Reduced Sleep in the Week Prior to Diagnosis of COVID-19 is Associated with the Severity of COVID-19

Abstract

Background

The rapid outbreak of coronavirus disease 2019 (COVID-19) is a major health concern, in response to which widespread risk factor research is being carried out.

Objective

To discover how physical activity and lifestyle affect the epidemic as well as the disease severity and prognosis of COVID-19 patients.

Methods

This multicenter, retrospective cohort study included 203 adults infected with COVID-19 and 228 uninfected adults in three Chinese provinces, with 164 (80.7%) of the infected participants and 188 (82.5%) of the uninfected participants answering a doctor-administered telephone questionnaire on lifestyle. The binary logistic regression model and the ordinal logit model were used to observe relevance.

Results

Comparing sick and non-sick patients, we found that irregular exercise (P=0.004), sedentary lifestyle (P=0.010), and overexertion (P<0.001) may be associated with the susceptibility to COVID-19. In symptomatic patients, using the recommended status as a reference, risk of severe infection increased with decreased sleep status, being 6.729 (95% CI=2.138–21.181) times higher for potentially appropriate sleep (P=0.001) and peaking at 8.612 (95% CI=1.913–38.760) times higher for lack of sleep (P=0.005). Reduction in average daily sleep time significantly increased the likely severity (P=0.002).

Discussion

Through further examination of damage of external lung organs, we found that lack of sleep affected not only disease severity but also prognosis. Based on these findings, the public should prioritize a healthy lifestyle and get adequate sleep in response to the outbreak. The study of life habits may bring new ideas for the prevention and treatment of COVID-19.

Keywords:

• COVID-19
• disease severity
• sleep status
• damage of external lung organs

Abbreviations

COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; RT-PCR, real-time reverse-transcription polymerase-chain-reaction; CT, computed tomography; IPAQ, International Physical Activity Questionnaire; NSF, National Sleep Foundation; OR, odds ratio; CI, confidence interval; BMI, body mass index; MET, metabolic equivalent of task.

Ethics Declarations

The study complied with the Declaration of Helsinki and the ethical approval in this study was obtained from the Research and Ethics Committee of the Chinese PLA General Hospital (No. S2020-063-01). All patients involved in this study signed informed consent.

Acknowledgments

We appreciated the parents and all the doctors and nurses involved in this study who contributed to the COVID-19 rescue and follow-up research.

Author Contributions

Baozhen Huang and Yanlin Niu contributed the same in this study. All authors made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed on the journal to which the article will be submitted; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflict of interest for this work.

Additional information

Funding

This research is supported by the Beijing Municipal Natural Science Foundation (No. 7204308); the National Natural Science Foundation of China (No. 81901404); and partially supported by the Open Project Program of the State Key Laboratory of Kidney Diseases in PLA General Hospital (No. KF2018-06).