Emotional and sleep disturbances among patients previously hospitalized due to COVID-19

To evaluate incidence of emotional and sleep disturbances (ESDs) in patients after hospitalization due to COVID-19, identify long-term predictors, and understand their influence on brain fog and quality of life at work (QWL).

Patients of 18 or more years retrospectively reported ESDs (sadness, anxiety, restlessness, insomnia, excessive daytime sleepiness, nightmares), brain fog symptoms (BFS), QWL before COVID-19 and within 0-4, 4-12, and >12 weeks postinfection using paper or online validated questionnaire. Data regarding age, sex, comorbidities, pre-admission therapy, and laboratory results were collected. Finally, the study included 181 hospitalized individuals (mean age 56.02 ± 13.02 years; 37.02% women).

COVID-19 increased 1.6-fold to 2.2-fold incidence of ESDs within 0-4, 4-12, and >12 weeks post-infection (66.85%, 60.77%, and 50.28%, respectively). In the multivariable model, new-onset ESDs after COVID-19 were predicted by hemoglobin levels in the acute phase of infection (OR = 0.64; 95% CI: 0.50-0.80 per g/L; p = 0.001). In patients with pre-existing and new-onset ESDs, COVID-19 showed a 1.9-fold and 3.9-fold increase in BFS within >12 weeks post-infection, respectively. Deterioration in QWL >12 weeks post-COVID was associated with age (OR = 0.62; 95% CI: 0.37-0.73 per 10 years; p < 0.001), female sex (OR = 3.47; 95% CI: 1.40-8.56; p = 0.007), pre-existing (OR = 21.58; 95% CI: 2.57-181.30; p = 0.005) and new-onset ESDs (OR = 30.88; 95% CI: 3.85-247.90; p = 0.001).

During follow-up, most patients with COVID-19 suffer from ESDs that are predicted by hemoglobin levels. The ESDs increase the risk of concomitant BFS. The ESDs, particularly sadness, restlessness, insomnia, and excessive daytime sleepiness, strongly affect QWL >12 weeks after COVID-19.