SARS-CoV-2 Infection: Paving Way for Sleep Disorders in Long Term!

Parasomnias During the COVID-19 Pandemic

COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.

Cognitive impairment after long COVID-19: current evidence and perspectives

COVID-19, caused by the SARS-CoV-2 virus, is a respiratory infectious disease. While most patients recover after treatment, there is growing evidence that COVID-19 may result in cognitive impairment. Recent studies reveal that some individuals experience cognitive deficits, such as diminished memory and attention, as well as sleep disturbances, suggesting that COVID-19 could have long-term effects on cognitive function. Research indicates that COVID-19 may contribute to cognitive decline by damaging crucial brain regions, including the hippocampus and anterior cingulate cortex. Additionally, studies have identified active neuroinflammation, mitochondrial dysfunction, and microglial activation in COVID-19 patients, implying that these factors may be potential mechanisms leading to cognitive impairment. Given these findings, the possibility of cognitive impairment following COVID-19 treatment warrants careful consideration. Large-scale follow-up studies are needed to investigate the impact of COVID-19 on cognitive function and offer evidence to support clinical treatment and rehabilitation practices. In-depth neuropathological and biological studies can elucidate precise mechanisms and provide a theoretical basis for prevention, treatment, and intervention research. Considering the risks of the long-term effects of COVID-19 and the possibility of reinfection, it is imperative to integrate basic and clinical research data to optimize the preservation of patients' cognitive function and quality of life. This integration will also offer valuable insights for responding to similar public health events in the future. This perspective article synthesizes clinical and basic evidence of cognitive impairment following COVID-19, discussing potential mechanisms and outlining future research directions.

Sleep disturbance in post COVID-19 conditions: Prevalence and quality of life

Post COVID-19 conditions are complaints and symptoms in patients with a history of probable or confirmed COVID-19 after 3 months of the onset of COVID-19 and last at least 2 months. About 10-20% of people may experience post COVID-19 conditions, one of which is sleep disturbance. There is a wide range of prevalence of sleep disturbances from 6% to more than 70%. An online survey of the post COVID-19 conditions in various countries showed that 78.58% of subjects had sleep disturbances, including insomnia, sleep-disordered breathing, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders. Sleep disturbance can be found starting from 2 weeks until 48 weeks or more after discharge or after having a negative COVID-19 test results. Women aged < 50 years old with severe COVID-19 infection reported a worse outcome. Several mechanisms may cause sleep disturbance in post COVID-19 condition, namely persistent viral infection and inflammation, immunity dysregulation, and mitochondrial dysfunction. Several studies discovered sleep disturbance was a major problem that affected different domains of QoL in post COVID-19 conditions. Significant correlation was found between several dimensions of SF-36 with moderate-to-severe insomnia in post COVID-19 conditions. Therefore, sleep disturbance is a major problem in post COVID-19 conditions and may affect patients' QoL, and the existence of sleep disturbance should be a concern in post COVID-19 conditions period. Further research is required to determine the prevalence based on agreed definition as well as methods to assess this condition and its impact on QoL.

The effects of a team-based planned care program on the quality of sleep in cardiac surgery patients hospitalized in the intensive care unit: A two-group controlled clinical trial

BACKGROUND

Sleep disturbances as a major health problem are common in patients hospitalized in critical care units. This study examined the effects of a team-based care plan on the quality of sleep in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital.

MATERIALS AND METHODS

In this clinical trial, 100 patients with cardiac surgery were selKMected through convenience sampling and then nonrandomly allocated to the intervention and or the control group. A plan of care with the recommendation of all intensive care unit care teams was designed and then applied. In this study, the Richards-Campbell Sleep Questionnaire was used to evaluate sleep quality. Patients in the intervention group received the care plan for two consecutive nights. The study's national approval code is IRCT2017091915512N2. Collected data were analyzed using SPSS software (v. 21), and by paired, independent t, Chi-square, and Fisher's exact tests.

RESULTS

Quality of sleep in patients admitted to the CSICU is significantly improved by noise reduction both in the first and second nights. Moreover, the team-based care plan requires good coordination between all team members taking care of cardiac surgery patients admitted to the CSICU (P < 0.001).

CONCLUSIONS

The team-based care plan significantly improves the quality of sleep. It may be due to the close coordination between all team members to avoid sleep disturbances.

Disrupted Sleep During a Pandemic

The COVID-19 pandemic affected sleep in several people. Though most of the studies argued that age, gender, employment, finances, responsibilities, and exposure to sunlight governed sleep-wake schedule and sleep disturbances, there is also scientific evidence to suggest that these issues could have aroused because of the infiltration of the central nervous system (CNS) by SARS-CoV-2. Sleep disturbances must be addressed during the pandemic as sleep disturbances and systemic inflammation run in a vicious cycle; quality of sleep and timing of vaccination can influence the immune response to vaccination and subjects having obstructive sleep apnea (OSA) are at higher risk for having SARS-CoV-2 infection-related complications.

Sleep During the COVID-19 Pandemic

PURPOSE OF REVIEW

We reviewed current evidence on the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep of different populations.

