Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

doi:10.1186/s12889-023-17258-3

. 2023 Nov 28;23(1):2352.

doi: 10.1186/s12889-023-17258-3.

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

Kentaro Matsui¹, Frances Chung², Adrijana Koscec Bjelajac³, Ilona Merikanto^{4

5}, Maria Korman⁶, Sérgio Mota-Rolim⁷, Ana Suely Cunha⁸, Bjørn Bjorvatn^{9

10}, Pei Xue¹¹, Christian Benedict¹¹, Charles M Morin¹², Colin A Espie¹³, Anne-Marie Landtblom^{14

15}, Thomas Penzel¹⁶, Luigi De Gennaro^{17

18}, Brigitte Holzinger¹⁹, Harald Hrubos-Strøm^{20

21}, Damien Leger^{22

23}, Courtney J Bolstad^{24

25}, Michael R Nadorff²⁴, Giuseppe Plazzi^{26

27}, Catia Reis^{28

29

30}, Ngan Yin Chan³¹, Yun Kwok Wing³¹, Juliana Yordanova³², Yves Dauvilliers³³, Markku Partinen^{34

35}, Yuichi Inoue^{36

37}

Affiliations

¹ Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
² Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
³ Institute for Medical Research and Occupational Health, Zagreb, Croatia.
⁴ SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁵ Orton Orthopaedics Hospital, Helsinki, Finland.
⁶ Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
⁷ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil.
⁸ Medical College, Potiguar University, Natal, Brazil.
⁹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹⁰ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
¹¹ Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden.
¹² Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec City Quebec, Canada.
¹³ Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹⁴ Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
¹⁵ Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹⁶ Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
¹⁷ Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
¹⁸ IRCCS Fondazione Santa Lucia, Roma, Italy.
¹⁹ Institute for Consciousness and Dream Research; Medical University of Vienna, Postgraduate Sleep Coaching, WienVienna, Austria.
²⁰ Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway.
²¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
²² VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Université Paris Cité, Paris, France.
²³ APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France.
²⁴ Department of Psychology, Mississippi State University, Mississippi State, MS, USA.
²⁵ South Texas Veterans Health Care System, San Antonio, Texas, USA.
²⁶ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
²⁷ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²⁸ Católica Research Centre for Psychological - Family and Social Wellbeing, Universidade Católica Portuguesa, Lisbon, Portugal.
²⁹ Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal.
³⁰ Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
³¹ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
³² Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
³³ Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France.
³⁴ Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland.
³⁵ Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
³⁶ Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan. inoue@somnology.com.
³⁷ Department of Somnology, Tokyo Medical University, Tokyo, Japan. inoue@somnology.com.

PMID: 38017498
PMCID: PMC10683140
DOI: 10.1186/s12889-023-17258-3

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

Kentaro Matsui et al. BMC Public Health. 2023.

. 2023 Nov 28;23(1):2352.

doi: 10.1186/s12889-023-17258-3.

Authors

Affiliations

¹ Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
² Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
³ Institute for Medical Research and Occupational Health, Zagreb, Croatia.
⁴ SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁵ Orton Orthopaedics Hospital, Helsinki, Finland.
⁶ Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
⁷ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil.
⁸ Medical College, Potiguar University, Natal, Brazil.
⁹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹⁰ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
¹¹ Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden.
¹² Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec City Quebec, Canada.
¹³ Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹⁴ Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
¹⁵ Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
¹⁶ Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany.
¹⁷ Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy.
¹⁸ IRCCS Fondazione Santa Lucia, Roma, Italy.
¹⁹ Institute for Consciousness and Dream Research; Medical University of Vienna, Postgraduate Sleep Coaching, WienVienna, Austria.
²⁰ Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway.
²¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
²² VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Université Paris Cité, Paris, France.
²³ APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France.
²⁴ Department of Psychology, Mississippi State University, Mississippi State, MS, USA.
²⁵ South Texas Veterans Health Care System, San Antonio, Texas, USA.
²⁶ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
²⁷ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²⁸ Católica Research Centre for Psychological - Family and Social Wellbeing, Universidade Católica Portuguesa, Lisbon, Portugal.
²⁹ Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal.
³⁰ Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
³¹ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
³² Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
³³ Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France.
³⁴ Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland.
³⁵ Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland.
³⁶ Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan. inoue@somnology.com.
³⁷ Department of Somnology, Tokyo Medical University, Tokyo, Japan. inoue@somnology.com.

PMID: 38017498
PMCID: PMC10683140
DOI: 10.1186/s12889-023-17258-3

Abstract

Background: Self-rated health (SRH) is widely recognized as a clinically significant predictor of subsequent mortality risk. Although COVID-19 may impair SRH, this relationship has not been extensively examined. The present study aimed to examine the correlation between habitual sleep duration, changes in sleep duration after infection, and SRH in subjects who have experienced SARS-CoV-2 infection.

