Psychosocial Predictors of Sleep Disturbances during COVID-19: differential contributions of demographic, psychological, pandemic-related factors to sleep health. (preprint)

Aim: Since the declaration of COVID-19 as a Public Health Emergency of International Concern on January 30, 2020, the disease escalated into a global pandemic forcing governments around the world to impose measures that affected all aspects of life. Among other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person to person.  Subjects and Methods: This cross-sectional study aimed to investigate the impact of those measures on sleep health in a Greek adult sample. An online questionnaire collected data during from 650 participant.  Results: 60% of responders scored below the clinical cut-off on the RU-SATED, indicating they experienced poor sleep health. Better sleep health was reported with increased age and years of education. On the other hand, higher trauma-related distress, depression, anxiety and stress symptomatology were related to poorer sleep health. No gender differences were observed, and degree of compliance to pandemic restrictions did not influence sleep health. Hierarchical regression analysis indicated difficulty in securing enough/healthy food, testing positive for COVID-19, experiencing an increase in verbal arguments/conflicts at home and an increase in responsibilities were the strongest predictors of poor sleep heath.  Conclusions: Results highlight the importance of maintaining good sleep health as a pillar of general physical and mental health.

Impact of the COVID-19 Pandemic on Swedish Adolescents’ Mental Health, Psychosocial Functioning, Risk Behaviours, and Victimisation: Gender Differences and Implications (preprint)

The COVID-19 pandemic has shown varying effects on adolescents’ mental health, psychosocial functioning, risk behaviours, and victimisation. This study aims to examine the changes reported by a sample of Swedish adolescents (N=1607) at the end of the first year of the pandemic in relation to these factors. Data was collected with an electronic survey between September 2020 and February 2021, targeting upper-secondary high school students (aged 15-19 years). The results indicate a relatively low overall impact of the pandemic on Swedish upper-secondary school students, with notable gender differences. Compared to females, a higher percentage of male adolescents reported experiencing elevated levels of anxiety, depression, sleep disturbances, anger, and increased illicit drug use as consequences of the pandemic. In contrast, females demonstrated an increase in several salutogenic behaviours. Victimisation rates generally decreased during this period. These findings underscore the importance of heightened awareness among professionals within schools, social services, and healthcare settings regarding the distinct challenges encountered by a larger portion of male adolescents during the COVID-19 pandemic in Sweden.

Prevalence and influencing factors of sleep disorders in medical students after the COVID-19 pandemic (preprint)

Background The prevalence of sleep disorders among medical students was high during the COVID-19 pandemic. However, there are fewer studies of sleep disorders in medical students after the COVID-19 pandemic. This study aimed to investigate the prevalence and factors influencing sleep disorders among Chinese medical students after COVID-19.Methods We enrolled 1194 medical students. The Self-administered scale was used to collect the demographic characteristics. The Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) were used to assess subjects' depression, anxiety, and sleep disorders, respectively. The chi-square test and binary logistic regression were used to identify factors that influence sleep disorders. The receiver operating characteristic (ROC) curve was used to assess the predictive value of relevant variables for sleep disorders.Results We found that the prevalence of sleep disorders among medical students after COVID-19 was 82.3%. According to logistic regression results, medical students with depression were 1.151 times more likely to have sleep disorders than those without depression (OR = 1.151, 95% CI 1.114 to 1.188). Doctoral students were 1.908 times more likely to have sleep disorders than graduate and undergraduate students (OR = 1.908, 95% CI 1.264 to 2.880). In addition, the area under the ROC curve for depression is 0.689.Conclusion The prevalence of sleep disorders among medical students is high after COVID-19. In addition, high academic level and depression are risk factors for sleep disorders. Therefore, medical colleges and administrators should pay more attention to sleep disorders in medical students after the COVID-19 pandemic. Regular assessment of sleep disorders and depression is extremely necessary.

