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

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 were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) nine 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 (OR: 2.85; 95% C.I.: 2.16 – 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% C.I.: 2.48 – 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% C.I.: 50.9 – 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% C.I.: 35.3 – 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% versus 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.