A study published in the Lancet Respiratory Medicine and presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) looks at sleep disturbance, dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK.


Prof David Ray, Professor of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Diabetes; and Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, said:

“This is an observational cohort study.  People hospitalised with Covid, after discharge were invited to take part, and about 50% of those approached did so.  Observational data can identify associations, and here breathlessness was associated with poor sleep.  It could be that breathlessness leads to poor sleep, the other way around, or something else e.g. anxiety could lead to both.  The authors acknowledge the limitations of the study design, and attempt to control for them.  However, it is clear that poor sleep and poor quality of life are closely linked, and so attention to improving sleep may be a low risk, and high gain approach to help people suffering with long covid.  That would require a proper interventional trial, and that may be hard to do as the covid waves are now subsiding.”


Prof Nicholas Hart, Professor of Respiratory and Critical Care Medicine, King’s College London, said:

“This important study provides further insights into physical and mental health impact following hospitalisation as a consequence of COVID-19 infection.  This study has shown that sleep disturbance, anxiety and dyspnoea (breathlessness) were more prevalent in hospitalised COVID-19 survivors following discharge.  Of particular interest, these patients showed greater rest time and less efficient sleep during recovery.  The next step is to confirm or exclude sleep disordered breathing or other sleep disorders, such as periodic limb movement disorder, so that we can apply interventions to improve sleep quality and assess the impact on breathlessness and anxiety.”


Dr Julie Darbyshire, Senior Researcher, University of Oxford, said:

“Patients rarely sleep well in hospital and poor sleep following hospital admission is common.  Feeling breathless, especially overnight, is distressing and this study demonstrates how this is associated with disturbed sleep.

“This study assessed sleep using validated methods which ensures quality of recording and comparison with other similar sleep assessment studies.

“It is important to note that this study asked people to recall their sleep before they were hospitalised which is an unreliable measure.  Comparisons between sleep before and after hospitalisation are therefore less reliable than comparisons between measures reported in real-time.  This should not detract from the wider message that sleep quality after hospitalisation with COVID-19 is poor and is also associated with lower measures of health.

“The statistical analysis in the article provides compelling evidence for the association between sleep and breathlessness, muscle weakness, and anxiety after hospitalisation for COVID-19.  The press release suggests that sleep disruption might cause breathlessness (dyspnoea) whereas the article itself reports an association between the two without attributing a causal pathway.  The press release does not mention the other primary associations with greatest sleep irregularity which include a lower deprivation index, smoking, existing depression or anxiety, diabetes, high blood pressure, and kidney disease.

“Although we can’t be sure from this study, it is plausible that targeting sleep disruption following admission to hospital for Covid may improve general health and recovery in some people, including muscle strength, anxiety, and breathlessness.  In general I would say that for any patient struggling to sleep, regardless of why they were admitted to hospital, addressing this is likely to have an effect on their recovery.”


Prof Amitava Banerjee, Professor of Clinical Data Science and Honorary Consultant Cardiologist, Institute of Health Informatics, UCL, said:

“This is a detailed and very interesting analysis using novel methods, showing that sleep disturbance is common in patients hospitalised with COVID, even 5-8 months following hospital admission, and the sleep quality seems to be worse, even when compared with control groups in UK Biobank, both hospitalised and non-hospitalised.  The authors found associations with multiple symptoms, especially shortness of breath, anxiety and muscle weakness.

“However, there are some limitations.  First, as the accompanying editorial notes, there may be biases in the patients who had sleep monitoring, compared to the overall population of people hospitalised with Covid.  Second, this study only concerns hospitalised post- Covid individuals.  The majority of people with Long Covid were not hospitalised for Covid so the results may not be generalisable to this larger group.  Third, this study only shows correlation and does not show that sleep disturbance causes the symptoms of long Covid.  For example, the sleep disturbances could well be an effect rather than a cause of symptoms like breathlessness and anxiety.

“Good quality sleep is important for health and reduces risk of chronic diseases, such that it is included in the American Heart Association’s “Life’s Essential 8” health behaviour recommendations (www.heart.org/en/healthy-living/healthy-lifestyle/life’s-essential-8).  Quality of sleep is therefore likely to be important for those with Long Covid in reducing their risk of chronic disease, but the role of sleep in the mechanism of Long Covid needs further research.”



‘Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study’ by Callum Jackson et al. was published in the Lancet Respiratory Medicine at 23:30 UK time on Saturday 15 April 2023.

DOI: 10.1016/S2213-2600(23)00124-8



Declared interests

Dr Julie Darbyshire: “I have no conflicts of interest to declare.  I was the Chief Investigator for the NIHR funded SILENCE study which investigated the relationship between sound levels, sleep, and delirium in the intensive care unit, and I’m currently working alongside patients with long covid to understand how long covid clinics can best support their recovery.”

Prof Amitava Banerjee is the chief investigator of STIMULATE-ICP, an NIHR-funded study in non-hospitalised individuals with Long Covid.  He has also received research funding from Astra Zeneca unrelated to Covid or Long Covid.

For all other experts, no reply to our request for DOIs was received.

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