key: cord-0871820-b2akycst
authors: Liguori, Claudio; Spanetta, Matteo; Sarmati, Loredana; Cesta, Novella; Pezzuto, Gabriella; Mina, Grazia Genga; Rogliani, Paola; Pierantozzi, Mariangela
title: Sleep and wake impairment in patients with SARS-CoV2 infection
date: 2020-07-17
journal: Sleep Med
DOI: 10.1016/j.sleep.2020.06.036
sha: 92aa38eb026aad75be34f1e9e7b33122a706f44b
doc_id: 871820
cord_uid: b2akycst

nan

Coronavirus Disease 2019 (COVID-19) is unquestionably a worldwide life-threatening condition causing severe acute respiratory distress; 1 however, pauci-symptomatic or non-severe forms of pneumonia currently represent the more frequent manifestations of the infection. 2 In this pandemic contest, clinicians should be aware of the possibility that extra-pulmonary symptoms may happen in patients with non-severe respiratory form of COVID-19; specifically, neurological symptoms merit clinical attention and appropriate treatments in order to reduce the patients' disease burden. [3] [4] Our NeuroCOVID-19 group performed a prospective observational study focused on the occurrence of subjective neurological symptoms in hospitalized patients with a non-severe respiratory form of COVID-19. 4 Here, we present data deriving from a secondary analysis of the previous study with the aims to emphasize and deepen the characteristics of sleep and wake impairment in patients with SARS-CoV2 infection and their relationships with the other neurological symptoms, white blood cells (WBC), C-reactive protein (CRP), and days of hospitalization.

One-hundred-and-three patients with SARS-CoV2 infection were included in the study. Among them, 51 patients reported sleep impairment and 34 patients complained daytime sleepiness (Table 1) ; only 11 patients concurrently reported sleep impairment and daytime sleepiness.

Considering patients with sleep impairment, they had higher CRP serum levels, more frequent dysgeusia, headache, and dizziness, and more concomitant neurological symptoms than patients without sleep alteration ( Table 1) . As regard patients with daytime sleepiness, they were more frequently female and presented higher CRP serum levels, lower WBC, more frequent confusion and muscle ache and, generally, more concomitant neurological symptoms than patients without daytime sleepiness.

Based on the results of this secondary analysis, it appears evident that sleep and wake impairment are common complaints in patients with COVID-19. Quite many patients did not concurrently report both symptoms; thus, it is possibly to hypothesize different causal pathological mechanisms. In fact, intrinsic properties of the virus, as well as the immune and inflammatory responses, may cause both sleep and wake impairment; however, also hospitalization per se may damage sleep and alter wake in patients with SARS-CoV2 infection. [4] [5] Considering the very high number of patients with COVID-19 and the increasing number of non- 

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Coronavirus Disease (COVID-19) in a Paucisymptomatic Patient: Epidemiological and Clinical Challenge in Settings With Limited Community Transmission

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease

Subjective Neurological Symptoms Frequently Occur in Patients With SARS-CoV2 Infection

Nervous system involvement after infection with COVID-19 and other coronaviruses