Sleep quality in individuals with post-COVID-19 condition: relation with emotional, cognitive and functional variables

Anxiety; COVID-19; Sleep qualityAnsietat; COVID 19; Qualitat del sonAnsiedad; COVID-19; Calidad de sueñoThe study aimed to assess sleep quality in PCC patients and its predictors by analysing its relationship with emotional, cognitive and functional variables, as well as possible differences based on COVID-19 severity. We included 368 individuals with PCC and 123 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575). We assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety (Generalized Anxiety Disorder, GAD-7), depression (Patient Health Questionnaire, PHQ-9), global cognition (Montreal Cognitive Assessment, MoCA), everyday memory failures (Memory Failures of Everyday Questionnaire, MFE-30), fatigue (Chadler Fatigue Questionnaire, CFQ), quality of life (European Quality of Life-5 Dimensions, EQ-5D), and physical activity levels (International Physical Activity Questionnaire, IPAQ). 203 were nonhospitalized, 83 were hospitalized and 82 were admitted to the intensive care unit (ICU). We found statistically significant differences in the PSQI total score between the PCC and HC groups (p < 0.0001), but there were no differences among the PCC groups. In the multiple linear regressions, the PHQ-9 score was a predictor of poor sleep quality for mild PCC patients (p = 0.003); GAD-7 (p = 0.032) and EQ-5D (p = 0.011) scores were predictors of poor sleep quality in the hospitalized PCC group; and GAD-7 (p = 0.045) and IPAQ (p = 0.005) scores were predictors of poor sleep quality in the group of ICU-PCC. These results indicate that worse sleep quality is related to higher levels of depression and anxiety, worse quality of life and less physical activity. Therapeutic strategies should focus on these factors to have a positive impact on the quality of sleep.L'estudi pretenia avaluar la qualitat del son en pacients amb PCC i els seus predictors mitjançant l'anàlisi de la seva relació amb variables emocionals, cognitives i funcionals, així com les possibles diferències en funció de la gravetat de la COVID-19. Es van incloure 368 individus amb PCC i 123 controls saludables (HC) del projecte NAUTILUS (NCT05307549 i NCT05307575). Es va avaluar la qualitat del son (índex de qualitat del son de Pittsburgh, PSQI), l'ansietat (trastorn d'ansietat generalitzada, GAD-7), la depressió (Patient Health Questionnaire, PHQ-9), la cognició global (Montreal Cognitive Assessment, MoCA), errors de memòria diària (memòria). Falles del Qüestionari diari, MFE-30), fatiga (Qüestionari de Fatiga de Chadler, CFQ), qualitat de vida (Qualitat de Vida Europea-5 Dimensions, EQ-5D) i nivells d'activitat física (Questionari Internacional d'Activitat Física, IPAQ). 203 estaven no hospitalitzats, 83 estaven hospitalitzats i 82 estaven ingressats a la unitat de cures intensives (UCI). Hem trobat diferències estadísticament significatives en la puntuació total de PSQI entre els grups PCC i HC (p <0, 0001), però no hi va haver diferències entre els grups PCC. En les regressions lineals múltiples, la puntuació PHQ-9 va ser un predictor de la mala qualitat del son per als pacients amb PCC lleus (p = 0,003); Les puntuacions GAD-7 (p = 0,032) i EQ-5D (p = 0,011) van ser predictors de mala qualitat del son en el grup de PCC hospitalitzat; i les puntuacions de GAD-7 (p = 0,045) i IPAQ (p = 0,005) van ser predictors de mala qualitat del son en el grup d'UCI-PCC. Aquests resultats indiquen que una pitjor qualitat del son està relacionada amb nivells més alts de depressió i ansietat, pitjor qualitat de vida i menys activitat física. Les estratègies terapèutiques haurien de centrar-se en aquests factors per tenir un impacte positiu en la qualitat del son.This research was supported by: Grants from the Agency for Management of University and Research Grants (AGAUR) from the Generalitat de Catalunya (Pandemies, 202PANDE00053) and La Marató de TV3 Foundation (202111-30-31-32) to MG.- Grants from the Instituto de Salud Carlos III de Madrid (PI22/01687, ISCIII) and Agency for Management of University and Research Grants (2021SGR 00761) to GPR

