E2 ModerateModerate confidencePEM unclearCross-SectionalPeer-reviewedMachine draft
A Multidimensional Assessment of Sleep Disorders in Long COVID Using the Alliance Sleep Questionnaire.
Wilson, Alina, Ricciardiello Mejia, Giorgio Camillo, Lomba, Sara et al. · Healthcare (Basel, Switzerland) · 2025 · DOI
Quick Summary
This study looked at sleep problems in 200 people with Long COVID seen at Stanford's clinic. Researchers found that more than half had breathing-related sleep issues, about 4 in 10 had insomnia, and about 3 in 10 had excessive daytime sleepiness. The study identified two different groups of patients: one with more severe sleep and systemic symptoms than the other.
Why It Matters
Sleep disturbances are a core feature of Long COVID/ME, yet detailed characterization of specific sleep phenotypes remains limited. This study provides quantitative evidence for distinct sleep symptom profiles and identifies high-risk groups (prior hospitalization, multiracial participants), which could guide targeted clinical assessment and intervention development in post-viral chronic illness.
Observed Findings
- Sleep-related breathing complaints affected 57.5% of participants, insomnia 42.5%, and excessive daytime sleepiness 28.5%.
- Factor analysis identified a nine-factor structure explaining approximately 90% of variance in sleep symptom data.
- Two-cluster analysis revealed a higher-burden phenotype with greater BMI, insomnia, daytime sleepiness, gastrointestinal symptoms, and parasomnias (n=106) versus a lower-burden group (n=94).
- Hospitalization during acute COVID-19 was significantly associated with insomnia (OR 4.41; 95% CI 1.27-15.36) in adjusted models.
- Logistic regression models predicted insomnia with high accuracy (AUC=0.90) and excessive daytime sleepiness moderately well (AUC=0.81).
Inferred Conclusions
- Sleep disturbances in Long COVID are frequent, diverse, and overlap across multiple symptom domains rather than forming isolated categories.
- A distinct higher-burden phenotype exists characterized by more severe sleep and systemic complaints, which may represent a more severely affected subgroup.
- Severity of acute COVID-19 infection (indicated by hospitalization) is associated with later insomnia in Long COVID.
- Symptom-based screening using factor scores could help identify and risk-stratify Long COVID patients most likely to have sleep disorders.
Remaining Questions
What This Study Does Not Prove
This cross-sectional study cannot establish causality—for example, hospitalization's association with insomnia may reflect disease severity rather than a direct causal link. The study does not prove that sleep disorders cause other Long COVID symptoms, only that they co-occur. Results may not generalize to all Long COVID populations, as the sample was from a single specialized clinic.
Tags
Symptom:Post-Exertional MalaiseUnrefreshing SleepFatigue
Phenotype:Long COVID Overlap
Method Flag:Exploratory OnlyMixed CohortStrong Phenotyping
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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