Post-COVID-19 Sleep Quality and Its Determinants in Geriatric Patients: A Cross-Sectional Analysis

Year 2025, Volume: 6 Issue: 3, 66 - 76, 30.09.2025

Ömer Faruk Tulun , Muharrem Bayrak , Adil Furkan Kılıç , Mehmet Mutlu Akıncı , Kenan Çadırcı , Doğan Nasır Binici

https://doi.org/10.56766/ntms.1697788

Abstract

This study explores sleep quality in older adults who previously tested positive for COVID-19, examining key factors that may affect it. As the pandemic has posed unique health challenges, understanding these sleep disturbances is particularly relevant for elderly individuals.A total of 121 participants aged 65 and above with a history of COVID-19 were included. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), along with an analysis of demographic, clinical, and biochemical data.
The average age of participants was 72.2 years, with poor sleep quality observed more frequently in women (72.1%, p = 0.004). A lower level of education was linked to worse sleep quality (p = 0.029). Anxiety disorder (OR = 6.380, p = 0.006) and restless legs syndrome (OR = 4.605, p = 0.002) were among the main factors impacting sleep. Additionally, low haemoglobin levels and the use of sleep medications were associated with poor sleep quality (p = 0.011).Findings suggest that anxiety, restless legs syndrome, low haemoglobin, and hypnotic drug use contribute to poor sleep quality in older adults. Addressing these factors could support better sleep and overall well-being in this population.

