Abstract
The current COVID-19 pandemic caused enormous suffering to people in the disease state and caused significant mortality; the morbidity of people after COVID-19 is also alarming. It is named post-COVID conditions by WHO and CDC USA. Its estimated prevalence ranges from 10% to 50%, and circadian rhythm sleep disturbance is one of the essential symptoms of the post-COVID state. The circadian sleep disturbance may appear isolated or comorbid, associated with other symptoms like chronic fatigue syndrome, depression, post-traumatic stress disorder, and anxiety. The relationship of the circadian rhythm disturbance with the comorbid condition may be bidirectional. The circadian rhythm modulates gene expression, body metabolism, immune status, and endocrine function of the body, as well as a person’s behavior. So, the consequences of sleep rhythm disturbance may be enormous.
The pathophysiology of sleep-rhythm disturbance in the post-COVID state is mainly unknown and is still under research. Persistence of the organism or prolonged and dysregulated inflammation also explains sleep, circadian rhythm, and other neuropsychiatric disorders in the post-COVID period. The countermeasures against this disorder are still under research. Sleep extension, appropriate bedtime recommendations, maintaining sleep hygiene and reciprocity between physical activity and the circadian system, time-of-day-restricted feeding (TRF), chronobiology, and drugs, like melatonin, may be an approach to treat such conditions. The concept of chronology is the newer one; it identifies the body’s circadian rhythm of various biologic responses and modifies the treatment to gain optimum benefit.
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References
Alimoradi Z, Brostrom A, Tsang HWH et al (2021) Sleep problems during COVID-19 pandemic and its’ association to psychological distress: a systematic review and meta-analysis. EClinicalMedicine 36:100916. https://doi.org/10.1016/j.eclinm.2021.100916
American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien, IL
Asher G, Sassone-Corsi P (2015) Time for food: the intimate interplay between nutrition, metabolism, and the circadian clock. Cell 161:84–92
Asyary A, Veruswati M (2020) Sunlight exposure increased Covid-19 recovery rates: a study in the central pandemic area of Indonesia. Sci Total Environ 729:139016. https://doi.org/10.1016/j.scitotenv.2020.139016. Epub 2020 Apr 27. PMID: 32361458; PMCID: PMC7184988
Axelrod J, Weissbach H (1960) Enzymatic O-methylation of N-acetyl serotonin to melatonin. Science 131:1312
Bailey SM, Udoh US, Young ME (2014) Circadian regulation of metabolism. J Endocrinol 222(2):R75–R96
Baquerizo-Sedano L, Chaquila JA, Aguilar L, Ordovás JM et al (2021) Anti-COVID-19 measures threaten our healthy body weight: changes in sleep and external synchronizers of circadian clocks during confinement. Clin Nutr 25. https://doi.org/10.1016/j.clnu.2021.06.019. Epub ahead of print. PMID: 34246488
Boiko DI, Skrypnikov AM, Shkodina AD et al (2022) Circadian rhythm disorder and anxiety as mental health complications in post-COVID-19. Environ Sci Pollut Res Int 29(19):28062–28069. https://doi.org/10.1007/s11356-021-18384-4. Epub 2022 Jan 5. PMID: 34988815; PMCID: PMC8730477
Bonnet MH, Arand DL (1995) We are chronically sleep deprived. Sleep 18(10):908–911. https://doi.org/10.1093/sleep/18.10.908. PMID: 8746400
Borbely AA (1982) A two process model of sleep regulation. Hum Neurobiol 1:195–204
Buman MP, King AC (2010) Exercise as a treatment to enhance sleep. Am J Lifestyle Med 4:500–514
Buxton OM, L’Hermite-Baleriaux M, Hirschfeld U et al (1997) Acute and delayed effects of exercise on human melatonin secretion. J Biol Rhythms 12:568–574. https://doi.org/10.1177/074873049701200611