Slight recovery of brain metabolic impairment in patients with persistent long COVID: a nine-month follow-up [18F]FDG-PET study (preprint)

Purpose A hypometabolic profile involving the limbic areas, brainstem and cerebellum has been identified in long COVID patients via cerebral [18F]fluorodeoxyglucose (FDG)-PET. This study was conducted to evaluate possible recovery of brain metabolism during the follow-up of patients with prolonged symptoms.Methods Fifty-six adults with long COVID who underwent two brain [18F]FDG-PET scans in our department in May 2020–October 2022 were retrospectively analysed and compared to 51 healthy subjects. On average, PET1 was performed 7 (range 3–17) months after acute COVID-19 infection, and PET2 was performed 16 (range 8–32) months after acute infection. PET was performed because of persistent symptoms, including the following conditions: asthenia, cognitive complaints, dyspnoea, and sleep disorders. Whole-brain voxel-based analysis compared PET1 and PET2 from long COVID patients to scans from healthy subjects (p-voxel < 0.001 uncorrected, p-cluster < 0.05 FWE-corrected) and PET1 to PET2 (with the same threshold and with a less constrained threshold of p-voxel < 0.005 uncorrected, p-cluster < 0.05 uncorrected).Results PET1 and PET2 scans revealed hypometabolism in the previously reported profile. The between-group analysis comparing PET1 and PET2 showed minor improvements in the pons and cerebellum (8.4 and 5.2%, respectively, only significant under the less constrained uncorrected p-threshold); for the pons, the improvement was correlated with the PET1-PET2 interval (r = 0.21, p < 0.05). Of the 14,068 hypometabolic voxels identified on PET1, 6,503 were also hypometabolic on PET2 (46%). Of the 7,732 hypometabolic voxels identified on PET2, 6,094 were also hypometabolic on PET1 (78%).Conclusion Subjects with persistent symptoms of long COVID exhibit durable changes in brain metabolism, with only slight improvement 9 months later.

COVID-19-Related Stressors and Psychophysical Health Conditions Among Italian University Students: A Post Pandemic Insight (preprint)

The COVID-19-medical emergency has ended worldwide, yet there is still a need to evaluate the psychological impact of these years of unprecedented changes on students’ life. Methods: This study aims to assess and compare COVID-19-related stressors (Relationships-and-Academic-Life; Isolation; Fear-of-Contagion) and psychophysical symptoms reported by university students in April-2020, April 2021, and April 2022. The predictive role of COVID-19-related stressors on psychophysical symptoms within each time was also tested. Data were collected among 637 university students in April-2020 (n = 197), April-2021 (n = 200), April-2022 (n = 240). Results: In April-2022, perceived Isolation and Fear-of-Contagion decreased from the peak registered in April-2021, but stress related to Relationships-and-Academic-Life remained noteworthy high. A sharp and ongoing increase in psychophysical symptoms was found, with more than 50% of students reporting clinical levels of Sleep-Disorders, Depression, Psychoticism, and Interpersonal-Sensitivity. In April-2022, students still perceiving stress related to Relationships-and-Academic-Life and Isolation were at risk for Anxiety, Somatization, and Sleep-Disorders, while those still perceiving stress related to Fear-of-Contagion were also at risk for Depression, Obsessive-Compulsive, and Psychoticism. Conclusion: Findings emphasized the long-lasting detrimental effects of the COVID-19-related stress. Interventions must pinpoint the complex post-pandemic adjustment process and their effects on university students' psychophysical health.

