Sleep Difficulties, Muscle Weakness May Persist 6 Months After COVID-19

Among patients hospitalized with coronavirus disease 2019 (COVID-19) in Wuhan, China, fatigue and muscle weakness, as well as sleep difficulties, were shown to persist in more than 1 in 4 patients after 6 months.

Among patients hospitalized with coronavirus disease 2019 (COVID-19) in Wuhan, China, symptoms of fatigue and muscle weakness, as well as sleep difficulties, were shown to persist in more than 1 in 4 patients after 6 months. In addition, more than 75% of patients reported at least 1 persistent symptom, according to study findings published last week in The Lancet.

As cases of COVID-19 continue to surge worldwide, researchers highlight that long-term health consequences remain largely unclear.

The nation’s top infectious disease expert, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted during a keynote presentation at the American Heart Association’s Scientific Sessions 2020 that up to a third of people will live with symptoms, such as profound fatigue and shortness of breath, for weeks or months after contracting COVID-19. However, he said that long-term follow-up was still warranted to understand effects when the disease lingers.

In the present ambidirectional cohort study, the researchers sought to describe the long-term health consequences of patients with COVID-19 in Wuhan who had been discharged from Jin Yin-tan Hospital between January 7, 2020, and May 29, 2020 (n = 1733; median age, 57 years; 52% men). They also investigated associated risk factors, particularly disease severity.

Participants were interviewed via questionnaires evaluating their symptoms and health-related quality of life, underwent physical examinations and a 6-minute walking test, and received blood tests. Disease severity was characterized by the highest 7-category scale during the hospital stay:

  • 1 – not admitted to hospital with resumption of normal activities
  • 2 – not admitted to hospital, but unable to resume normal activities
  • 3 – admitted to hospital but not requiring supplemental oxygen
  • 4 – admitted to hospital but requiring supplemental oxygen
  • 5 – admitted to hospital requiring high-flow nasal cannula, noninvasive mechanical ventilation, or both
  • 6 – admitted to hospital requiring extracorporeal membrane oxygenation, invasive mechanical ventilation, or both
  • 7 – death.

“Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests,” added researchers. “Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.”

Based on findings derived from the follow-up study that was conducted from June 16 to September 3, 2020, fatigue and muscle weakness (63%) and sleep difficulties (26%) were the most common symptoms. Additional symptoms reported included anxiety and depression, present in 23% of patients.

Notably, patients who presented with more severe illness during their hospital stay, scale 5–6, exhibited more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations. These patients also performed worse in the 6-minute walking test, with 29% unable to reach the lower distance limit of the normal range.

The study additionally addressed a prominent concern among those who have already been infected with COVID-19. Among a group of 94 patients, levels of neutralizing antibodies fell by an average of 53% during the 6-month study period after their sickness peaked.

“These results support that those with severe disease need post-discharge care,” concluded the study authors. “Longer follow-up studies in a larger population are necessary to understand the full spectrum of health consequences from COVID-19.”


Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. Published online January 8, 2021. doi:10.1016/S0140-6736(20)32656-8

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