Carfì A, Bernabei R, Landi F et al (2020) Persistent symptoms in patients after acute COVID-19. JAMA 324(6):603–605. https://doi.org/10.1001/jama.2020.12603. PMID: 32644129; PMCID: PMC7349096
Carruthers BM, Jain AK, De Meirleir KL et al (2003) Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols (Canadian case definition). J Chronic Fatigue Syndr 11(1):7–115
Cellini N, Canale N, Mioni G et al (2020) Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res 29:e13074. https://doi.org/10.1111/jsr.13074
Centers for Disease Control and Prevention, USA (2021) Post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed 19 Jul 2021
Charrier A, Olliac B, Roubertoux P et al (2017) Clock genes and altered sleep-wake rhythms: their role in the development of psychiatric disorders. Int J Mol Sci 18(5):E938
Chen G, Wu D, Guo W et al (2020) Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 130(5). https://doi.org/10.1172/JCI137244. PMID: 32217835
Choudhry AA, Shahzeen F, Choudhry SA et al (2021) Impact of COVID-19 infection on quality of sleep. Cureus 13(9):e18182. https://doi.org/10.7759/cureus.18182
Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Board on the Health of Select Populations; Institute of Medicine (2015. https://www.ncbi.nlm.nih.gov/books/NBK274235/) Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. National Academies Press (US), Washington, DC. https://doi.org/10.17226/19012
Cooper AB, Thornley KS, Young GB et al (2000) Sleep in critically ill patients requiring mechanical ventilation. Chest 117:809–818. https://doi.org/10.1378/chest.117.3.809
Daou M, Telias I, Younes M et al (2020) Abnormal sleep, circadian rhythm disruption, and delirium in the ICU: are they related? Front Neurol 18(11):549908. https://doi.org/10.3389/fneur.2020.549908. PMID: 33071941; PMCID: PMC7530631
Dewald-Kaufmann JF, Oort FJ, Meijer AM (2013) The effects of sleep extension on sleep and cognitive performance in adolescents with chronic sleep reduction: an experimental study. Sleep Med 14(6):510–517. https://doi.org/10.1016/j.sleep.2013.01.012. Epub 2013 Mar 21. PMID: 23523432
Dibner C, Schibler U, Albrecht U (2010) The mammalian circadian timing system: organization and coordination of central and peripheral clocks. Annu Rev Physiol 72:517–549. https://doi.org/10.1146/annurev-physiol-021909-135821. PMID: 20148687
Dubocovich ML (2007) Melatonin receptors: role on sleep and circadian rhythm regulation. Sleep Med 8(Suppl 3):34–42. https://doi.org/10.1016/j.sleep.2007.10.007. PMID: 18032103
El Sayed S, Gomaa S, Shokry D et al (2021) Sleep in post-COVID-19 recovery period and its impact on different domains of quality of life. Egypt J Neurol Psychiatr Neurosurg 57(1):172. https://doi.org/10.1186/s41983-021-00429-7. Epub 2021 Dec 14. PMID: 34924750; PMCID: PMC8669420
Faltraco F, Palm D, Coogan A et al (2021) Remdesivir shifts circadian rhythmicity to eveningness; similar to the most prevalent chronotype in ADHD. J Neural Transm 128(7):1159–1168. https://doi.org/10.1007/s00702-021-02375-3. Epub 2021 Jul 17. PMID: 34273024; PMCID: PMC8285716
Fernández-de-Las-Peñas C, Gómez-Mayordomo V, de la Llave-Rincón AI et al (2021) Anxiety, depression and poor sleep quality as long-term post-COVID sequelae in previously hospitalized patients: a multicenter study. J Infect 83(4):496–522. https://doi.org/10.1016/j.jinf.2021.06.022. Epub 2021 Jun 27. PMID: 34192525; PMCID: PMC8236125
Foster RG (2020) Sleep, circadian rhythms and health. Interface Focus 10(3):20190098. https://doi.org/10.1098/rsfs.2019.0098. Epub 2020 Apr 17. PMID: 32382406; PMCID: PMC7202392
Gabel K, Hoddy KK, Haggerty N et al (2018) Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study. Nutr Healthy Aging 4(4):345–353. https://doi.org/10.3233/NHA-170036. PMID: 29951594; PMCID: PMC6004924
Generoso JS, Barichello De Quevedo JL, Cattani M et al (2021) Neurobiology of COVID-19: how can the virus affect the brain? Br J Psychiatry 43(6):650–664. https://doi.org/10.1590/1516-4446-2020-1488