Mood Disorders and Sleep Quality among Undergraduate Students during Covid-19 (preprint)

Studies have established the crucial role of sleep among the students which plays a significant role in their mood. This study aimed to examine the mood disorders and sleep quality among undergraduate students at the University of Georgia (UG) and comparison between students’ nationality.This cross-sectional study was a self-reported questionnaire comprised of demographics including age, gender, year of study, current location, lifestyle data (Exercise and smoking), the Depression, Anxiety, and Stress Scale (DAS21) and the Pittsburgh Sleep Quality Index (PSQI). We performed a descriptive analysis, and the Chi-square was statistically significant at p<0.05. The prevalence was at a 95% confidence interval (95% CI) as multivariate analysis examined the multicollinearity. The female students were most of the respondents, below the age of 20 years. The student's mean age was 20.20 (SD± 3.0). DAS report presented 72.7% of students with depressive symptoms, 77.8% with anxiety symptoms, and 62.2% had stress. Georgian students were more at risk of having depressive complaints (95% Cl[1.567-3.788]), anxiety (95% Cl[1.612-4.285]), and stress symptoms (95% Cl[1.743-3.831]). There was a strong relationship between the students who experienced poor sleeping patterns and depressive complaints (aOR 0.10). The students who were smokers (aOR 0.39) were more likely to report anxiety symptoms than the students that do not exercise (aOR 1.68). It was observed that students with depressive symptoms, anxiety, and complaints of stress had a significantly high risk of poor sleep quality. Further studies are recommended to curb psychological symptoms of mood changes in association with sleep disorders among students.

Bidirectional relationship between sleep problems and long COVID: a longitudinal analysis of data from the COVIDENCE UK study (preprint)

Summary: Background: Studies into the bidirectional relationship between sleep and long COVID have been limited by retrospective pre-infection sleep data and infrequent post-infection follow-up. We therefore used prospectively collected monthly data to evaluate how pre-infection sleep characteristics affect risk of long COVID, and to track changes in sleep duration during the year after SARS-CoV-2 infection. Methods: COVIDENCE UK is a prospective, population-based UK study of COVID-19 in adults. We included non-hospitalised participants with evidence of SARS-CoV-2 infection, and estimated odds ratios (ORs) for the association between pre-infection sleep characteristics and long COVID using logistic regression, adjusting for potential confounders. We assessed changes in sleep duration after infection using multilevel mixed models. We defined long COVID as unresolved symptoms at least 12 weeks after infection. We defined sleep quality according to age-dependent combinations of sleep duration and efficiency. COVIDENCE UK is registered with ClinicalTrials.gov, NCT04330599 . Findings: We included 3994 participants in our long COVID risk analysis, of whom 327 (8.2%) reported long COVID. We found an inverse relationship between pre-infection sleep quality and risk of long COVID (medium vs good quality: OR 1.37[95% CI 1.04-1.81]; medium–low vs good: 1.55 [1.12-2.16]; low vs good: 1.94 [1.11–3.38]). Greater variability in pre-infection sleep efficiency was also associated with long COVID (OR per percentage-point increase 1.06 [1.01–1.11]). We assessed post-infection sleep duration in 6860 participants, observing a 0.11 h (95% CI 0.08–0.13) increase in the first month after infection compared with pre-infection, with larger increases for more severe infections. After 1 month, sleep duration largely returned to pre-infection levels, although fluctuations in duration lasted up to 6 months after infection among people reporting long COVID. Interpretation: Our findings highlight the bidirectional relationship between sleep and long COVID. While poor-quality sleep before SARS-CoV-2 infection associates with increased risk of long COVID thereafter, changes in sleep duration after infection in these non-hospitalised cases were modest and generally quick to resolve.

The Impact of COVID-19 Pandemic on Sleep Quality in Healthcare Workers in Turkey (preprint)

