Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID

Linor Berezin, Rida Waseem, Ilona Merikanto, Christian Benedict, Brigitte Holzinger, Luigi De Gennaro, Yun Kwok Wing, Bjørn Bjorvatn, Maria Korman, Charles M. Morin, Colin Espie, Anne Marie Landtblom, Thomas Penzel, Kentaro Matsui, Harald Hrubos-Strøm, Sérgio Mota-Rolim, Michael R. Nadorff, Giuseppe Plazzi, Catia Reis, Rachel Ngan Yin ChanAna Suely Cunha, Juliana Yordanova, Adrijana Koscec Bjelajac, Yuichi Inoue, Yves Dauvilliers, Markku Partinen, Frances Chung

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Study Objectives: Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration. Methods: Using data from 13,461 respondents from 16 countries who participated in the 2021 survey-based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID. Results: Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average-length sleepers without pre-existing conditions. Conclusions: Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients.

Original languageEnglish
Pages (from-to)111-119
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number1
StatePublished - 1 Jan 2024


  • COVID-19
  • International COVID Sleep Study Survey
  • long COVID
  • pre-existing medical conditions
  • sleep duration


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