Giri A, Srinivasan A, Sundar IK (2021) COVID-19: sleep, circadian rhythms and immunity - repurposing drugs and chronotherapeutics for SARS-CoV-2. Front Neurosci 18(15):674204. https://doi.org/10.3389/fnins.2021.674204. PMID: 34220430; PMCID: PMC8249936
Güldür T, Otlu HG (2017) Circadian rhythm in mammals: time to eat & time to sleep. Biol Rhythm Res 48(2):243–261
Gulia KK, Kumar VM (2018) Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 18(3):155–165. https://doi.org/10.1111/psyg.12319. PMID: 29878472
Gupta R, Grover S, Basu A et al (2020) Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry 62(4):370–378. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_523_20. Epub 2020 Jul 27. PMID: 33165382; PMCID: PMC7597722
Haspel JA, Anafi R, Brown MK (2020) Perfect timing: circadian rhythms, sleep, and immunity - an NIH workshop summary. JCI Insight 5:e131487
Heesakkers H, van der Hoeven JG, Corsten S et al (2022) Clinical outcomes among patients with 1-year survival following intensive care unit treatment for COVID-19. JAMA 327(6):559–565. https://doi.org/10.1001/jama.2022.0040
Hida A, Kitamura S, Katayose Y et al (2014) Screening of clock gene polymorphisms demonstrates association of a PER3 polymorphism with morningness-eveningness preference and circadian rhythm sleep disorder. Sci Rep 9(4):6309. https://doi.org/10.1038/srep06309. PMID: 25201053; PMCID: PMC4158573
Hsu PY, Harmer SL (2014) Global profiling of the circadian transcriptome using microarrays. Methods Mol Biol 1158:45–56
Huang C, Huang L, Wang Y et al (2021) 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 397(10270):220–232. https://doi.org/10.1016/S0140-6736(20)32656-8. Epub 2021 Jan 8. PMID: 33428867; PMCID: PMC7833295
Jahrami H, BaHammam AS, Bragazzi NL et al (2021) Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med 17(2):299–313
Jahrami HA, Alhaj OA, Humood AM et al (2022) Sleep disturbances during the COVID-19 pandemic: a systematic review, meta-analysis, and meta-regression. Sleep Med Rev 62:101591. https://doi.org/10.1016/j.smrv.2022.101591. Epub 2022 Jan 22. PMID: 35131664; PMCID: PMC8782754
Johnson DA (2020) Sleep disparities in the era of the COVID-19 pandemic highlight the urgent need to address social determinants of health like the virus of racism. J Clin Sleep Med 16(8):1401–1402. https://doi.org/10.5664/jcsm.8570. PMID: 32400388; PMCID: PMC7446086
Kline CE (2014) The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am J Lifestyle Med 8(6):375–379. https://doi.org/10.1177/1559827614544437. PMID: 25729341; PMCID: PMC4341978
Kriegsfeld LJ, Silver R (2006) The regulation of neuroendocrine function: timing is everything. Horm Behav 49:557–574
Labrecque N, Cermakian N (2015) Circadian clocks in the immune system. J Biol Rhythm 30:277–290
Lee EK (2020) Advanced sleep-wake rhythm disorder. In: Auger R (ed) Circadian rhythm sleep-wake disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-43803-6_8
Loef B, Dollé MET, Proper KI et al (2022) Night-shift work is associated with increased susceptibility to SARS-CoV-2 infection. Chronobiol Int 39(8):1100–1109. https://doi.org/10.1080/07420528.2022.2069031. Epub 2022 May 2. PMID: 35502475
Logue JK, Franko NM, McCulloch DJ et al (2021) Sequelae in adults at 6 months after COVID-19 infection. JAMA Netw Open 4(2):e210830. https://doi.org/10.1001/jamanetworkopen.2021.0830. PMID: 33606031; PMCID: PMC7896197
Longo VD, Panda S (2016) Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metab 23(6):1048–1059. https://doi.org/10.1016/j.cmet.2016.06.001. PMID: 27304506; PMCID: PMC5388543
Lowenstein CJ, Solomon SD (2020) Severe COVID-19 is a microvascular disease. Circulation 142(17):1609–1611
