Association Between Hypersomnolence and the COVID-19 Pandemic: The International COVID-19 Sleep Study (ICOSS)

Authors

• Tomi Sarkanen, Tampere University
• Markku Partinen, University of Helsinki
• Bjørn Bjorvatn, University of Bergen
• Ilona Merikanto, University of Helsinki
• Christian Benedict, Uppsala University
• Michael R. Nadorff, Mississippi State University
• Courtney J. Bolstad, Mississippi State University
• Colin Espie, University of Oxford
• Kentaro Matsui, National Center of Neurology and Psychiatry
• Frances Chung, University of Toronto
• Charles M. Morin, Université Laval
• Yun Kwok Wing, The Chinese University of Hong Kong
• Thomas Penzel, Charite University Hospital
• Tainá Macêdo, Federal University of Rio Grande do Norte
• Sérgio Mota-Rolim, Federal University of Rio Grande do Norte
• Brigitte Holzinger, Medical University Vienna
• Giuseppe Plazzi, University of Modena and Reggio Emilia
• Luigi De Gennaro, Sapienza University of Rome
• Anne-Marie Landtblom, Dept of Medical Sciences, Uppsala university, Uppsala, Sweden.
• Yuichi Inoue, Tokyo Medical University
• Mariuz Sieminski, Medical University of Gdansk
• Damien Leger, Tampere University Hospital
• Yves Dauvilliers, Tampere University Hospital

ORCID

Sarkanen: https://orcid.org/0000-0001-8815-2807; Bolstad: https://orcid.org/0000-0003-2297-2778

MSU Affiliation

College of Arts and Sciences; Department of Psychology

Creation Date

2026-06-30

Abstract

BACKGROUND: The COVID-19 pandemic and related restriction measures have affected our daily life, sleep, and circadian rhythms worldwide. Their effects on hypersomnolence and fatigue remain unclear. METHODS: The International COVID-19 Sleep Study questionnaire which included items on hypersomnolence such as excessive daytime sleepiness (EDS), and excessive quantity of sleep (EQS), as well as sociodemographic factors, sleep patterns, psychological symptoms, and quality of life was distributed in 15 countries across the world from May to September in 2020. RESULTS: Altogether responses from 18,785 survey participants (65% women, median age 39 years) were available for analysis. Only 2.8% reported having had COVID-19. Compared to before the pandemic, the prevalence of EDS, EQS, and fatigue increased from 17.9% to 25.5%, 1.6%-4.9%, and 19.4%-28.3% amid the pandemic, respectively. In univariate logistic regression models, reports of having a COVID-19 were associated with EQS (OR 5.3; 95%-CI 3.6-8.0), EDS (2.6; 2.0-3.4), and fatigue (2.8; 2.1-3.6). In adjusted multivariate logistic regression, sleep duration shorter than desired (3.9; 3.2-4.7), depressive symptoms (3.1; 2.7-3.5), use of hypnotics (2.3; 1.9-2.8), and having reported COVID-19 (1.9; 1.3-2.6) remained strong predictors of EDS. Similar associations emerged for fatigue. In the multivariate model, depressive symptoms (4.1; 3.6-4.6) and reports of having COVID-19 (2.0; 1.4-2.8) remained associated with EQS. CONCLUSIONS: A large increase in EDS, EQS, and fatigue occurred due to the COVID-19 pandemic, and especially in self-reported cases of COVID-19. These findings warrant a thorough understanding of their pathophysiology to target prevention and treatment strategies for long COVID condition.

Publication Date

5-6-2023

Publication Title

Sleep Medicine

Publisher

Elsevier

First Page

108

Last Page

115

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Rights

© 2023 The Author(s)

Recommended Citation

Sarkanen, T., Partinen, M., Bjorvatn, B., Merikanto, I., Benedict, C., Nadorff, M. R., Bolstad, C. J., Espie, C., Matsui, K., Chung, F., Morin, C. M., Wing, Y. K., Penzel, T., Macêdo, T., Mota-Rolim, S., Holzinger, B., Plazzi, G., De Gennaro, L., Landtblom, A.-M., … Dauvilliers, Y. (2023). Association between hypersomnolence and the COVID-19 pandemic: The International COVID-19 Sleep Study (ICOSS). Sleep Medicine, 107, 108–115. https://doi.org/10.1016/j.sleep.2023.04.024