Methods: Participants from 16 countries participated in the International COVID Sleep Study-II (ICOSS-II) online survey in 2021. A total of 10,794 of these participants were included in the analysis, including 1,509 COVID-19 individuals (who reported that they had tested positive for COVID-19). SRH was evaluated using a 0-100 linear visual analog scale. Habitual sleep durations of < 6 h and > 9 h were defined as short and long habitual sleep duration, respectively. Changes in habitual sleep duration after infection of ≤ -2 h and ≥ 1 h were defined as decreased or increased, respectively.

Results: Participants with COVID-19 had lower SRH scores than non-infected participants, and those with more severe COVID-19 had a tendency towards even lower SRH scores. In a multivariate regression analysis of participants who had experienced COVID-19, both decreased and increased habitual sleep duration after infection were significantly associated with lower SRH after controlling for sleep quality (β = -0.056 and -0.058, respectively, both p < 0.05); however, associations between current short or long habitual sleep duration and SRH were negligible. Multinomial logistic regression analysis showed that decreased habitual sleep duration was significantly related to increased fatigue (odds ratio [OR] = 1.824, p < 0.01), shortness of breath (OR = 1.725, p < 0.05), diarrhea/nausea/vomiting (OR = 2.636, p < 0.01), and hallucinations (OR = 5.091, p < 0.05), while increased habitual sleep duration was significantly related to increased fatigue (OR = 1.900, p < 0.01).

Conclusions: Changes in habitual sleep duration following SARS-CoV-2 infection were associated with lower SRH. Decreased or increased habitual sleep duration might have a bidirectional relation with post-COVID-19 symptoms. Further research is needed to better understand the mechanisms underlying these relationships for in order to improve SRH in individuals with COVID-19.

Keywords: Coronavirus infections; Fatigue; Health status indicators; Post-Acute Sequelae of SARS-CoV-2 Infection (PASC); Sleep wake disorders.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig 1.**
Comparisons of self-rated health according to respective measure categories in the COVID-19 group. Mean self-rated health (SRH) score is shown for respective categories: according to the severity of COVID-19 (A), according to current sleep duration (B), and according to the change in habitual sleep duration after SARS-CoV-2 infection (C). Error bars represent 95% confidence intervals. The dashed green line indicates the mean SRH of the non-infected participants. P-values were calculated through one-way analysis of variance without weighting, followed by Bonferroni post hoc tests

**Fig 2.**
Self-rated health by positivities for respective post-COVID-19 symptoms. Error bars represent 95% confidence intervals. The dashed green line indicates the mean SRH of the participants who did not test positive for COVID-19. Note that the presence of multiple post-COVID-19 symptoms in many individuals of the COVID-19 group precludes the use of a one-way analysis of variance, as it cannot adequately address the resulting interdependencies and complexities

See this image and copyright information in PMC

References

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[1] Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med (1982) 2009;69(3):307–316. doi: 10.1016/j.socscimed.2009.05.013. - DOI - PubMed

[2] Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med (1982) 2009;69(3):307–316. doi: 10.1016/j.socscimed.2009.05.013. - DOI - PubMed

[3] Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37. doi: 10.2307/2955359. - DOI - PubMed

[4] Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37. doi: 10.2307/2955359. - DOI - PubMed

[5] Seedhouse D. Health: the foundations for achievement. Chichester: John Wiley & Sons; 1986.

[6] Seedhouse D. Health: the foundations for achievement. Chichester: John Wiley & Sons; 1986.

[7] Kananen L, Enroth L, Raitanen J, Jylhävä J, Bürkle A, Moreno-Villanueva M, Bernhardt J, Toussaint O, Grubeck-Loebenstein B, Malavolta M, et al. Self-rated health in individuals with and without disease is associated with multiple biomarkers representing multiple biological domains. Sci Rep. 2021;11(1):6139. doi: 10.1038/s41598-021-85668-7. - DOI - PMC - PubMed

[8] Kananen L, Enroth L, Raitanen J, Jylhävä J, Bürkle A, Moreno-Villanueva M, Bernhardt J, Toussaint O, Grubeck-Loebenstein B, Malavolta M, et al. Self-rated health in individuals with and without disease is associated with multiple biomarkers representing multiple biological domains. Sci Rep. 2021;11(1):6139. doi: 10.1038/s41598-021-85668-7. - DOI - PMC - PubMed

[9] DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Internal Med. 2006;21(3):267–275. doi: 10.1111/j.1525-1497.2005.00291.x. - DOI - PMC - PubMed

[10] DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Internal Med. 2006;21(3):267–275. doi: 10.1111/j.1525-1497.2005.00291.x. - DOI - PMC - PubMed

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Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

Affiliations

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

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Abstract

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