Insomnia and Post Acute Sequelae of COVID-19 in an outpatient neurology cohort
Sujata Thawani1, Rachel Kenney2, Sara Hyman3, Azizi Seixas4, Girardin Jean-Louis4, Laura Balcer5
1NYU Neurology Associates, 2Vanderbilt School of Medicine, 3NYU Grossman School of Medicine, 4University of Miami, 5NYU School of Medicine
Objective:
This study aimed to evaluate levels of insomnia in a cohort of PASC patients.
Background:
Insomnia may be a symptom that patients with Post-acute COVID-19 sequelae (PASC) experience.
Design/Methods:
This study analyzed symptoms of 93 SARS-CoV-2 positive patients who were recruited from an outpatient neurology clinic. During an initial baseline assessment and at a 1-year-follow up, standardized assessment scales were used during a phone interview. The Insomnia Severity Index is a validated tool to assess insomnia symptoms. Among the 42 patients that completed the follow-up, symptoms between the initial and 1-year follow-up evaluation were compared.
Results:
At baseline, 51% of participants reported difficulty sleeping, compared to 48% at follow-up. Of follow-up participants, 47% reported no clinically significant insomnia, 33% reported subthreshold insomnia, 16% reported moderate clinical insomnia, and 5% reported severe clinical insomnia. Of people who reported difficulty sleeping (n=20), 11 (55%) had no insomnia or subthreshold insomnia, and 9 scored in the moderate to severe range on the ISI scale. Difficulty sleeping at baseline evaluation was not associated with ISI scores at the follow-up visit. Binary ISI (scores less than 15 = no or subthreshold insomnia or greater than 15=moderate to severe insomnia) was associated with Neuro-QOL anxiety t-score (p=0.034, logistic regression adjusting for age, gender, race/ethnicity), fatigue t-score (p=0.009), depression t-score (p=0.023) and MOCA score (p=0.048). Binary ISI was not associated with HIT6 or number of headaches in the last 30 days on the AMPP questionnaire.
Conclusions:
Sleep disturbances may be an important symptom which may be overlooked in patients suffering from PASC, which can be ongoing and disruptive for periods of years. Furthermore, association with worsened quality-of-life measures for depression, fatigue, and anxiety make this area of PASC one that warrants further attention.