Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study

Nynke L Rauwerda; Tanja A Kuut; Annemarie M J Braamse; Irene Csorba; Pythia Nieuwkerk; Annemieke van Straten; Hans Knoop

doi:10.1016/j.jpsychores.2023.111522

Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study

J Psychosom Res. 2024 Feb:177:111522. doi: 10.1016/j.jpsychores.2023.111522. Epub 2023 Oct 14.

Authors

Nynke L Rauwerda¹, Tanja A Kuut², Annemarie M J Braamse², Irene Csorba², Pythia Nieuwkerk³, Annemieke van Straten⁴, Hans Knoop²

Affiliations

¹ Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Hospital Gelderse Vallei, Ede, the Netherlands. Electronic address: rauwerdan@zgv.nl.
² Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands.
³ Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Clinical, Neuro and Developmental Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands.

PMID: 38113796
DOI: 10.1016/j.jpsychores.2023.111522

Abstract

Objective: Following COVID-19 many patients report persistent fatigue and insomnia. Given the overlapping features, insomnia can be underdiagnosed in post-COVID-19 fatigue patients. This study aimed to determine insomnia severity, prevalence of clinical insomnia and sleep characteristics of post-COVID-19 fatigue patients. Data of post-COVID-19 fatigue patients were compared with those of patients with chronic fatigue syndrome (ME/CFS), a condition resembling post-COVID-19 fatigue.

Methods: In this cross-sectional case-controlled study, insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score ≥ 10), were determined in patients with post-COVID-19 fatigue (n = 114) and compared with ME/CFS (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate whether mood, concentration problems, pain, fatigue (assessed with questionnaires) and diagnosis were associated with insomnia. Sleep characteristics were determined with a sleep diary and accelerometer in post-COVID-19 fatigue and compared with ME/CFS using ANCOVA.

Results: In patients with post-COVID-19 fatigue mean (SD) insomnia severity was 11.46 (5.7) and 64% reported clinical insomnia. Insomnia severity was significantly associated with depressive symptoms (ß = 0.49, p = 0.006) and age (ß = 0.08, p = 0.04). The mean (SD) subjective sleep duration was 7.4 (1.0) hours with a sleep efficiency of 82 (11)%. Several subjective sleep characteristics of the post-COVID-19 fatigue patients differed from ME/CFS patients; only sleep duration, being significantly shorter in post-COVID-19 fatigue patients (p = 0.003), seemed clinically relevant (d = 0.58).

Conclusion: Insomnia severity and prevalence of clinical insomnia are high in patients with post-COVID-19 fatigue. Insomnia should be assessed and if present treated with insomnia focused therapy.

Keywords: COVID-19; Chronic fatigue; Insomnia; ME/CFS; Sleep.

MeSH terms

COVID-19* / complications
Cross-Sectional Studies
Fatigue Syndrome, Chronic* / complications
Fatigue Syndrome, Chronic* / epidemiology
Humans
Sleep
Sleep Initiation and Maintenance Disorders* / complications
Sleep Initiation and Maintenance Disorders* / etiology