1134 Post-acute Sequelae SARS CoV-2 Related Sleep Study and Symptom-based Factors Associated with Sleep Disturbances

Abstract Introduction Post-Acute Sequelae of SARS-CoV-2 (PASC) poses a global public health challenge, manifesting in persistent sleep disturbances beyond four weeks post-acute infection Despite the high prevalence of PASC-related sleep symptoms, there is a critical lack of objective evidence, particularly in sleep study characterization and symptom-based PASC contributors to reported sleep disturbances(SD). We sought to identify distinct sleep study features and PASC-related symptoms associated with patient-reported SD. Methods This cross-sectional ReCOVER cohort involved patients presenting with PASC from February 2021-May 2023 who underwent sleep studies following a positive COVID test with PROMIS-Sleep Disturbance(PROMIS-SD) collected within 6 months. Sleep study variables (sleep apnea and sleep architectural indices) and PASC-specific symptoms were stratified by PROMIS-SD score. A dichotomized T-score ≥60 defined moderate-severe SD. Multivariable logistic regression models adjusted for age, sex, race, and COVID hospitalization, assessed the association of sleep study indices and PASC symptom status (never, resolved,recurrent or new) across SD severity group. Statistical interaction of sleep study indices by sex and race were examined. Results The sample included 494 patients(age:49.5±12 years,BMI:35±9 kg/m²,73.1% female,82.5% vaccinated). Of 365 patients completing PROMIS-SD,166(45.5%) reported moderate/severe SD. Of all sleep study indices examined, only lower REM % was associated with higher SD, OR=0.95, 95% CI=0.92-0.99, p=0.01. Notably, males and black patients with moderate-severe SD exhibited higher average heart rate during sleep(statistical interaction p-values=0.01). Recurrent PASC symptoms were more common in moderate to severe vs normal/mild SD respectively: dyspnea(75.2 vs 60.9%,p=0.008),joint aches/pains(47.7 vs 31.1%,p=0.04) and headaches(47.7 vs 33.1%,p=0.03). Conclusion The sleep architectural alteration of lower percentage of REM sleep is associated with greater degree or patient-reported sleep disruption in PASC. Males and black individuals experiencing moderate-severe SD showed elevated heart rate during sleep, potentially reflecting sleep-related autonomic dysfunction in PASC. PASC-specific symptoms of dyspnea,joint pain and headaches appear to be clinically relevant sleep disruptors in recurrent PASC. Future investigation should focus on enhanced understanding of REM sleep-specific neural circuitry and memory consolidation in PASC as well as sleep-related autonomic fluctuations in predisposed subgroups. Moreover, targeting treatment of specific PASC symptoms such as dyspnea and pain may mitigate compromise in sleep and improve clinical outcomes. Support (if any)