Sleep disturbance affects inflammatory resolution in Long COVID

Sleep disturbance, which is a common symptom in Long COVID, promotes a pro-inflammatory state and dysregulates lipid-derived specialized pro-resolving mediators (SPMs), presumably contributing to chronic unresolved inflammation. This study aimed to investigate the role of sleep disturbance in inflammatory resolution in Long COVID.

We studied 39 participants (30F/9M, age range 22-68 years), including 31 individuals with Long COVID and 8 SARS-CoV-2-infected controls, who did not develop Long COVID. The study consisted of a 14-day at-home phase followed by a 1-day (24-h) in-laboratory stay. Sleep disturbance was assessed using PROMIS Sleep Disturbance T-scores. During the in-laboratory stay, a fasting morning blood sample was taken for assessment of lipid mediators. Data were analyzed using generalized linear mixed models.

Participants with Long COVID reported higher sleep disturbance than controls (p<.001). Pro-inflammatory lipid pathways were upregulated in Long COVID compared to control, as indicated by higher prostaglandin E₂ (PGE₂) levels (p<.05). Long COVID participants with high sleep disturbance (PROMIS Sleep Disturbance T-score ≥60) had lower SPM levels, including the precursor of D-series resolvins 17-hydroxydocosahexaenoic acid (17-HDHA), 17R/S-resolvin D1 (17R/S-RvD1), 15R-lipoxin B4 (15R-LXB4), and protectin D1_{n-3 DPA} (PD1_{n-3 DPA}) than those with low sleep disturbance (T-score <60) (p<.05).

This study suggests that sleep disturbance may contribute to chronic inflammation in Long COVID by compromising certain inflammatory resolution pathways. Promoting inflammatory resolution physiology in particular in those individuals with Long COVID suffering from sleep disturbance may serve as a mechanistic target to mitigate inflammation and symptom burden in Long COVID.

ClinicalTrials.gov NCT05606211.