COVID-19 linked to lingering sleep problems and fatigue

Researchers recently analyzed health records of almost 12 million people in the United Kingdom to assess whether there is a link between SARS-CoV-2 infection and psychiatric conditions.They found an association between SARS-CoV-2 infection and lingering sleep problems and fatigue but not conditions such as depression, self-harm, and anxiety.
ResearchTrusted Source suggests that many people experience fatigue, brain fog, and sleep problems after contracting SARS-CoV-2. Other studies have reportedTrusted Source worsening mental health, although not all have reportedTrusted Source anxiety or depression.

According to the researchers

However, only about 1 in 4Trusted Source people presented for testing.

Observational studies investigating the effects of SARS-CoV-2 infection can be limited. For instance, they cannot account for certain factors that influence an individual’s risk of contracting the virus, including their occupation. Also, some people are more likely than others to seek a test and visit healthcare services.

One wayTrusted Source to account for these factors is to compare the health outcomes of the individuals

The present study included data of almost 12 million people. The study authors compared the psychiatric health outcomes of those who tested positive for SARS-CoV-2 with those who tested negative.

The study appears in the journal JAMA Network OpenTrusted Source.

“The findings with respect to sleep problems and fatigue were what we anticipated,” Dr. Matthias Pierce. Ph.D., senior author of the study, explained to Medical News Today.

“Fatigue in particular is well known as being associated with other serious viruses, such as [severe acute respiratory syndrome (SARS)] and [Middle East respiratory syndrome (MERS)], as well as meningitis, hepatitis, and glandular fever.”

“What surprised us was that there was a similar risk of mental distress for those who tested negative for SARS-CoV-2 as [for] those who tested positive.

The findings suggest that psychiatric conditions stemming from SARS-CoV-2 may be overstated from health record analyses involving only positive SARS-CoV-2 PCR test results.

Data analysis

The researchers included data from the participants who were 16 years old or older and who attended health clinics between February 1 and December 9, 2020.

Altogether, the researchers included data of 11,923,105 individuals in their analysis. Of those, 232,780, or 2%, received a positive SARS-CoV-2 test result during the study period.

The researchers analyzed the participants’ health records for diagnosis or symptoms of psychiatric conditions, including depression, self-harm, and sleep problems. They also examined the data for prescriptions of psychotic medications, such as antidepressants and mood stabilizers.

After accounting for various factors, including ethnicity, smoking status, and BMI, the study authors found

There was a particular link between a positive test result and a higher risk of sleep problems and prescriptions for medications such as antipsychotics, nonbenzodiazepine hypnotics, and mood stabilizers.

Moreover, the researchers note that those aged 80 years and older were most likely to develop psychiatric conditions, that those aged 60–69 years were at the greatest risk of fatigue and sleep disorders, and that women were at a greater overall risk of developing any condition than men.

Unknown mechanisms

The underlying mechanism linking SARS-CoV-2 with sleep problems is unknown. Dr. Pierce hypothesizes that inflammation might play a role:

“[The cause of fatigue is] likely multifactorial,” Dr. Aaron Bunnell, associate professor of rehabilitation medicine at the University of Washington School of Medicine in Seattle, told MNT.

“[It may include] sleep disorders, ongoing autoimmune or systemic responses to the infection even though it has resolved, effects on other organ systems — neuropathies, autonomic myopathies, etc. — and myalgic encephalomyelitis/chronic fatigue syndrome.”

“[Sleep disorders following SARS-CoV-2] may be due to inflammatory responses or blood-brain barrier dysfunction. Sleep disturbance is also seen in myalgic encephalomyelitis/chronic fatigue syndrome,” he added.


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Health anxiety

The researchers say that these unobserved factors are most likely related to occupation and health anxiety.

The researchers further write that those seeking a test for COVID-19 may have already experienced health anxiety, which in itself may indicate future mental illness.

This, the authors explain, is notable, as those with negative test results were more likely to have had mental illness than those with positive tests.


The researchers also investigated rates of psychiatric conditions among individuals who had influenza. They found that those with influenza during the same study period were more likely to develop psychiatric symptoms than those with SARS-CoV-2.

The authors explain that this might be because previous studies did not follow up individuals with SARS-CoV-2 infection from the same date, nor did they adjust for patient distance to hospitals and hospital capacities.


Some limitations

The study authors note there are some limitations to their findings.

Misclassification of these individuals would make their results less sensitive to any associations between SARS-CoV-2 and psychiatric health.

“Future research might focus on mechanisms of fatigue, and sleep problems, and to further understand if there are psychiatric risks to [SARS-CoV-2] infection,” said Dr. Pierce. “Interventions should focus on prevention as well as ameliorating symptoms and improving quality of life via different interventions.”

“I think [these findings] support some of the previous efforts to really examine fatigue and sleep as a key component to rigorously assess and manage in these populations,” Dr. Bunnell explained.

“Multiple studies are looking at patient-reported outcomes [and] objective sleep assessments in these populations,” he continued.

As the results of this work roll in, the effect of SARS-CoV-2 infection on sleep should steadily grow clearer.

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