COVID 1005. Dr. de Gonzalo-Calvo has received financial support from Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by the European Social Fund/“Investing in your future.” Drs. de Gonzalo-Calvo and Barbé disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Clinical chronology of COVID-19 patients included in the study. The time of hospitalization and time spent at the ICU are represented as median (percentile 25–75).
Figure 2.
Figure 2.
Predictive factors for poor sleep quality and increased fragmentation of the circadian rest-activity rhythm after hospital discharge. t test was performed to assess correlations between the variables. The p value threshold defining statistical significance was set at less than 0.05. PSQI = Pittsburgh Sleep Quality Index.
See this image and copyright information in PMC

Comment in

  • COVID-19, Critical Illness, and Sleep.
    Chatterjee AB. Chatterjee AB. Crit Care Med. 2022 Jun 1;50(6):1021-1023. doi: 10.1097/CCM.0000000000005519. Epub 2022 Feb 28. Crit Care Med. 2022. PMID: 35220341 Free PMC article. No abstract available.

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