COVID-19 Infection and Sleep Health: Findings from the Nationally Representative COVID-19 Unequal Racial Burden Survey

Study Objectives: To estimate overall and racial/ethnic-specific associations between COVID-19 infection status and sleep health.

Methods: We analyzed online survey data collected from December 2020-February 2021 among Asian, Black, Latino (English and Spanish-speaking), and White adults (n=1000 each), along with American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and multiracial adults (n=500). COVID-19 infection (confirmed, probable, suspected), based on self-reported data on symptoms and infected contacts, was classified using World Health Organization definitions. Sleep disturbances were categorized as 'yes' (mild/moderate/severe) versus 'no' (normal). Weighted analyses were used to generate nationally representative estimates within each racial/ethnic group. Adjusting for sociodemographic and health behaviors, Poisson regression with robust variance estimated prevalence ratios (PRs) and confidence intervals (CIs) for sleep disturbances among individuals with a COVID-19 infection vs. not in the overall population and by race/ethnicity, gender, and ability to get healthcare.

Results: Among 5,359 eligible participants, 24% had a COVID-19 infection. COVID-19 infection was associated with a 32% higher prevalence of sleep disturbances (PR=1.32 [95% CI: 1.22-1.42]). Associations of COVID-sleep associations were higher among AI/AN (PR=1.64 [1.30-2.08]), NH/PI (PR=1.53 [1.24-1.90]), and English-speaking Latino (PR=1.49 [1.20-1.86]) compared to White adults (PR=1.14 [0.93-1.41]), although confidence intervals overlapped,. The higher prevalence of sleep disturbances among women with COVID-19 (PR=1.32 [1.19-1.45]) was similar to men (PR=1.34 [1.18-1.53]). COVID-19 infection also had a similar association with sleep disturbances among participants who did and did not report being unable to get needed healthcare.

Conclusions: COVID-19 infections may lead to sleep disturbances, among racial/ethnic groups.