Poor Sleep, Extreme Sleep Duration Linked With Past COVID-19 Infection


A recent study observed that poor sleep quality and having very little or a lot of sleep were associated with greater likelihood of having had COVID-19 in the past, while poor sleep quality was linked with an increased requirement of hospitalization for severe COVID-19.

Poor sleep quality and very little or a lot of sleep were found to be associated with greater odds of having had COVID-19, and poor sleep quality was associated with an increased need of hospitalization for severe COVID-19, found a study in The American Journal of Medicine.

This study was conducted because medical comorbidities increase the risk of severe COVID-19, and even though sleep problems are common after COVID-19 infection, whether insomnia, poor sleep quality, and extremely long or short sleep duration increased the risk of developing COVID-19 or hospitalization was not clear. Researchers were trying to understand if sleep problems increase the risk of contracting COVID-19 or requiring hospitalization.

Disease burden of COVID-19 remains high, and it is known that older individuals and those with several common medical conditions are at greater jeopardy for COVID-19 related hospitalization and death.

“However, with the exception of several studies implicating obstructive sleep apnea to higher rates of COVID-19 infection, morbidity, and mortality, there have been relatively few investigations of dysfunctional sleep as a potential risk for developing COVID-19,” said the researchers.

For this study, data was used from the first 4 2022 waves of The COVID-19 Outbreak Public Evaluation (COPE) Initiative, which is a program focused on collecting and disseminating data on public attitudes, behaviors and beliefs related to the COVID-19 pandemic, along with mental and behavioral health during the pandemic from large-scale, demographically representative samples of United States adults. A cross-sectional survey of a diverse sample of 19,926 US adults was evaluated from the COPE Initiative survey.

The prevalence rates of COVID-19 infection and hospitalization were 40.1% and 2.9% respectively, and insomnia and poor sleep quality were reported in 10.8% and 40.1% respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but omitting participants who reported COVID-19 associated sleep problems, poor sleep quality but not insomnia was correlated with COVID-19 infection (adjusted odds ratio [aOR], 1.16; 95% CI, 1.07-1.26) and COVID-19 hospitalization (aOR, 1.50; 95% CI, 1.18-1.91).

Compared to habitual sleep duration of 7-8 hours, sleep durations less than 7 hours (aOR, 1.14; 95% CI, 1.06-1.23) and sleep duration of 12 hours (aOR, 1.61; 95% CI, 1.12-2.31) were correlated with increased odds of COVID-19 infection.

Upon observation, no correlation between sleep duration and COVID-19 hospitalization was seen.

The relationship of short sleep duration was stronger than the one of long sleep duration regarding association with prior COVID-19 infection or hospitalization.

The authors said the findings suggested that efforts for improving sleep health might help decrease the impact of COVID-19 infection in the general population. The results back up the findings of previous studies that showed a linkage between insomnia and poor sleep quality, and COVID-19 infection and hospitalization.

The explanation as to why there’s an increase in COVID-19 infection and hospitalization related to insomnia or poor sleep quality is not clear but it is thought that these factors are associated with higher stress that can increase the likelihood of susceptibility of viral infection and a weakened immune system. To the researchers’ knowledge, no previous studies showing any associations between long sleep duration and COVID-19 infection have been done.

The researchers continued by saying, “Furthermore, our finding that the association between sleep duration and COVID-19 infection appeared to fit a quadratic (U-shaped) pattern is similar to observations found between sleep duration and other conditions such as cardiovascular disease, diabetes, and cognitive impairment suggesting that there might be a similar or shared underlying mechanism.”

Additionally, one limitation of this study included cross-sectional analyses, so the researchers warn that causal inferences should be interpreted cautiously. Secondly, predictive factors and COVID-19 outcomes were self-reported, and insomnia and other sleep problems are common sequelae following COVID-19 infection.

“In conclusion, insomnia, poor sleep quality and extremes of sleep duration are associated with increased COVID-19 infection and hospitalization. These findings provide evidence that a public health approach encouraging healthy sleep practices will lessen the impact of the COVID-19 pandemic,” they said.


Quan SF, Weaver MD, Czeisler MÉ, et al. Insomnia, poor sleep quality and sleep duration and risk for COVID-19 infection and hospitalization. Am J Med. Published online April 17, 2023. https://doi.org/10.1016/j.amjmed.2023.04.002

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