Cognitive and emotional predictors of quality of life and functioning after COVID-19

Quality of life; Cognitive and emotional predictors; COVID-19Calidad de vida; Predictores cognitivos y emocionales; COVID-19Qualitat de vida; Predictors cognitius i emocionals; COVID-19Objective: A long-term decline in health-related quality of life (HRQoL) has been reported after coronavirus disease 2019 (COVID-19). Studies with people with persistent symptoms showed inconsistent outcomes. Cognition and emotion are important determinants in HRQoL, but few studies have examined their prognostic significance for HRQoL and functionality in post-COVID patients with persisting symptoms. We aimed to describe QoL, HRQoL, and functioning in individuals post-COVID with varying COVID-19 severities and to investigate the predictive value of cognitive and emotional variables for QoL, HRQoL, and functioning. Methods: In total, 492 participants (398 post-COVID and 124 healthy controls) underwent a neurobehavioral examination that included assessments of cognition, mood, QoL/HRQoL (WHOQOL-BREF, EQ-5D), and functioning (WHODAS-II). Analysis of covariance and linear regression models were used to study intergroup differences and the relationship between cognitive and emotional variables and QoL and functioning. Results: The Physical and Psychological dimensions of WHOQoL, EQ-5D, and WHODAS Cognition, Mobility, Life Activities, and Participation dimensions were significantly lower in post-COVID groups compared with a control group. Regression models explaining 23.9%-53.9% of variance were obtained for the WHOQoL-BREF dimensions and EQ-5D, with depressive symptoms, post-COVID symptoms, employment status, income, and mental speed processing as main predictors. For the WHODAS, models explaining 17%-60.2% of the variance were obtained. Fatigue, depressive symptoms, mental speed processing, and post-COVID symptoms were the main predictors. Interpretation: QoL/HRQoL and functioning after COVID-19 in individuals with persistent symptoms were lower than in non-affected persons. Depressive symptoms, fatigue, and slower mental processing speed were predictors of lower QoL/HRQoL and functioning.This research was supported by the Agency for Management of University and Research Grants (AGAUR) from the Generalitat de Catalunya (Pandemies, 202PANDE 00053) and La Marato de TV3 Foundation (202111-30- 31-32)

Cognitive reserve, depressive symptoms, obesity, and change in employment status predict mental processing speed and executive function after COVID-19

Post-COVID-19 condition; Mental speed processing; Logistic regressionCondición post-COVID-19; Procesamiento de velocidad mental; Regresión logísticaEstat post-COVID-19; Processament de velocitat mental; Regressió logísticaThe risk factors for post-COVID-19 cognitive impairment have been poorly described. This study aimed to identify the sociodemographic, clinical, and lifestyle characteristics that characterize a group of post-COVID-19 condition (PCC) participants with neuropsychological impairment. The study sample included 426 participants with PCC who underwent a neurobehavioral evaluation. We selected seven mental speed processing and executive function variables to obtain a data-driven partition. Clustering algorithms were applied, including K-means, bisecting K-means, and Gaussian mixture models. Different machine learning algorithms were then used to obtain a classifier able to separate the two clusters according to the demographic, clinical, emotional, and lifestyle variables, including logistic regression with least absolute shrinkage and selection operator (LASSO) (L1) and Ridge (L2) regularization, support vector machines (linear/quadratic/radial basis function kernels), and decision tree ensembles (random forest/gradient boosting trees). All clustering quality measures were in agreement in detecting only two clusters in the data based solely on cognitive performance. A model with four variables (cognitive reserve, depressive symptoms, obesity, and change in work situation) obtained with logistic regression with LASSO regularization was able to classify between good and poor cognitive performers with an accuracy and a weighted averaged precision of 72%, a recall of 73%, and an area under the curve of 0.72. PCC individuals with a lower cognitive reserve, more depressive symptoms, obesity, and a change in employment status were at greater risk for poor performance on tasks requiring mental processing speed and executive function.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research was supported by the European Archives of Psychiatry and Clinical Neuroscience Agency for Management of University and Research Grants (AGAUR) from the Generalitat de Catalunya (Pandemies, 2020PANDE00053), the La Marató de TV3 Foundation (202111–30-31–32), the Ministerio de Ciencia e Innovación (TED2021-130409B-C55)