RECENT FINDINGS

Several studies demonstrated that sleep deprivation may cause immune system dysregulation, which deteriorates the course of COVID-19. The increased prevalence of sleep disorders among COVID-19 patients has been associated with more severe disease and worse clinical outcomes. Healthcare workers who were subjected to atypical workload and more nightshifts developed sleep disorders which associated with work-related errors and COVID-19 infection susceptibility. In general population, circadian misalignment and excessive stressors impaired sleep quality. Sleep dysfunction has been recorded due to the pandemic. It is essential to implement interventions in order to alleviate pandemic-related sleep disorders. Telemedicine, cognitive behavioral therapy, and sleep hygiene practices appear to be helpful. Psychotropic medication should be cautiously administered, while other pharmacological agents, such as melatonin, have shown promising results.

Sleep EEG Signatures in COVID-19 Survivors

Study Objectives

Effect of COVID-19 on sleep architecture is not known. This study was done to find out EEG changes seen during sleep in COVID-19 survivors.

Methodology

In this prospective single centre study, consecutive patients diagnosed with RTPCR confirmed COVID 19 were included after 4–6 weeks of discharge from hospital. All patients underwent level I PSG. EEG was analysed for presence of abnormal EEG pattern.

Results

Total 189 patients were contacted telephonically for participation in this study. Finally 81 patients (55 males, 26 females) underwent Level I PSG. Total sleep time was 345.1 ± 85.1 min. Sleep efficiency was 76.0 ± 14.2%. Mean time (%) during N1, N2, N3 and Rapid Eye movement (REM) was 16.4%, 59.2%, 7.9% and 18.4% percentage, respectively. Mean AHI was 28.7 ± 22.8 per hour and arousal index was 23.9 ± 13.3. Alpha intrusion was the most common EEG finding (78%), followed by cyclical alternating pattern (59%). REM density was significantly increased in 38% of patients. REM alpha bursts and increased spindles were also seen in 27% and 16%.

Conclusion

Abnormal EEG waves are very commonly seen in COVID-19 survivors. Presence of these abnormal PSG-EEG waves hints that COVID-19 might have similar effects as depression, insomnia on these subjects, at least in short run. Whether these changes are temporary or permanent needs to be evaluated by performing serial polysomnographies in patients with COVID-19 ARDS.

The Endocannabinoid System as Prognostic Biomarker of the Obstructive Sleep Apnea Morbidity in COVID-19-Recovered Individuals

The endocannabinoid system is a neurobiological signaling network that is present in the human biological systems, including the brain. This neurobiological system comprises cannabinoid receptors, endogenous ligands, as well as enzymatic synthesis, degradation and transport of endocannabinoids and has been suggested as a modulator of multiple physiological processes, including the sleep–wake cycle. On the other hand, the COVID-19 pandemic, originated by the novel coronavirus SARS-CoV-2, has caused global catastrophes in economic, social, and health spheres. COVID-19 is a multi-organ disease with a broad spectrum of health complications, such as respiratory infections leading to respiratory-related symptoms and disorders. The development, approval, and application of vaccines against SARS-CoV-2 is ongoing; however, there are increasing reports of prolonged effects after COVID-19 infection, including respiratory and neurological sequelae. Here, I provide a comprehensive review of the current literature on the endocannabinoid system and their role in sleep modulation. Whilst I discuss relevant considerations for the high risk for developing sleep disorders related to respiratory failures, such as obstructive sleep apnea (OSA) in recovered COVID-19-infected subjects. Finally, I propose a framework that integrates the analysis of the components of the endocannabinoid system as prognostic biomarkers of the likely OSA after COVID-19 infection.

Insomnia in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Issues

BACKGROUND

Given the importance of sleep, several studies were conducted during the first wave of the COVID-19 pandemic in Bangladesh, but no study was conducted during the second wave. Thus, this study assessed the prevalence rate, associated factors, and predictive models of insomnia during the second wave of the COVID-19 pandemic.

METHODS

An online-based cross-sectional survey was conducted during the second wave of the pandemic (within April 1-13, 2021) and collected information on sociodemographic, behavior and health, COVID-19 risk, fear of COVID-19, depression, anxiety, suicidality, and insomnia. A total of 756 data from Bangladeshi young adults (22.24 ± 4.39 years) were finally analyzed.

RESULTS

About 13% of the participants (n = 98 out of a total of 756) had the symptoms of insomnia. Insomnia had a significant gender difference, where females were more prone to be insomniac. Besides, middle class, urban residence, smoking status, not engaging in physical exercise, poor health status, and multi-comorbidities were also profoundly associated with insomnia. In addition, fear of COVID-19, COVID-19 risk, and mental health problems (i.e., depression, anxiety, and suicidality) showed a significant relationship in terms of insomnia. A total of 31.2% variance predicting insomnia was identified considering all of the studied variables.

CONCLUSIONS

The prevalence of insomnia reported herein seems relatively lower than the prior studies, but this figure is not neglectable. Thus, the identified associated factors are highly suggested to consider in policy actions with a special focus on mental health problems to elevate the risk of sleep problems.