2025 American Academy of Neurology Abstract Website

Objective:

To characterize risk factors of Long COVID sleep disturbance at a city hospital.

Background:

Millions globally suffer from long-term functional and cognitive impairment from post-acute SARS-CoV-2 infection (PASC), or “Long COVID.” Sleep disturbances (SDs), either new or exacerbated, are common but under-researched in this population despite their impact on immune function, chronic organ illness, and quality of life.

Design/Methods:

Retrospective chart review of patients seen at a hospital-based Long COVID Clinic (01/2022-12/2023). SDs experienced during PASC were classified into four phenotypes: insomnia, hypersomnia, mixed, and other. Binomial and multinomial regression identified predictors, with no SD as the reference and Area Deprivation Index (ADI) as the covariate. P-values were adjusted for multiplicity using the Benjamini-Hochberg method.

Results:

Of 452 patients (median age 47, 70.4% Female, 46% White), 71.9% reported SDs, of which 34.5% experienced new-onset and 23.2% reported exacerbation of prior disturbances. ADI was the only demographic predictor (p=.016) of SD. Vaccination status, number of infections, and hospitalization were not predictive.

Key PASC risk factors for SDs (all p<.01 unless specified) included post-exertional malaise (OR=7.98), fatigue (OR=6.39), dysautonomia/POTS (OR=5.96), gait instability (OR=5.36, p=.019), depression (OR=4.95), brain fog (OR=3.85), myalgias/arthralgias (OR=3.19), anxiety (OR=3.06), SOB/DOE (OR=2.17). Key prescription risk factors included antidepressants, albuterol, and benzodiazepines (OR>2.0, p<.01).

PASC neurologic symptoms of paresthesia, weakness, dizziness, and migraines predicted insomnia (OR>2.39, p<.027). Insomnia was also associated with pre-existing pain, anxiety, and depression. Benzodiazepines were stronger predictors of insomnia than anxiety (OR=3.53 vs. 2.96, p< .01). Beta blockers and PPIs predicted insomnia, while stimulants did not. Muscle relaxants predicted insomnia (OR=5.30, p=.016), while opioids predicted hypersomnia (OR=11.16, p=.018). Sleep aids like melatonin, mirtazapine, trazodone, doxepin, and zolpidem were protective, unlike antihistamines.

Conclusions:

PASC symptoms, comorbidities, and medications predicted sleep disturbances, revealing distinct patterns for insomnia and hypersomnia. Identifying these risk factors could enable earlier interventions and inform future treatment strategies.