Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 12;5(1):zpae002.
doi: 10.1093/sleepadvances/zpae002. eCollection 2024.

Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic

Kathryn J Reid  1   2 , Louis T Ingram  1   2 , Millenia Jimenez  1 , Zachary S Orban  1 , Sabra M Abbott  1   2 , Daniela Grimaldi  1   2 , Kristen L Knutson  1   2 , Phyllis C Zee  1   2 , Igor J Koralnik  1 , Mathew B Maas  1   2
Affiliations

Impact of sleep disruption on cognitive function in patients with postacute sequelae of SARS-CoV-2 infection: initial findings from a Neuro-COVID-19 clinic

Kathryn J Reid et al. Sleep Adv. .

Abstract

Introduction: Fatigue, brain fog, and sleep disturbance are among the most common symptoms of postacute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality of life in patients with neurologic manifestations of PASC (Neuro-PASC).

Methods: Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH Toolbox cognitive tests, and 7 days of wrist actigraphy.

Results: The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p < 0.001), and later sleep midpoint (p = 0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with the severity of fatigue (p < 0.001), anxiety (p = 0.05), and depression (p < 0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency, and latency were associated with decreased performance in attention and processing speed.

Conclusion: Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.

Keywords: COVID-19; cognition; fatigue; insomnia; long COVID; neurology; post-acute sequelae of SARS-CoV-2 infection; sleep.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Neuro-PASC patient flow diagram. A total of 40 patients were consented, of these 39 contributed NIH Toolbox data, 39 contributed questionnaire data, and 38 contributed actigraphy data (two subjects were excluded due to insufficient wear time). Solid line indicates measures conducted at clinic visits and dashed line indicates measures collected at home starting immediately after the clinic visit.
Figure 2.
Figure 2.
Quality of Life and cognitive function results from the PROMIS Questionnaires and NIH Toolbox in Neuro-PASC patients. Neuro-PASC patients reported worse quality of life in cognition, fatigue, sleep disturbance, anxiety, and depression domains. Neuro-PASC patients had worse performance on the attention task compared to the US normative population.
Figure 3.
Figure 3.
Example Actograms from Neuro-PASC patients, including two participants with high PROMIS fatigue and sleep scores and poor sleep based on actigraphy. The participant in the left panel (A) has poor sleep continuity, while the participant in image (B) takes more than 30 minutes to fall asleep. Black line indicates activity level, yellow line indicates light level, small blue triangles indicate participant marker usage for initiation or termination of the rest/sleep period, light and medium blue indicate rest and sleep intervals, and dark blue indicates device removed.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Multidimensional Characterization of Long COVID Fatigue.
    Maas MB, Reid KJ, Jimenez M, Lopez M, Miller J, Carnethon MR, Zee PC, Knutson KL, Koralnik IJ. Maas MB, et al. Behav Sleep Med. 2025 Jun 19:1-10. doi: 10.1080/15402002.2025.2522671. Online ahead of print. Behav Sleep Med. 2025. PMID: 40537100
  • Cognition and objective sleep quality in post-COVID-19 patients.
    Carnes-Vendrell A, Piñol-Ripoll G, Targa A, Tahan N, Ariza M, Cano N, Segura B, Junque C, Béjar J, Barrue C; Nautilus Project Collaborative Group; Garolera M. Carnes-Vendrell A, et al. Front Psychol. 2025 Feb 3;16:1418602. doi: 10.3389/fpsyg.2025.1418602. eCollection 2025. Front Psychol. 2025. PMID: 39963680 Free PMC article.

References

    1. JHU Medicine. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University & Medicine. https://coronavirus.jhu.edu/map.html.Accessed September 21, 2022.
    1. Frontera J, Mainali S, Fink EL, et al. .; GCS-NeuroCOVID Study. Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): study design and rationale. Neurocrit Care. 2020;33(1):25–34. doi:10.1007/s12028-020-00995-3 - DOI - PMC - PubMed
    1. Liotta EM, Batra A, Clark JR, et al. . Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020;7(11):2221–2230. doi:10.1002/acn3.51210 - DOI - PMC - PubMed
    1. Mao L, Jin H, Wang M, et al. .. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–690. doi:10.1001/jamaneurol.2020.1127 - DOI - PMC - PubMed
    1. Romero-Sanchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. . Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology. 2020;95(8):e1060–e1070. doi:10.1212/WNL.0000000000009937 - DOI - PMC - PubMed