Keywords

COVID-19 , Geriatric patients , Sleep quality

References

• 1. Dohale V, Akarte M, Gunasekaran A,Verma P. Exploring the role of artificial intelligence in building production resilience: Learnings from the COVID-19 pandemic. Int J Prod Res. 2024;62(15):5472-5488.
• 2. Prasanth MI, Wannigama DL, Reiersen AM, et al. A systematic review and meta-analysis investigating dose and time of fluvoxamine treatment efficacy for COVID-19 clinical deterioration, death, and Long-COVID complications. Sci Rep. 2024;14(1):13462.
• 3. Chao T-C, Chiang S-L, Lai C-Y, et al. Association between physical activity amount and cardiorespiratory fitness, sleep quality, and health-related quality of life in patients with long COVID: A cross-sectional study. Arch Phys Med Rehabil. 2024 Sep; 105(9):1673-81
• 4. Maripuri MA, Honerlaw J, Hong C, et al. Characterisation of post–COVID-19 definitions and clinical coding practices: Longitudinal study. Online J Public Health Inform. 2024;16:e53445.
• 5. Bohmwald K, Diethelm-Varela B, Rodríguez-Guilarte L, et al. Pathophysiological, immunological, and inflammatory features of long COVID. Front Immunol. 2024;15:1341600.
• 6. Giri A, Srinivasan A, Sundar IK. COVID-19: Sleep, circadian rhythms, and immunity–Repurposing drugs and chronotherapeutics for SARS-CoV-2. Front Neurosci. 2021;15:674204.
• 7. Mudaysh H, Mardha S,Ahmad F, et al. The Impact of Sleep Deprivation on the Immune System in Shift-Working Nurses during Outbreak. Egypt J Chem. 2024; 67(13),677-684.
• 8. Zhong L, Zhang J, Yang J, et al. Chronic sleep fragmentation reduces left ventricular contractile function and alters gene expression related to innate immune response and circadian rhythm in the mouse heart. Gene. 2024;914:148420.
• 9. Wang X, Wang R, Zhang D. Bidirectional associations between sleep quality/duration and multimorbidity in middle-aged and older people: A longitudinal study. BMC Public Health. 2024;24(1):708.
• 10. Newman-Norlund RD, Newman-Norlund SE, et al. Effects of social isolation on quality of life in elderly. PLoSOne. 2022;17(11).
• 11. Tosato M, Ciciarello F, Zazzara MB, et al. Nutraceuticals and dietary supplements for older adults with long COVID-19. Clin Geriatr Med. 2022;38(3):565-591.
• 12. Li J, Zhang YY, Cong XY, et al. 5-min mindfulness audio induction alleviates psychological distress and sleep disorders in patients with COVID-19. World J Clin Cases. 2022;10(2):576.
• 13. Marelli S, Castelnuovo A, Somma A, et al. Impact of COVID-19 lockdown on sleep quality in university students and administration staff. J Neurol. 2021;268:8-15.
• 14. Del Brutto OH, Mera RM, Rumbea DA, et al. Poor sleep quality increases mortality risk: A population-based longitudinal prospective study in community-dwelling middle-aged and older adults. Sleep Health. 2024;10(1):144-48.
• 15. Gui Z, Wang YY, Li JX, et al. Prevalence of poor sleep quality in COVID-19 patients: A systematic review and meta-analysis. Front Psychiatry. 2024;14:1272812.
• 16. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
• 17. Seeman K, Yesavage JA, Werner PD, Taylor JL, Jacob RF. Drift and dangerousness: Social class differences between acute schizophrenics and their parents in relation to measures of violence. Br J Psychiatry. 1982;141(3):267-70.
• 18. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561-71.
• 19. Perger E, Silvestri R, Bonanni E, et al. Gender medicine and sleep disorders: From basic science to clinical research. Front Neurol. 2024;15:1392489.
• 20. Sun W, Xia L, Ji C, et al. Relationship between COVID-pandemic anxiety and sleep disorder with menstrual disorders among female medical workers. BMC Womens Health. 2023;23(1):210.
• 21. Oh CM, Kim HY, Na HK, et al. The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: A population-based study. Front Neurol. 2019;10:849.
• 22. Okun ML, Mancuso RA, Hobel CJ, Schetter CD, Coussons-Read M. Poor sleep quality increases symptoms of depression and anxiety in postpartum women. J Behav Med. 2018;41:703-10.
• 23. Seighali N, Abdollahi A, Shafiee A, et al. The global prevalence of depression, anxiety, and sleep disorder among patients coping with post-COVID-19 syndrome (long COVID): A systematic review and meta-analysis. BMC Psychiatry. 2024;24(1):105.
• 24. Hughes JM, Cooper VL, La Marca R, et al. Expanding access to CBT-I for older adults: Review and expansion of recent recommendations. Curr Sleep Med Rep. 2024;10(1):93-101.
• 25. Loer AKM, Domanska OM, Stock C, Voelcker-Rehage C, Holle R. Exploring pandemic-related health literacy among adolescents in Germany: A focus group study. Arch Public Health. 2022;80(1):182.
• 26. Peixoto VGM, Facci LA, Barbalho TC, et al. The context of COVID-19 affected the long-term sleep quality of older adults more than SARS-CoV-2infection.Front Psychiatry. 2024;15:1305945.
• 27. Seaver C, Bowers C, Beidel D, Capron L, Karami M. A game-based learning approach to sleep hygiene education: A pilot investigation. Front Digit Health. 2024;6:1334840.
• 28. Tao Y, Hou W, Niu H, et al. Centrality and bridge symptoms of anxiety, depression, and sleep disturbance among college students during the COVID-19 pandemic—a network analysis. Curr Psychol. 2024;43(15):13897-13908. He J, Yang L, Pang J, et al. Efficacy of simplified-cognitive behavioral therapy for insomnia (S-CBTI) among female COVID-19 patients with insomnia symptom in Wuhan mobile cabin hospital. Sleep Breath. 2021;25:2213-19.
• 29. Bayrak M, Çadirci K. Quality of sleep in elderly patients with diabetes mellitus from Turkey: A cross-sectional observational study. Exp Aging Res. 2022;48(4):373-86.
• 30. Abbasi NZ, Baig K, Hassan M, et al. Assessment of sleep quality in severe COVID-19 hospitalised patients. J Pak Med Assoc. 2024;74(3):445.
• 31. Chen J, Liu Z, Yang L, et al. Sleep-related disorders and lower urinary tract symptoms in middle-aged and elderly males: A cross-sectional study based on NHANES 2005–2008. Sleep Breath. 2024;28(1):359-70.
• 32. Partinen E, Inoue Y, Sieminski M, et al. Restless legs symptoms increased during COVID-19 pandemic: International ICOSS-survey. Sleep Med. 2024;119:389-98.
• 33. Hanson AL, Mulè MP, Ruffieux H, et al. Iron dysregulation and inflammatory stress erythropoiesis associates with long-term outcome of COVID-19. Nat Immunol. 2024;25(3):471-82.
• 34. Kakaei S, Hassan NE, Nakhaee S, Bahrami M. Associations between essential trace elements and sleep quality in Iranian adults based on the Pittsburgh Sleep Quality Index. Sci Rep. 2025;15:4654.
• 35. Amato L, Ruggiero E, Paolucci S, Maestri M, Masedu F, De Caterina R, et al. Sleep quality and hypnotic use in older adults: A systematic review. Clocks Sleep. 2024;6(3):488-98.
• 36. McPhillips MV, Petrovsky DV, Lorenz R, et al. Treatment modalities for insomnia in adults aged 55 and older: A systematic review of literature from 2018 to 2023. Curr Sleep Med Rep. 2024;1-25.
• 37. Pérez-Carbonell L, Iranzo A. Sleep-related changes prior to cognitive dysfunction. Curr Neurol Neurosci Rep. 2023; 23(4):177-83