The Relationship between Nonrestorative Sleep and Persistent Post-Acute Sequelae of COVID-19: A Longitudinal Study of Recovery Trajectories

Objectives: Nonrestorative sleep (NRS) may contribute to the persistence of post-acute sequelae of COVID-19 (PASC), but no longitudinal studies have investigated this relationship. This study examined the association between NRS and PASC persistence over one year. Study design: This was a one-year prospective cohort study conducted using an online survey. Methods: We conducted a one-year prospective cohort study through an online survey between September 2022 (Time 1, T1) and September 2023 (Time 2, T2). Eligible patients were adults aged18 years or older who had experienced COVID-19 infection after February 2022 and were more than one month post-infection with at least one PASC symptom. NRS, difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awaking (EMA) were evaluated at T1. PASC persistence was evaluated at T2. Relative risk ratio calculations with multiple imputations were performed to examine associations between sleep disturbances and PASC. Results: Among 957 participants with PASC at baseline, 559 (58.4%) completed the follow-up assessment. NRS at T1 was associated with PASC persistence at T2 (Relative Risk = 1.33, 95% confidence interval = 1.08 – 1.64). In contrast, DIS, DMS, and EMA showed no significant associations with PASC persistence. Sensitivity analyses using different NRS thresholds yielded consistent trends. Conclusion: This study suggests that NRS might contribute to PASC persistence through a potentially distinct mechanism from DIS, DMS, and EMA.