Mahmud R, Rahman MM, Rassel MA et al (2021) Post-COVID-19 syndrome among symptomatic COVID-19 patients: a prospective cohort study in a tertiary care center of Bangladesh. PLoS One 16(4):e0249644. https://doi.org/10.1371/journal.pone.0249644. PMID: 33831043; PMCID: PMC8031743
Mallampalli MP, Carter CL (2014) Exploring sex and gender differences in sleep health: a Society for Women’s Health Research Report. J Womens Health (Larchmt) 23(7):553–562. https://doi.org/10.1089/jwh.2014.4816. Epub 2014 Jun 23. PMID: 24956068; PMCID: PMC4089020
Mandelkorn U, Genzer S, Choshen-Hillel S et al (2021) Escalation of sleep disturbances amid the COVID-19 pandemic: a cross-sectional international study. J Clin Sleep Med 17(1):45–53
McKenna H, van der Horst GTJ, Reiss I et al (2018) Clinical chronobiology: a timely consideration in critical care medicine. Crit Care 22:124. https://doi.org/10.1186/s13054-018-2041-x
Mekhael M, Lim CH, El Hajjar AH (2022) Studying the effect of long COVID-19 infection on sleep quality using wearable health devices: observational study. J Med Internet Res 24(7):e38000. https://doi.org/10.2196/38000. PMID: 35731968
Melhuish Beaupre L, Brown GM, Kennedy JL (2018) Circadian genes in major depressive disorder. World J Biol Psychiatry 26:1e11
Mohawk JA, Green CB, Takahashi JS (2012) Central and peripheral circadian clocks in mammals. Annu Rev Neurosci 35:445–462
Moro T, Tinsley G, Bianco A et al (2016) Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med 14(1):290. https://doi.org/10.1186/s12967-016-1044-0. PMID: 27737674; PMCID: PMC5064803
Mussa BM, Srivastava A, Verberne AJM (2021) COVID-19 and neurological impairment: hypothalamic circuits and beyond. Viruses 13(3):498. https://doi.org/10.3390/v13030498. PMID: 33802995; PMCID: PMC8002703
Ong JL, Lau T, Karsikas M et al (2021) A longitudinal analysis of COVID-19 lockdown stringency on sleep and resting heart rate measures across 20 countries. Sci Rep 11(1):14413. https://doi.org/10.1038/s41598-021-93924-z. PMID: 34257380; PMCID: PMC8277902
Partinen M, Holzinger B, Morin CM et al (2021) Sleep and daytime problems during the COVID-19 pandemic and effects of coronavirus infection, confinement and financial suffering: a multinational survey using a harmonised questionnaire. BMJ Open 11(12):e050672. https://doi.org/10.1136/bmjopen-2021-050672. PMID: 34903540; PMCID: PMC8671846
Patel NP, Grandner MA, Xie D et al (2010) “Sleep disparity” in the population: poor sleep quality is strongly associated with poverty and ethnicity. BMC Public Health 10:475. https://doi.org/10.1186/1471-2458-10-475
Peirson SN, Halford S, Foster RG (2009) The evolution of irradiance detection: melanopsin and the non-visual opsins. Philos Trans R Soc Lond B Biol Sci. 364(1531):2849–2865. https://doi.org/10.1098/rstb.2009.0050. PMID: 19720649; PMCID: PMC2781857
Poza JJ, Pujol M, Ortega-Albás JJ, Romero O (2018) Melatonin in sleep disorders. Neurologia (Engl Ed). https://doi.org/10.1016/j.nrl.2018.08.002. Epub ahead of print. PMID: 30466801
Premraj L, Kannapadi NV, Briggs J et al (2022) Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis. J Neurol Sci 434:120162. https://doi.org/10.1016/j.jns.2022.120162. Epub 2022 Jan 29. PMID: 35121209; PMCID: PMC8798975
Priday LJ, Byrne C, Totsika V (2016) Behavioural interventions for sleep problems in people with an intellectual disability: a systematic review and meta-analysis of single case and group studies. J Intellect Disabil Res 61(1):1–15. https://doi.org/10.1111/jir.12265. Epub 2016 Mar 7. PMID: 26952339
Qin C, Zhou L, Hu Z et al (2020) Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa248. PMID: 32161940
Radnis C, Qiu S, Jhaveri M et al (2020) Radiographic and clinical neurologic manifestations of COVID-19 related hypoxemia. J Neurol Sci 418:117119
Roenneberg T, Foster RG (1997) Twilight times: light and the circadian system. Photochem Photobiol 66:549–561. https://doi.org/10.1111/j.1751-1097.1997.tb03188.x