Neuropsychological impairment in post-COVID condition individuals with and without cognitive complaints

COVID-19; Cognitive function; Neuropsychological testCOVID-19; Función cognitiva; Test neuropsicológicoCOVID-19; Funció cognitiva; Test neuropsicològicOne of the most prevalent symptoms of post-COVID condition is cognitive impairment, which results in a significant degree of disability and low quality of life. In studies with large sample sizes, attention, memory, and executive function were reported as long-term cognitive symptoms. This study aims to describe cognitive dysfunction in large post-COVID condition individuals, compare objective neuropsychological performance in those post-COVID condition individuals with and without cognitive complaints, and identify short cognitive exams that can differentiate individuals with post-COVID symptoms from controls. To address these aims, the Nautilus project was started in June 2021. During the first year, we collected 428 participants' data, including 319 post-COVID and 109 healthy controls (18-65 years old) from those who underwent a comprehensive neuropsychological battery for cognitive assessment. Scores on tests assessing global cognition, learning and long-term memory, processing speed, language and executive functions were significantly worse in the post-COVID condition group than in healthy controls. Montreal Cognitive Assessment, digit symbol test, and phonetic verbal fluency were significant in the binomial logistic regression model and could effectively distinguish patients from controls with good overall sensitivity and accuracy. Neuropsychological test results did not differ between those with and without cognitive complaints. Our research suggests that patients with post-COVID conditions experience significant cognitive impairment and that routine tests like the Montreal Cognitive Assessment, digit symbol, and phonetic verbal fluency test might identify cognitive impairment. Thus, the administration of these tests would be helpful for all patients with post-COVID-19 symptoms, regardless of whether cognitive complaints are present or absent

Can Personality Traits Affect Sleep Quality in Post-COVID-19 Patients?

Objectives: In the present study, we aimed (i) to describe the personality traits of a cohort of post-COVID-19 condition (PCC) patients compared with a healthy control (HC) group, (ii) to evaluate the relationship between sleep quality and personality traits, and (iii) to investigate whether this relationship differs according to disease severity. Methods: We included 599 participants from the Nautilus Project (ClincalTrials.gov IDs: NCT05307549 and NCT05307575) with an age range from 20 to 65 years old. Of 599 participants, 280 were nonhospitalized (mild PCC), 87 were hospitalized (hospitalized PCC), 98 were in the PCC-ICU, and 134 were in the HC group. We assessed sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and personality traits with the NEO Five-Factor Inventory (NEO FFI). Results: We found that mild-PCC patients had higher scores of neuroticism than HCs (p < 0.001) and ICU-PCC patients did (p = 0.020). The higher the neuroticism score was, the higher the total PSQI score (B 0.162; p < 0.001), the worse the sleep latency (B 0.049; p < 0.001), the greater the degree of sleep disturbance (B 0.060; p < 0.001), the greater the use of sleeping medication (B 0.035; p = 0.033), and the greater the incidence of daytime disturbances (B 0.065; p < 0.001) among the PCC patients. High neuroticism is also an indicator of worse sleep quality in mild-PCC (t = 3.269; p 0.001) and hospitalized-PCC (t = 6.401; p < 0.001) patients and HCs (t = 4.876; p < 0.001) but not in ICU-PCC patients. Conclusions: Although neuroticism affected sleep quality in both the PCC patients and HCs, the clinical implications and magnitude of the relationship were more significant in the PCC group. Specific and multidimensional interventions are needed to treat sleep problems in this population, and the influence of their personality traits should be considered

COVID-19 severity is related to poor executive function in people with post-COVID conditions

