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. 2025 Jun 1;21(6):1053-1063.
doi: 10.5664/jcsm.11638.

COVID-19 infection and sleep health: findings from the nationally representative COVID-19's Unequal Racial Burden survey

Dana M Alhasan  1 , Symielle A Gaston  1 , Paula D Strassle  2 , Anna María Nápoles  2 , Chandra L Jackson  1   2
Affiliations

COVID-19 infection and sleep health: findings from the nationally representative COVID-19's Unequal Racial Burden survey

Dana M Alhasan et al. J Clin Sleep Med. .

Abstract

Study objectives: To estimate overall and racial/ethnic-specific associations between COVID-19 infection status and sleep health.

Methods: We analyzed online survey data collected from December 2020 to February 2021 among Asian, Black, Latino (English- and Spanish-speaking), and White adults (n = 1,000 each), along with American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial adults (n = 500). COVID-19 infection (confirmed, probable, suspected), based on self-reported data on symptoms and infected contacts, was classified using World Health Organization definitions. Sleep disturbances were categorized as "yes" (mild/moderate/severe) vs "no" (normal). Weighted analyses were used to generate nationally representative estimates within each racial/ethnic group. Adjusting for sociodemographic and health behaviors, Poisson regression with robust variance estimated prevalence ratios and confidence intervals for sleep disturbances among individuals with vs without a COVID-19 infection in the overall population and by gender, ability to get health care, and race/ethnicity.

Results: Among 5,359 eligible participants, 24% had a COVID-19 infection. COVID-19 infection was associated with a 32% higher prevalence of sleep disturbances (PR = 1.32 [95% confidence interval: 1.22-1.42]). The higher prevalence of sleep disturbances among women with vs without COVID-19 (PR = 1.32 [1.19-1.45]) was similar to men (PR = 1.34 [1.18-1.53]). COVID-19 infection was associated with an even higher prevalence of sleep disturbances among participants who reported being able vs unable to get needed health care. COVID-sleep associations were higher among American Indian/Alaska Native (PR = 1.64 [1.30-2.09]), Native Hawaiian/Pacific Islander (PR = 1.53 [1.24-1.90]), and English-speaking Latino (PR = 1.49 [1.20-1.86]) adults compared to White adults (PR = 1.14 [0.93-1.41]), although confidence intervals overlapped.

Conclusions: COVID-19 infections may lead to sleep disturbances among US adults.

Citation: Alhasan DM, Gaston SA, Strassle PD, Nápoles AM, Jackson CL. COVID-19 infection and sleep health: findings from the nationally representative COVID-19's Unequal Racial Burden survey. J Clin Sleep Med. 2025;21(6):1053-1063.

Keywords: COVID-19; delayed diagnosis; delivery of health care; minority groups; sleep; sleep initiation and maintenance disorders.

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Conflict of interest statement

All authors have seen and approved the manuscript. This work was funded by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (Z1AES103325), and by the Division of Intramural Research at the NIH, National Institute on Minority Health and Health Disparities (C.L. Jackson). The authors report no conflicts of interest.

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