The aim of this study is to evaluate the sleep behaviors of healthcare professionals working in secondary and tertiary hospitals in a large population in Turkey and to show how sleep quality is affected during the pandemic process by using the easily applicable Jenkins sleep scale (JSS). Methods The population of this cross-sectional descriptive study consists of two pandemic hospitals (2nd level state hospital and 3rd level university hospital) determined in Kahramanmaraş province. Data were collected between 03.08.2020 and 30.09.2020 with responses to online survey questions. The security of the data was assigned to SurveyMonkey enterprise. In our questionnaire, we asked subjective sleep quality (poor, moderate, high), sleep time (<24:00 and ≥24:00), time to fall asleep (minutes), total sleep time (hours), and medication use (sleeping pills). We also used Jenkins Sleep Scale Turkish version (JSS-TR) to assess sleep quality and the Epworth sleepiness scale (ESS) for increased daytime sleepiness. Results Healthcare workers who participated in our survey reported that they started to go to bed later, fell asleep later (mean: 41.75±35.35 minutes), their total sleep time (mean: 6.67±1.88 hours) was shortened, and they needed medication to sleep more (%5.7) after the COVID-19 pandemic. During the COVID-19 pandemic, bedtime behavior after 24:00 decreased from 80.1% to 43.9% of those who previously went to bed before 24:00. For those who went to bed after 24:00 before, it increased from 19.9% to 56.1%.In addition, sleep quality as assessed by subjective and JSS significantly deteriorated after the COVID-19 pandemic. Excessive daytime sleepiness increased. Those with ESS>10 before COVID-19 were 3.9%, post- COVID-19 ESS>10 14.1% (p<0.001). Conclusion The COVID-19 pandemic has significantly adversely affected the sleep behavior and sleep quality of healthcare professionals. The JSS is an easily applicable scale for assessing sleep quality in large population studies.

Pregnancy, mental well-being and lockdown: a nationwide online survey in France (preprint)

Objective: To compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. Design: Survey. Setting: France. Population: Women between 18 and 45 years of age during the second and third weeks of global lockdown (March 25–April 07, 2020) during the COVID-19 pandemic. Methods: : Nationwide online quantitative survey. Main Outcome Measures: Mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Results: : This study analysed 275 responses from pregnant women and compared them with those from a propensity score–matched sample of 825 non-pregnant women. The median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. Conclusion: During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women’s well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being.

Prevalence of post-COVID symptoms in a cohort of hospitalized patients in the North Coast of Colombia (preprint)

Understanding the prevalence and severity of post-COVID-19 conditions among hospitalized patients is crucial for developing effective strategies for managing the long-term consequences of the disease. This study aimed to estimate the prevalence and severity of post-COVID-19 conditions in previously hospitalized COVID-19 patients. The study involved two phases: first, participants were contacted via phone call by trained personnel from the healthcare company and surveyed. In the second phase, two months after the telephone survey, a medical visit was conducted in the group of individuals who reported persistent symptoms in the previous call. Summary statistics such as mean, standard deviation (SD), interquartile range (IQR), 95%CI as well as absolute and relative frequencies of patients' baseline characteristics were reported. Changes were assessed through statistical tests for differences in means and proportions. Multivariate analyses were also conducted. The prevalence of at least one post-hospitalization condition after three months of COVID-19 hospitalization was 78.7 per 100 people. The most common symptoms included fatigue (55.4%), joint pain (46.0%), dyspnea (44.6%), sleep disorders (36.1%), anorexia (33.7%), and chest pain (31.7%). These conditions were frequent and disabling, experiencing at least one condition after three months. Within this group, more than 70% showed a deterioration in their health status (EQ5D-5L Scale) or experienced new or worsened disability in at least one domain of the Washington Group. Our study demonstrates that post-COVID-19 conditions in previously hospitalized patients are highly prevalent, which can adversely affect patients' quality of life and lead to increased demand for healthcare services.

Long COVID is associated with severe cognitive slowing (preprint)

Background COVID-19 survivors may suffer from a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing. Methods To examine cognitive slowing, PCC patients completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). Findings We identified pronounced cognitive slowing in PCC patients, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-second task measuring simple reaction time (SRT), with PCC patients responding to stimuli ~3 standard deviations slower than healthy controls. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in PCC patients. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of PCC patients on the NVT measure of sustained attention. Interpretation Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in PCC patients. Funding Wellcome Trust (206330/Z/17/Z), NIHR Oxford Health Biomedical Research Centre, the Thuringer Aufbaubank (2021 FGI 0060), German Forschungsgemeinschaft (DFG, FI 1424/2-1) and the Horizon 2020 Framework Programme of the European Union (ITN SmartAge, H2020-MSCA-ITN-2019-859890).

