.jpg "Shiv Patel, BS photo")
James Andrews, M.D.
Assistant Professor
University of Washington, United States
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Title: Initial Symptoms and Development of Cognitive or Sleep Deficits after COVID-19 Hospitalization
Introduction: Adverse neurocognitive effects are common long-term sequelae of SARS-COV-2 infection, however which individuals most at risk is not known. We examined whether initial symptom burden, the number of symptoms at time of COVID-19 presentation, is associated with self- reported cognition and sleep scores 30 days after COVID-19 hospitalization discharge.
Methods: Individuals ages 18 years and older who were hospitalized with COVID-19 at the University of Washington, were alive at 30 days after hospital discharge, and who spoke English were eligible. All data, including pre-COVID assessments, were collected by telephone interview at 30 days after hospital discharge. Cognition and sleep were assessed by the PROMIS Cognitive Function-Abilities (CA), Cognitive Function (CF), and Sleep Disturbance (SL) 4a short forms. Raw scores were converted to standardized T-scores for analysis (mean=50, and SD=10). Lower CA and CF T-scores, and higher SL T-score indicate greater impairment. A decrease of 5 T-score points indicates a clinically significant decline. Linear regression analyses modeled the associations between the initial symptom burden and cognition and sleep measure T-scores at 30 days after discharge with and without adjusting for covariates (baseline T-score, age, sex, race, ICU admission, hospital length of stay).
Results: Thirty-seven individuals are included, with mean age 56 (SD = 16.2) years and mean number of initial symptoms 6 (SD = 2.4). The most common initial symptoms were dyspnea (70%) and cough (65%). Mean CA, CF, SL T-scores were 56.6 (SD=7.8), 54.2 (SD=6.7), and 53.3 (SD-9.2) pre-COVID; and were 48.3 (SD=9.6), 47.5 (SD=10.9), and 58.2 (SD=10.3) at 30-days after discharge, respectively. Twenty five (68%) individuals developed a clinically significant decline in cognition and/or sleep T-scores, and 21 (57%) developed at least mild impairment compared to pre-COVID. In adjusted models, symptom burden was statistically significantly associated with SL (1.92 (95% CI: 0.45, 3.39)) T-score at 30 days.
Conclusion: Cognitive and sleep deficits at 30 days after discharge from COVID-19 hospitalization were common among our cohort. Our findings suggest that initial COVID-19 symptom burden may be an important risk factor for the development of sleep impairment among survivors of COVID-19 hospitalization.