Patients with post-coronavirus disease 2019 (COVID-19) conditions typically experience cognitive problems. Some studies have linked COVID-19 severity with long-term cognitive damage, while others did not observe such associations. This discrepancy can be attributed to methodological and sample variations. We aimed to clarify the relationship between COVID-19 severity and long-term cognitive outcomes and determine whether the initial symptomatology can predict long-term cognitive problems. Cognitive evaluations were performed on 109 healthy controls and 319 post-COVID individuals categorized into three groups according to the WHO clinical progression scale: severe-critical (n = 77), moderate-hospitalized (n = 73), and outpatients (n = 169). Principal component analysis was used to identify factors associated with symptoms in the acute-phase and cognitive domains. Analyses of variance and regression linear models were used to study intergroup differences and the relationship between initial symptomatology and long-term cognitive problems. The severe-critical group performed significantly worse than the control group in general cognition (Montreal Cognitive Assessment), executive function (Digit symbol, Trail Making Test B, phonetic fluency), and social cognition (Reading the Mind in the Eyes test). Five components of symptoms emerged from the principal component analysis: the "Neurologic/Pain/Dermatologic" "Digestive/Headache", "Respiratory/Fever/Fatigue/Psychiatric" and "Smell/ Taste" components were predictors of Montreal Cognitive Assessment scores; the "Neurologic/Pain/Dermatologic" component predicted attention and working memory; the "Neurologic/Pain/Dermatologic" and "Respiratory/Fever/Fatigue/Psychiatric" components predicted verbal memory, and the "Respiratory/Fever/Fatigue/Psychiatric," "Neurologic/Pain/Dermatologic," and "Digestive/Headache" components predicted executive function. Patients with severe COVID-19 exhibited persistent deficits in executive function. Several initial symptoms were predictors of long-term sequelae, indicating the role of systemic inflammation and neuroinflammation in the acute-phase symptoms of COVID-19.

Functional brain abnormalities in post COVID-19 condition and their relationship with cognition.

After COVID-19 infection, some patients develop a post-COVID condition (PCC) that is popularly referred to as long COVID. Among its symptoms is persistent cognitive dysfunction that is potentially linked to altered brain functional connectivity (FC). While research has explored functional reorganization in patients with PCC, the intra- and inter- network connectivity and its relationship with cognitive status and clinical outcomes remain unclear. In this study, we recruited 121 individuals with PCC (67 with, and 54 without, cognitive impairment), 20 months after infection, along with 37 non-infected healthy controls from the NAUTILUS Project (ClinicalTrials.gov IDs: NCT05307549 and NCT05307575). Participants underwent resting-state functional magnetic resonance imaging and comprehensive neuropsychological assessment. Resting-state networks were characterized using independent component analyses, dual regression and network modelling for individual FC characterization. Group differences in intra- and inter-network FC, and their associations with clinical and neuropsychological data, were studied. Significance was set at a corrected p-value of < 0.05. Patients with PCC showed increased intra-network FC in 10 cognitively relevant networks, including the default mode, salience, executive control, auditory and basal ganglia networks, correlating positively with general cognition (Montreal Cognitive Assessment scores), time since infection, fatigue and subjective memory failures. Increased inter-network FC between default mode and sensorimotor networks was also observed. Increases in FC may reflect an inefficient compensatory mechanism in patients with PCC, associated with fatigue, subjective memory complaints and persistence of PCC.  