A pragmatic randomized controlled trial of a telemedicine self-management intervention for adults with long COVID: The COPE study protocol (preprint)

Background: Long COVID is a serious public health concern due to its high prevalence and potentially debilitating symptoms. Symptoms may include fatigue, dyspnea, cognitive problems, insomnia, anxiety and depression. There is currently no cure for long COVID and the average length of recovery and proportion of patients who fully recover are still unknown. Subsequently, there is a critical need to improve function. Research in other chronic conditions suggests that psychosocial self-management interventions reduce symptom severity and interference with functioning. We describe the design of our study to examine the feasibility, acceptability, appropriateness and preliminary efficacy of an intervention designed to improve symptom management and coping in adults with long COVID. Methods: This pilot trial (N=50) uses a pragmatic, randomized 2-group parallel design set within the MASKED Post-COVID Rehabilitation and Recovery Clinic. The self-management intervention is a 6-week, group-based telemedicine intervention that teaches evidence-based strategies to manage common symptoms and improve stress management as well as communication and self-advocacy. The comparator is a wait-list control. Participants complete self-report measures of the primary and secondary outcomes at baseline and post-treatment/wait-list. Primary outcomes include intervention feasibility, acceptability, and appropriateness. Secondary outcomes include Patient-Reported Outcomes Measurement Information System measures of fatigue, sleep disturbance, cognitive difficulties, self-efficacy, pain interference, depression and anxiety symptoms as well as a measure of long COVID symptoms and impression of change. At post-intervention, intervention participants also complete a qualitative interview to inform intervention refinement. Quantitative data will be examined using descriptive and statistical analysis including ttests and chi-square tests to compare the intervention and wait-list groups on secondary outcomes. Qualitative data will be analyzed using the rigorous and accelerated data reduction technique. Discussion: Results of this pilot randomized controlled trial will characterize the feasibility, acceptability, and appropriateness of the self-management intervention and inform intervention refinement necessary prior to further testing. Long COVID is a public health concern and rehabilitation approaches that equip patients to manage symptoms may improve patient function and quality of life and reduce burden on the health system. Clinical Trial Registration No.: NCT05658536. Date of Trial Registration: December 16, 2022

Nationally representative prevalence and determinants of post-acute sequelae of SARS-CoV-2 infection (Long COVID) amongst Mexican adults in 2022 (preprint)

OBJECTIVETo characterize the epidemiology of post-acute sequelae after SARS-CoV-2 infection (PASC) in Mexico during 2022 and identify potential predictors of PASC prevalence using nationally representative data. METHODSWe analyzed data from the 2022 Mexican National Health and Nutrition Survey (ENSANUT) totaling 24,434 participants, representing 85,521,661 adults [≥]20 years. PASC was defined using both the World Health Organization definition and a PASC score [≥]12. Estimates of PASC prevalence were stratified by age, sex, rural vs. urban setting, social lag quartiles, number of reinfections, vaccination status and by periods of predominance of SARS-CoV-2 circulating variants. Predictors of PASC were assessed using logistic regression models adjusted by survey weights. RESULTSPersistent symptoms after SARS-CoV-2 infection were reported by 12.44% (95%CI 11.89-12.99) of adults [≥]20 years in Mexico during 2022. The most common persistent symptoms were musculoskeletal pain, headache, cough, loss of smell or taste, fever, post-exertional malaise, brain fog, anxiety, chest pain, and sleep disorders. PASC was present in 21.21% (95%CI 7.71-9.65) subjects with previously diagnosed COVID-19. Over 28.6% patients with PASC reported symptoms persistence [≥]6 months and 14.05% reported incapacitating symptoms. Higher PASC prevalence was associated with SARS-CoV-2 reinfections, depressive symptoms and living in states with high social lag. PASC prevalence, particularly its more severe forms, decreased with COVID-19 vaccination and for infections during periods of Omicron variant predominance. CONCLUSIONSPASC implies a significant public health burden in Mexico as the COVID-19 pandemic transitions into endemicity. Promoting reinfection prevention and booster vaccination may be useful to reduce PASC burden.

