Most of the acute effects of SARS-CoV-2 infection have been focused on the upper airway, lungs, and the cardiovascular system. Research has shown that the health and function of these systems are mediated by sleep and circadian rhythms biology. This relationship is further strengthened by recent evidence indicating that the risk of illness severity and death may be higher among COVID-19 patients with untreated sleep apnea. Furthermore, widespread reports of cognitive impairment in symptomatic patients indicate that the virus exerts direct and/or indirect effects on the central nervous system. The evidence for a neurological component to COVID-19 is further supported by documentation of the most common symptoms experienced by individuals after COVID-19: debilitating fatigue, difficulty breathing, cognitive dysfunction (or “brain fog”), and sleep disturbances, including insomnia. For example, evidence suggests that in some cases, respiratory failure and consequent mortality caused by the virus is not solely mediated through damage to the lungs but may also involve impairments to brainstem circuitry that regulates breathing.
Sleep and circadian biology are intrinsically tied to immune function and play a fundamental role in both mental and physical health. Extensive research has established that poor sleep and circadian misalignment undermines the immune system’s ability to fight infections, may impair the effectiveness of some vaccines and may delay recovery from critical illness. Early reports suggest that sleep is affected by SARS-CoV-2 infection, and fatigue/sleep deficiency is a common complaint from those experiencing post-acute sequelae of SARS-CoV-2 (PASC) or “Long COVID.” In addition to the significant impact on the health of the millions of individuals who have been infected by the virus, the COVID-19 pandemic has led to long-term behavioral, psychological, social, and economic consequences that will need to be addressed in the coming years. Adequate sleep duration, sleep quality, and regular sleep schedules are essential for coping with physiological and psychosocial stressors, such as the COVID-19 pandemic.
While accumulating research demonstrates that sleep disruption is a prevalent feature of COVID-19, research is urgently needed to determine whether sleep is directly involved in COVID-19 susceptibility, immune response, and related pathophysiology. Sleep deficiency is modifiable, and a potential target to improve COVID-19 prevention, management and long-term outcomes.
High-Priority Research Areas
- The role of sleep and circadian disruption in risk of infection and severity of acute COVID-19 across vulnerable populations.
- Sleep and circadian disruption as modifiers of COVID-19 pathobiology and risk of developing PASC.
- The long-term effects of COVID-19 on sleep and circadian biology.
- The contribution of sleep deficiency to COVID-19 long-term effects on the cardiovascular, pulmonary, hematological systems, cancer and other diseases.
- Understanding causes of fatigue as a symptom in many different disease conditions, and the roles of sleep and circadian mechanisms in exacerbating or mitigating fatigue in these conditions.
- The bidirectional relationship between alcohol misuse and sleep disruption as modifiers of COVID-19 outcomes.
- The effects of chronic alcohol drinking on sleep quality and their contributions to other symptoms such as cognitive impairment, pain, and anxiety associated with PASC.
- How shift work and chronic sleep disruption combined with alcohol misuse and alcohol use disorder (AUD) may worsen COVID-19 outcomes.
- The role of complementary and integrative health approaches (such as botanicals, probiotics/microbials, acupuncture and other manual therapies, yoga, meditation) in the improvement or prevention of sleep and circadian disruption related to COVID-19.
- The role of sleep and circadian rhythm disruption in long-term chronic disease-related cognitive impairments such as PASC “brain fog” or “chemobrain.”
- Disruption of sleep in women – due to pregnancy and to factors such as COVID-19-related caretaking responsibilities or burnout.
- The impact of mitigation efforts in response to the COVID-19 pandemic on sleep, mental health, and well-being.
- The role of sleep and circadian disruption on the effects of COVID-19 across the cancer continuum, from cancer risk factors and diagnosis to treatment and survivorship.
- Modifications in the homeostatic system that prohibit sleep from reversing the fatigue associated with PASC.