Roenneberg T, Keller LK, Fischer D et al (2015) Human activity and rest in situ. Methods Enzymol 552:257–283. https://doi.org/10.1016/bs.mie.2014.11.028. Epub 2015 Jan 5. PMID: 25707281
Romano F, Muscogiuri G, Di Benedetto E et al (2020) Vitamin D and sleep regulation: is there a role for vitamin D? Curr Pharm Des 26(21):2492–2496. https://doi.org/10.2174/1381612826666200310145935. PMID: 32156230
Rosbash M (2009) The implications of multiple circadian clock origins. PLoS Biol 7:e62. https://doi.org/10.1371/journal.pbio.1000062
Sidiropoulou P, Docea AO, Nikolaou V et al (2021) Unraveling the roles of vitamin D status and melanin during Covid-19 (Review). Int J Mol Med 47(1):92–100. https://doi.org/10.3892/ijmm.2020.4802. Epub 2020 Nov 30. PMID: 33416113; PMCID: PMC7723676
Solomon IH, Normandin E, Bhattacharyya S et al (2020) Neuropathological features of Covid-19. N Engl J Med 383(10):989–992
Tan E, Healey D, Gray AR et al (2012) Sleep hygiene intervention for youth aged 10 to 18 years with problematic sleep: a before-after pilot study. BMC Pediatr 12:189. https://doi.org/10.1186/1471-2431-12-189
Tao S, Wu X, Li S et al (2021) Circadian rhythm abnormalities during the COVID-19 outbreak related to mental health in China: a nationwide university-based survey. Sleep Med 84:165–172. https://doi.org/10.1016/j.sleep.2021.05.028
Tate W, Walker M, Sweetman E et al (2022) Molecular mechanisms of neuroinflammation in ME/CFS and long COVID to sustain disease and promote relapses. Front Neurol 25(13):877772. https://doi.org/10.3389/fneur.2022.877772. PMID: 35693009; PMCID: PMC9174654
Tenforde MW, Kim SS, Lindsell CJ (2020) Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network: United States, March–June 2020. MMWR Morb Mortal Wkly Rep 69(30):993–998. https://doi.org/10.15585/mmwr.mm6930e1. PMID: 32730238
Tordjman S, Chokron S, Delorme R et al (2017) Melatonin: pharmacology, functions and therapeutic benefits. Curr Neuropharmacol 15(3):434–443. https://doi.org/10.2174/1570159X14666161228122115. PMID: 28503116; PMCID: PMC5405617
Townsend L, Dyer AH, Jones K et al (2020) Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 15(11):e0240784. https://doi.org/10.1371/journal.pone.0240784
Tsang S, Avery AR, Seto EYW et al (2021) Is COVID-19 keeping us up at night? Stress, anxiety, and sleep among adult twins. Front Neurosci 26(15):665777. https://doi.org/10.3389/fnins.2021.665777. PMID: 33981199; PMCID: PMC8107288
WHO (2020) Support for rehabilitation self-management after COVID-19-related illness. https://apps.who.int/iris/bitstream/handle/10665/333287/WHO-EURO-2020-855-40590-54571-eng.pdf. Accessed 1 Sept 2022
Wichniak A, Kania A, Siemiński M, Cubała WJ (2021) Melatonin as a potential adjuvant treatment for COVID-19 beyond sleep disorders. Int J Mol Sci 22(16):8623. https://doi.org/10.3390/ijms22168623
Yamanaka Y, Hashimoto S, Takasu NN et al (2015) Morning and evening physical exercise differentially regulate the autonomic nervous system during nocturnal sleep in humans. Am J Phys Regul Integr Comp Phys 309:R1112–R1121. https://doi.org/10.1152/ajpregu.00127.2015
Yoshitane H, Asano Y, Sagami A et al (2019) Functional D-box sequences reset the circadian clock and drive mRNA rhythms. Commun Biol 2:300. https://doi.org/10.1038/s42003-019-0522-3
Zhou Y, Fu B, Zheng X et al (2020) Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients. Natl Sci Rev 7(6):998–1002
Zhuang X, Rambhatla SB, Lai AG et al (2017) Interplay between circadian clock and viral infection. J Mol Med 95:1283–1289
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Mahmud, R. (2023). Sleep and Circadian Rhythm in Post-COVID-19 Patients. In: BaHammam, A., Pandi-Perumal, S.R., Jahrami, H. (eds) COVID-19 and Sleep: A Global Outlook. Progress in Sleep Research. Springer, Singapore. https://doi.org/10.1007/978-981-99-0240-8_12
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