The Role of VSL#3 in the Treatment of Fatigue and Other Symptoms in Long Covid-19 Syndrome: a Randomized, Double-blind, Placebo-controlled Pilot Study (DELong#3) (preprint)

Long COVID, also known as Post-acute COVID-19 Syndrome (PACS), is a chronic condition affecting individuals who have recovered from acute COVID-19. It is currently estimated that around 65 million people worldwide suffer from Long COVID. It is characterized by a range of symptoms, including fatigue, exertion intolerance, neurocognitive and sensory impairment, sleep disturbance, myalgia/arthralgia, and dysautonomia. Among them fatigue has emerged as a burdensome and pervasive issue, significantly impacting the quality of life and daily functioning of Long COVID patients. Alterations in the composition of the intestinal microbiota has been reported in COVID-19 patients. Dysbiosis persists even after several months of recovery from acute SARS-CoV-2 infection. Based on this evidence, we carried out a phase 3, randomized, double-blind, placebo-controlled trial aimed at evaluating the efficacy of VSL#3, a consortium of probiotic bacterial strains, in reducing fatigue and improving various aspects of patients' well-being in patients with Long COVID syndrome.

COVID-19 and Sleep Disturbances: A Literature Review of Clinical Evidence.

The need for adequate good quality sleep to optimally function is well known. Over years, various physical, psychological, biological, and social factors have been investigated to understand their impact on sleep. However, understanding the etiological processes that are involved in causing sleep disturbances (SD) as impacted by stressful phases such as pandemics has not been well studied. Many such etiological and management strategies have surfaced during the latest "coronavirus disease of 2019 (COVID-19) pandemic. The occurrence of these SD in the infected and uninfected individuals poses a need to investigate factors linked to such occurrence during this phase. Some of such factors include stressful practices such as social distancing, masking, vaccines, and medications availability, changes in routines, and lifestyles. As the status of infection improved, a collective term for all the prolonged effects of COVID-19 after the resolution of the primary infection called the post-COVID-19 syndrome (PCS) surfaced. Apart from impacting sleep during the infectious phase, the aftereffects of this virus left an even greater impact during the PCS. Various mechanisms have been hypothesized to be linked to such SD during the PCS, but the available data are inconclusive. Further, the varied patterns of incidence of these SDs differed by many factors, such as age, gender, and geographical location, making clinical management even more challenging. This review elucidates the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease on sleep health during the various phases of the COVID-19 pandemic. We also investigate different causal relationships, management strategies, and knowledge gaps related to SD during the COVID-19 pandemic.

Association between COVID-19 lockdown and sleep behaviors in Korean adolescents.

To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10-1.19), 6 hours, OR 1.07; 95% CI 1.03-1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06-1.11) and late chronotype (OR, 1.43; 95% CI, 1.38-1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.

The comparison of the consultation-liaison in the psychiatry department of a general hospital before and after the outbreak of COVID-19 (preprint)

Objective: To compare the status of the consultation-liaison in the psychiatry department of inpatients in a general hospital before and after the outbreak of COVID-19.  Methods: 842 patients in a tertiary hospital during 2019 and 904 patients since the beginning of the epidemic in 2020 were enrolled in this study. Demographic data, departments that requested consultation, mental disorders, and the psychiatric treatments were retrospectively analyzed.  Results: Among the 1746 patients, most patients were 45 to 70 years old. The department of hematology received the most applications for consultation. In 2020, requests from the departments of cardiac and vascular surgeries, contrary to the emergency department, increased significantly. 32.6% patients were diagnosed with organic mental disorder. Delirium was the most common disorder, followed by anxiety and depression. After the COVID-19 outbreak in 2020, the stress-associated and sleep disorders increased.  Conclusions: In general hospitals, clinical departments have great demands forpsychiatric consultation.Since the pandemic, patients requiring consultations for stress-related disorders and sleep disorders increased. Moreover, patients with cardiac and major vascular surgeries suffering from mental and emotional disturbances also increased. The ability of non-psychiatrists in identifying and treating mental disorders and the awareness of biopsychosocial (BPS) models need to be improved.

