Sleep quality deterioration in middle-aged and older adults living in a rural Ecuadorian village severely struck by the SARS-CoV-2 pandemic. A population-based longitudinal prospective study

• Published in: Sleep (New York, N.Y.) Vol. 44; no. 8; p. 1
• Main Authors: Del Brutto, Oscar H, Mera, Robertino M, Costa, Aldo F, Recalde, Bettsy Y, Castillo, Pablo R
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-08-2021
• Subjects: Aged; Analysis; Antibodies; COVID-19; Ecuador - epidemiology; Health aspects; Humans; Infection; Middle age; Middle Aged; Older people; Original; Pandemics; Population-based studies; Prospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sleep; Sleep disorders; Viral antibodies; Ecuador; Pittsburgh Sleep Quality Index; COVID-19; Coronavirus-19; SARS-CoV-2; sleep quality
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsab041

Abstract
Study Objectives
This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community dwellers enrolled in the Atahualpa Project.
Methods
Atahualpa residents aged ≥40 years were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) 9 months before the pandemic and a lateral flow-based test for identification of SARS-CoV-2 antibodies during the peak of the pandemic. Six months later, individuals completed a follow-up PSQI. The independent relationship between SARS-CoV-2 infection and deterioration in sleep quality was assessed by fitting logistic mixed models for longitudinal data.
Results
Of 639 participants (mean age at baseline: 59 ± 12.8 years), 325 (51%) had SARS-CoV-2 antibodies. A total of 185 (29%) individuals at baseline and 311 (49%) at follow-up were poor sleepers (p < 0.001). Mixed logistic regression models demonstrated a significant increase in poor sleepers at follow-up (odds ratio [OR]: 2.85; 95% CI: 2.16 to 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% CI: 2.48 to 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% CI: 50.9% to 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% CI: 35.3% to 46.1%) in their seronegative counterparts (p < 0.001). Likewise, progression from a good to a poor sleeper status was higher among seropositive individuals than in their seronegative counterparts (38.1% vs 22.3%; p < 0.001), after adjusting for relevant covariates.
Conclusions
This study shows a deleterious effect of SARS-CoV-2 in sleep quality. An effect of SARS-CoV-2 in disrupting sleep-related pathways cannot be ruled out.
Trial registration
The Atahualpa Project has been registered at ClinicalTrials.gov; the identifier number is NCT01627600, and the date was: 10/02/2012 (https://clinicaltrials.gov/ct2/show/NCT01627600?cond=Atahualpa&draw=2&rank=1). The Sleep Disorders substudy has been registered at ClinicalTrials.gov; the identifier number is NCT01877616, and the date was: 06/13/2013 (https://clinicaltrials.gov/ct2/show/NCT01877616?cond=Atahualpa&draw=2&rank=4).