Poor sleep quality may trigger cognitive deficits after recovery from COVID-19

ObjectiveIn the present study, we aimed to assess the cognition of post-COVID-19 condition (PCC) participants in relation to their subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and to analyse possible moderators of this effect, such as quality of life (European Quality of Life-5 Dimensions, EQ-5D), fatigue (Chadler Fatigue Questionnaire, CFQ), cognitive reserve (Cognitive Reserve Questionnaire, CRC), and subjective cognitive complaints (Memory Failures of Everyday Questionnaire, MFE-30).MethodsWe included 373 individuals with PCC and 126 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575) who were assessed with a comprehensive neuropsychological battery and various questionnaires.ResultsWe found that PCC participants with poor sleep quality had a 4.3% greater risk of immediate verbal memory deficits than those with good sleep quality, as indicated by the greater odds ratio (OR) of 1.043 and confidence interval (CI) of 1.023–1.063. Additionally, their risk of immediate verbal memory disorders was multiplied by 2.4 when their EQ-5D score was low (OR 0.33; CI 0.145–0.748), and they had a lower risk of delayed visual memory deficits with a greater CRC (OR 0.963; CI 0.929–0.999). With respect to processing speed, PCC participants with poor sleep quality had a 6.7% greater risk of deficits as the MFE increased (OR 1.059; CI 1.024–1.096), and the risk of slowed processing speed tripled with a lower EQ-5D (OR 0.021; CI 0.003–0.141).ConclusionThese results indicate that poor subjective sleep quality is a potential trigger for cognitive deficits. Therapeutic strategies to maximize sleep quality could include reducing sleep disturbances and perhaps cognitive impairment in PCC individuals

Cognition and objective sleep quality in post-COVID-19 patients

In the current study, we aimed (i) to evaluate sleep quality via wrist actigraphy monitoring of nonhospitalized and hospitalized post-COVID-19 condition (PCC) participants; (ii) to correlate actigraphy measures with subjective measures of sleep quality, such as the Pittsburgh Sleep Quality Index (PSQI); and (iii) to investigate whether total sleep time or sleep efficiency could affect PCC cognitive performance. We included 49 individuals with PCC from the NAUTILUS Project (NCT05307549 and NCT05307575) who were monitored for 1 week via actigraphy and who were also assessed with a comprehensive neuropsychological battery and the PSQI. We found that there were significant differences between nonhospitalized PCCs and hospitalized PCCs in the number of awakenings. We also found a correlation between the total sleep time of both measures (actigraphy and PSQI), but we did not observe correlations between objective and subjective parameters of latency and sleep efficiency. Regarding cognition and actigraphy measures, there was a trend of statistical significance in the performance of immediate visual memory, attention span and social cognition according to sleep efficiency. In conclusion, results indicate that although the PSQI provides clinically relevant indicators of sleep, there are divergent results between self-reported and objective sleep measures (actigraphy). Furthermore, we found a tendency toward statistical significance in cognitive performance in PCC participants according to their sleep efficiency which could indicate that is more important for cognitive function of post-COVID-19 patients than total sleep time

Can Personality Traits Affect Sleep Quality in Post-COVID-19 Patients?

Objectives: In the present study, we aimed (i) to describe the personality traits of a cohort of post-COVID-19 condition (PCC) patients compared with a healthy control (HC) group, (ii) to evaluate the relationship between sleep quality and personality traits, and (iii) to investigate whether this relationship differs according to disease severity. Methods: We included 599 participants from the Nautilus Project (ClincalTrials.gov IDs: NCT05307549 and NCT05307575) with an age range from 20 to 65 years old. Of 599 participants, 280 were nonhospitalized (mild PCC), 87 were hospitalized (hospitalized PCC), 98 were in the PCC-ICU, and 134 were in the HC group. We assessed sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and personality traits with the NEO Five-Factor Inventory (NEO FFI). Results: We found that mild-PCC patients had higher scores of neuroticism than HCs (p &lt; 0.001) and ICU-PCC patients did (p = 0.020). The higher the neuroticism score was, the higher the total PSQI score (B 0.162; p &lt; 0.001), the worse the sleep latency (B 0.049; p &lt; 0.001), the greater the degree of sleep disturbance (B 0.060; p &lt; 0.001), the greater the use of sleeping medication (B 0.035; p = 0.033), and the greater the incidence of daytime disturbances (B 0.065; p &lt; 0.001) among the PCC patients. High neuroticism is also an indicator of worse sleep quality in mild-PCC (t = 3.269; p 0.001) and hospitalized-PCC (t = 6.401; p &lt; 0.001) patients and HCs (t = 4.876; p &lt; 0.001) but not in ICU-PCC patients. Conclusions: Although neuroticism affected sleep quality in both the PCC patients and HCs, the clinical implications and magnitude of the relationship were more significant in the PCC group. Specific and multidimensional interventions are needed to treat sleep problems in this population, and the influence of their personality traits should be considered