Proteomic landscape of astrocytes and pericytes infected with HIV/SARS-CoV-2 mono/co-infection, impacting on neurological complications (preprint)

Background Although most individuals recover from coronavirus disease 2019 (COVID-19) within a few weeks, some people continue to experience a wide range of symptoms known as post-acute sequelae of SARS-CoV-2 (PASC) or long COVID. Majority of patients with PASC develop neurological disorders like brain fog, fatigue, mood swings, sleep disorders, loss of smell and test among others collectively called neuro-PASC. While the people living with HIV (PWH) do not have a higher risk of developing severe disease and mortality/morbidity due to COVID-19. As a large section of PWH suffered from HIV-associated neurocognitive disorders (HAND), it is essential to understand the impact of neuro-PASC on people with HAND. In pursuit of this, we infected HIV/SARS-CoV-2 alone or together in primary human astrocytes and pericytes and performed proteomics to understand the impact of co-infection in the central nervous system.Methods Primary human astrocytes and pericytes were infected with SARS-CoV-2 or HIV or HIV + SARS-CoV-2. The concentration of HIV and SARS-CoV-2 genomic RNA in the culture supernatant was quantified using reverse transcriptase quantitative real time polymerase chain reaction (RT-qPCR). This was followed by a quantitative proteomics analysis of mock, HIV, SARS-CoV-2, and HIV + SARS-CoV-2 infected astrocytes and pericytes to understand the impact of the virus in CNS cell types.Results Both healthy and HIV-infected astrocytes and pericytes support abortive/low level of SARS-CoV-2 replication. In both mono-infected and co-infected cells, we observe a modest increase in the expression of SARS-CoV-2 host cell entry factors (ACE2, TMPRSS2, NRP1, and TRIM28) and inflammatory mediators (IL-6, TNF-α, IL-1β and IL-18). Quantitative proteomic analysis has identified uniquely regulated pathways in mock vs SARS-CoV-2, mock vs HIV + SARS-CoV-2, and HIV vs HIV + SARS-CoV-2 infected astrocytes and pericytes. The gene set enrichment analysis revealed that the top ten enriched pathways are linked to several neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis.Conclusions Our study emphasizes the significance of long-term monitoring of patients co-infected with HIV and SARS-CoV-2 to detect and understand the development of neurological abnormalities. By unraveling the molecular mechanisms involved, we can identify potential targets for future therapeutic interventions.

Association between sleep and seroconversion after vaccination with inactivated SARS-CoV-2 in pregnant women (preprint)

To assess the association between sleep and seroconversion after receipt of two doses of inactivated severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) vaccines in pregnant women. The serum level of immunoglobulin (Ig)G antibodies against the nucleic acids of SARS-CoV-2 was measured. Logistic regression was used to analyze the association between sleep and seroconversion. After two doses of SARS-CoV-2 vaccine, 41.2% of the study cohort reached seroconversion. Analysis revealed that pregnant women with poor quality of sleep had a lower serum level of IgG antibodies (P = 0.008, 95%CI = 0.285-0.826) and that sleeping late at night (SLaN) may be a risk factor for a low serum level of IgG antibodies (P = 0.025, 95%CI = 0.436-0.946). Besides sleep, age and the time since vaccination were important influences on seroconversion. A stratified analysis revealed that the effects of sleep quality and SLaN on seroconversion occurred mainly in pregnant women aged <35 years. Thus, sleep quality and SLaN can affect the serum level of IgG antibodies in pregnant women after vaccination with inactivated SARS-CoV-2.