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.
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.
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DOI：
10.1016/s2213-2600(23)00124-8
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发表时间：
2023-08
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影响因子：
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无论是由于新冠肺炎还是其他原因，入院后睡眠障碍都很常见。尽管睡眠障碍在其他情况下会导致发病率，但入院后恢复的临床相关性却鲜为人知。我们的目的是调查新冠肺炎患者出院后睡眠障碍的发生率和性质，并评估这是否与呼吸困难有关。CircCOVID是一项前瞻性多中心队列子研究，旨在调查新冠肺炎术后昼夜节律紊乱和睡眠障碍对康复的影响。研究对象为18岁及以上的参与者，他们因新冠肺炎在英国住院，并于2020年3月至2021年10月出院。参与者是从住院后新冠肺炎研究(PHOSP-COVID)招募的。在两个时间点收集随访数据：早期时间点在出院后2-7个月，晚期时间点在出院后10-14个月。使用匹兹堡睡眠质量指数问卷和数字评定量表对睡眠质量进行主观评估。睡眠质量也用戴在手腕上的加速度计(活动记录仪)评估了14天。参与者还在出院后的早期时间进行了临床表型，包括症状评估(即焦虑[广泛性焦虑症7项量表问卷]、肌肉功能[SARC-F问卷]、呼吸困难[呼吸困难-12问卷]和肺功能测量)。肌动描记结果也与匹配的英国生物库队列(非住院个人和最近住院的个人)进行了比较。多变量线性回归用于确定睡眠障碍与呼吸困难和其他临床症状的主要结果之间的关系。PHOSP-COVID在ISRCTN注册中心注册(ISRCTN10980107)。在PHOSP-COVID研究的2468名参与者中，有2320人参加了英国83家医院出院后5个月(IQR 4-6)的早期时间点研究访问。通过主观测量(匹兹堡睡眠质量指数问卷和数字评定量表)对638名参与者在早期时间点的睡眠质量数据进行评估。729名参与者出院后的中位数为7个月(IQR 5-8个月)，使用基于设备的测量(活动记录仪)对睡眠质量进行了评估。出院后，在因新冠肺炎入院的638名参与者中，大多数(62%)在匹兹堡睡眠质量指数问卷调查中报告睡眠质量差。根据数字评定量表的评估，同样比例的参与者(338[53%])在新冠肺炎入院后感到他们的睡眠质量在出院后恶化。将基于设备的测量结果与年龄匹配、性别匹配、体重指数匹配、出院时间匹配的英国生物银行最近住院的队列进行比较。与最近住院的匹配英国生物库队列相比，我们研究中的参与者平均多睡65分钟(95%可信区间59至71)，睡眠规律性指数较低(-19%；95%可信区间-20至-16)，睡眠效率较低(3.83个百分点；95%可信区间3.40至4.26)。当与未住院的英国生物银行队列进行比较时，也得到了类似的结果。总体睡眠质量(未调整效果估计值3·94；95%可信区间2·78~5·10)、入院后睡眠质量下降(3·00；1·82~4·28)和睡眠规律(4·38；2·10~6·65)与较高的呼吸困难评分相关。根据用力肺活量的评估，睡眠质量差、睡眠质量恶化和睡眠规律性也与肺功能受损有关。根据睡眠指标的不同，焦虑在睡眠障碍对呼吸困难的影响中起到了18%-39%的作用，而肌肉无力起到了27%-41%的作用。新冠肺炎入院后的睡眠障碍与呼吸困难、焦虑和肌肉无力有关。由于与多种症状有关，靶向睡眠障碍可能有助于治疗新冠肺炎后的状况。英国研究与创新，国家健康研究所，以及工程和物理科学研究理事会。
Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2–7 months after hospital discharge and a later time point 10–14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4–6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5–8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (–19%; 95% CI –20 to –16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18–39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27–41% of this effect. Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.
影响因子：
4.6
作者：
Zhang L;Li T;Chen L;Wu F;Xia W;Huang M;Guo Z;Song L;Yin H;Zhang Y;Yu Y;Cai S;Lu Z;Rong S;Bao W
通讯作者：
Bao W
影响因子：
4.4
作者：
Kim JS;Dashti HS;Huang T;Cade BE;Podolanczuk AJ;O'Hearn DJ;Hoffman EA;Wang H;Blaikley J;Barr RG;Redline S
通讯作者：
Redline S
影响因子：
4
作者：
Bethea, Traci N.;Zhai, Wanting;Zhou, Xingtao;Ahles, Tim A.;Ahn, Jaeil;Cohen, Harvey J.;Dilawari, Asma A.;Graham, Deena M. A.;Jim, Heather S. L.;McDonald, Brenna C.;Nakamura, Zev M.;Patel, Sunita K.;Rentscher, Kelly E.;Root, James;Saykin, Andrew J.;Small, Brent J.;Van Dyk, Kathleen M.;Mandelblatt, Jeanne S.;Carroll, Judith E.
通讯作者：
Carroll, Judith E.