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Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing

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Viehmann-Wical K. Evaluating sleep quality with coronavirus disease 2019 (COVID-19) testing. J Clin Sleep Med. 2021;17(2):355.


What a great time to be in sleep medicine! This is the perfect time for sleep specialists to speak up about the immune-boosting, virus-fighting health benefits of sleep.

Rapid eye movement (REM) sleep is the key sleep cycle for fighting viruses.13 The 2–5% of patients positive for coronavirus disease 2019 (COVID-19) admitted into the hospital and intensive care units are most likely patients with REM sleep problems. Asking patients getting tested for COVID-19 if they have untreated snoring (even better using a Pittsburgh Sleep Quality Index form) would quickly identify the high-risk population for sleep problems and worse COVID-19 prognosis.

Promoting sleep health and educating individuals how to protect REM sleep would decrease deaths, restore economic stability, and decrease severity for the 2–5% of individuals admitted for COVID-19 treatment. Unfortunately, sleep health knowledge and understanding are low among health care providers and even lower within the general public.4

The 3 main underknown health challenges that fragment, block, or decrease REM sleep are as follows: undiagnosed and untreated nightly snoring/sleep apnea,5 drinking alcohol within 6 hours of bedtime,6 or having caffeinated products in the last 6 to 8 hours before bed.7 Sleep specialists are key to diagnosing and treating chronic snoring and sleep apnea, plus educating patients about major risk factors that decrease high-quality REM sleep.

The key area where sleep specialists can decrease virus severity is with patients with undiagnosed/untreated sleep apnea. Sleep apnea fragments and blocks REM sleep,5 decreasing immunity.1,3 Apnea is also associated with gut dysbiosis, leading to weight gain and hormone imbalance.8 A body mass index, especially over 40 kg/m2 in males, is associated with higher risk of COVID-19 symptoms and death.9 Diagnosing and treating the nearly one-quarter of females and one-half of males10 with undiagnosed moderate–severe chronic snoring/apnea would protect health and ability to fight off viruses.1,3


The author has seen and approved this manuscript. The author reports no conflicts of interest.