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Association of Prior COVID-19 Infection with Restorative Sleep Quality Using REST-Q Scores: Findings from the COPE

Monisha Das Ireland, Mark É Czeisler, Mark E Howard

Medrxiv : the Preprint Server for Health Sciences

|November 24, 2025

Summary

Prior COVID-19 infection is linked to poorer restorative sleep quality. This association persists even after accounting for other factors, suggesting a potential long-term impact on sleep health.

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Area of Science:

Sleep Science
Infectious Disease Epidemiology
Public Health

Background:

The COVID-19 pandemic has significantly impacted global sleep health.
The specific relationship between SARS-CoV-2 infection and subjective restorative sleep quality requires further investigation.

Purpose of the Study:

To evaluate the association between prior SARS-CoV-2 infection and restorative sleep quality.
To utilize the validated Restorative Sleep Questionnaire (REST-Q) in a large, nationally representative U.S. sample.

Main Methods:

Cross-sectional online survey (COVID-19 Outbreak Public Evaluation Initiative) of 4,982 U.S. adults.
Restorative sleep assessed using the 9-item REST-Q; infection status self-reported (never, one, or ≥2 infections).
Statistical analyses included general linear models and ordinal logistic regression, adjusting for covariates.

Main Results:

Individuals with prior COVID-19 infection reported significantly lower REST-Q scores compared to uninfected individuals (52.1±22.5 vs. 57.9±24.4, p<0.001).
Prior infection increased the odds of reporting low restorative sleep (adjusted OR=1.15, 95% CI: 1.02-1.30, p=0.019).
REST-Q scores decreased with an increasing number of infections; association attenuated but remained significant in sensitivity analyses.

Conclusions:

Prior COVID-19 infection is independently associated with reduced restorative sleep quality.
The link between COVID-19 and poor sleep is partly explained by anxiety and depression but persists.
Findings highlight the need for research into post-COVID sleep impairments and interventions.