Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period

BACKGROUND

Sleep is a complex, reversible process that is responsible for the modulation of various physiological mechanisms. COVID-19-related sleep disorders are affecting different populations with a heterogenous prevalence, yet high rates among infected patients are frequently reported. The aim of the study is to assess the prevalence of insomnia in the early post-COVID-19 recovery period and explore the differences in the results acquired by the Athens Insomnia Scale (AIS) by gender and selected infection severity parameters.

METHODS

The data presented in the paper come from a prospective, observational study on COVID-19 complications (SILCOV-19) consisting of 200 COVID-19 patients. The AIS was used for the quantitative measurement of insomnia symptoms based on ICD-10 criteria.

RESULTS

32% (n = 64) of all patients in the study group obtained results indicating sleep disturbances (>5 points on the scale), while 21.5% (n = 43) obtained results indicating insomnia (>10 points on the scale). The analysis of the results obtained by all patients in the AIS showed a significant correlation with the duration of symptoms (Spearman's rank-order: R = 0.18; p < 0.05), but not with the number of days spent in the hospital or age. Women achieved a higher score in overall AIS, as well as in questions assessing total sleep time, well-being the next day, physical and mental fitness the next day, and sleepiness during the day (p < 0.05).

CONCLUSIONS

the prevalence of insomnia in the early post-COVID-19 recovery period is high.

Post-COVID-19 complications in hospitalized and non-hospitalized patients: the Silesian complications of the COVID-19 (SILCOV-19) database

INTRODUCTION

Due to the extent of the pandemic, a high prevalence and severity of complications in the early post-recovery period are expected.

OBJECTIVES

This study aimed to compare the scope of early complications after COVID-19 in patients who had the disease with and without hospitalization.

PATIENTS AND METHODS

This study was designed as a prospective observational registry-based cohort study at the tertiary cardiovascular hospital in Silesia, Poland. The interdisciplinary diagnostics during the study visit, including cardiovascular, pneumatological, neurological, and psychiatric tests, were performed. All patients completed the study. Two-hundred unselected adult Caucasian men and women who had symptoms of COVID-19 in the acute phase were included, of which 86 patients had the disease without the need for hospitalization.

RESULTS

The median (IQR) time from symptom onset to the study visit was 107 (87-117) and 105 (79-127) days in non-hospitalized and hospitalized patients, respectively. Lung lesions in high-resolution computed tomography were found in 10 (8.8%) and 33 (39.3%) non-hospitalized and hospitalized patients (P <0.01), respectively; no lesions were visualized on chest X-ray images. Elevated platelet distribution width was found in more than 70% of patients in both groups. More than half of the patients had insomnia, regardless of the hospitalization status.

CONCLUSIONS

The abnormal platelet parameters, NT-proBNP levels, functional and radiological findings in the lungs, and insomnia were the most frequent short-term COVID-19 complications in hospitalized and non-hospitalized patients. Considering the number of patients who have had COVID-19 worldwide, the high burden of the post-COVID-19 complications might be expected.

Immunosuppressive Treatment and Its Effect on the Occurrence of Pneumocystis jiroveci, Mycoplasma pneumoniae, Chlamydophila pnemoniae, and Legionella pneumophila Infections/Colonizations Among Lung Transplant Recipients

BACKGROUND

The aim of the study was to assess the frequency of infections caused by Pneumocystis jiroveci, Chlamydophila pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae among lung transplant recipients in the context of immunosuppression.

METHODS

The study group consisted of 94 patients (37 women and 57 men; mean age 42.03 years) transplanted between 2009 and 2016 at the Silesia Center for Heart Diseases (SCCS). Immunosuppressive treatment (induction and maintenance therapy) was assessed. The immunofluorescence methods were used to detect the P. jiroveci, L. pneumophila, C. pneumoniae, and M. pneumoniae antigens in samples obtained from the respiratory tract.

RESULTS

Thirty-two of 94 graft recipients developed atypical or opportunistic infection. The median time of its occurrence was 178 days after transplantation. P. jiroveci was responsible for 84.38% of first infections. Five patients developed infection with P. jiroveci and C. pneumoniae. None of the infections occurred during induction of immunosuppression. An opportunistic or atypical infection developed in 19.35% of the patients treated with a tacrolimus-based regimen, and in 43.33% of patients on a cyclosporine-based regimen.

CONCLUSION

Infection with P. jiroveci is a recognized problem after lung transplantation and should be monitored. The percentage of infected patients is higher in patients treated with a cyclosporine-based regimen in comparison to those treated with tacrolimus.

Prognostic value of neutrophil‑to‑lymphocyte ratio in predicting long-term mortality in patients with ischemic and nonischemic heart failure

INTRODUCTION

Previous studies have shown that an elevated neutrophil-to-lymphocyte ratio (NLR) was associated with a poorer long-term prognosis in patients with heart failure (HF).

OBJECTIVES

We aimed to study the predictive value of the NLR in patients with left ventricular ejection fraction of 35% or lower. The second objective was to establish whether the NLR has the same prognostic value in patients with ischemic and nonischemic HF.

PATIENTS AND METHODS

The study group consisted of a cohort of patients with HF (1387 men, 347 women; median age, 61 years) from the prospective COMMIT-HF registry. The primary endpoint was all-cause mortality. Patients were divided into tertiles based on the NLR values on admission. The first (low), second (medium), and third (high) tertiles were defined as NLR ≤2.04 (n = 578), NLR 2.05-3.1 (n = 578) and NLR >3.1 (n = 578), respectively.

RESULTS

During long-term follow-up, 443 deaths were reported. The 12-month mortality in patients in the third NLR tertile was almost 3-fold higher compared with those in the first tertile (7.61% vs 20.07%; P <0.001). In a multivariate analysis, the NLR was an independent factor of mortality (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.82-2.92; P <0.0001). In addition, the multivariate analysis revealed that the third NLR tertile in the ischemic HF group was an independent factor related to longterm mortality (HR, 1.51; 95% CI, 1.11-2.04; P = 0.008). In the nonischemic HF group, the influence of the NLR on long-term survival was not confirmed.

CONCLUSIONS

The association between the NLR and the risk of death in long-term follow-up was confirmed only in the subgroup of patients with ischemic HF.