COVID-19 Pandemic and Its Impact on Sleep Health: A Rapid Review (2025)

Abstract

This rapid review aims to elucidate the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease—both in the acute phase and the “long-hauler” syndrome—on sleep health. Literature regarding the direct physiologic impact of COVID disease on sleep is sparse but has illuminated a toxic synergy between the immune response to COVID disease and the pro-inflammatory state brought on by obstructive sleep apnea (OSA). Primary care physicians and sleep medicine specialists should aggressively screen for OSA in COVID patients.

Introduction

COVID is the acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which emerged dramatically two years ago in Wuhan, China, sparking a worldwide pandemic and causing morbidity, death, and societal upheaval virtually unmatched by any other disease of the last 100 years. As of December 29, 2021, the WHO reported 281,808,270 confirmed global cases of COVID, including 5,411,759 deaths. The United States’ share of this grisly toll was 52,543,602 confirmed cases and 812,577 deaths by the same date.1 COVID was the third leading cause of death in the U.S. in 2020 behind only heart disease and cancer and the total number of deaths in the U.S. increased in 2019 by 17.7%— mainly attributable to the impact of COVID.2 Those with pre-existing medical conditions, especially pulmonary, are most vulnerable to COVID, and strong links between mental and neurologic disorders and COVID morbidity have been established.3 The societal response to the pandemic including lockdowns, remote work arrangements, school closures, and hospital overload—to name only a few—has caused widespread unrest, stress, and heated controversy. In this environment, sleep problems such as insomnia have risen in incidence and given rise to new terminology such as “coronasomnia.”4 The purpose of this rapid review is to explore the impact of the pandemic on sleep health with the aim of informing future sleep health strategies and minimizing negative impacts of the pandemic.

Methods

This rapid review is based on a literature search of articles published in English between December 2019 and October 2021. Pubmed and Google Scholar were the primary engines used in the search. Keywords including “COVID,” “SARS-CoV-2,” “sleep,” “sleep problem,” and “insomnia,” and their derivatives were used. The search included retrospective studies, cross-sectional studies, observational studies, letters to editors, editorials, and surveys. The articles were screened by two independent reviewers for relevance and eligibility for inclusion.

Results

A total of 78 articles were reviewed with 65 ultimately included. These can be roughly divided into three groups: those focused on the burden to the healthcare system and healthcare workers (HCWs) in general, those dealing with the stressors on the general population, and those dealing with the pathological effects of COVID disease itself.

Discussion

General Pathophysiology and Effects of COVID

It was clear early on that COVID is a cause of potentially fatal pulmonary disease due to the disturbingly high number of patients developing acute respiratory distress syndrome (ARDS) requiring mechanical ventilation and ultimately proceeding to multi-organ failure and death. It is now known that survivors continue to demonstrate impaired gas exchange for months after the infection.5 It has also become clear that a more sinister phenotype of COVID associated with excessive systemic inflammation has emerged; in children it is now termed Multisystem Inflammatory Syndrome (MIS-C). In adults no name has been coined, but the clinical state is known to have features similar to hemophagocytic lymphohistiocytosis (HLH) and the antiphospholipid syndrome (APS), with virtually every organ system implicated in receiving some type of damage.6^,7 SARS-CoV-2 gains entry to the body via Angiotensin Converting Enzyme 2 (ACE2), an important counterregulatory enzyme which attenuates the volume-bolstering effects of the renin-angiotensin-aldosterone system (RAAS). Use of ACE2 effectively downregulates its attenuating effect on the RAAS, resulting in the hypertension and end-organ injury sometimes seen in COVID patients. Further, a long-term syndrome known as “long COVID,” or the “post-acute COVID syndrome,” or the “post- COVID condition” has increasingly gained attention in a subset of patients now termed “long-haulers.” Studies conducted worldwide have revealed this entity can afflict those with a mild disease course as well as those who required hospitalization. “Long-haulers’” symptoms vary greatly with reports of atypical chest pain, neurocognitive difficulties, fatigue, anxiety, and depression leading the way. These appear to linger for months after infection.8^,9 It remains unclear if the SARS-CoV-2 infection causes these symptoms via primary organ involvement, aberrant immunological response, or exacerbation of already-known symptoms. What has become increasingly clear, however, is that “long-haulers” tend to be females of working age with lower serum IgG titers for SARS-CoV-2 and anosmia at disease onset. Initial reports suggest “long-haulers” suffer with substantial detrimental impacts on work and daily life, including sleep health.9^–11

Psychologic Impact of COVID on HCWs and Society

Studies conducted across Asia, Europe, the Pacific rim, and the Americas through early and mid-2020 revealed high levels of psychological stress across all strata of society, but primarily concentrated in the health care community. This is understandable as HCWs are literally on the frontline of the pandemic, deeply involved in the diagnosis, treatment, and care of COVID patients. In COVID ‘hotspots,’ e.g. Wuhan, New York, and Italy, the huge workload, lack of personal protection equipment (PPE), and lack of ventilators and medicines were understandably contributory. Studies also showed that HCWs’ fear of being infected and passing on the disease to family and friends gave rise to considerable reluctance to work, thoughts of resignation, and high levels of anxiety and depression. The long-term psychological consequences for health care workers are an open question at present and will require substantial study moving forward.12 In the population at large, the effects of lockdown including unemployment, social distancing, and isolation have been noted to yield detrimental effects on physical activity, mental well-being, and sleep. The psychological impact of quarantine has been found to be wide-ranging, substantial, and long-lasting. 13

“Coronasomnia” or “COVID-somnia” Resulting from COVID

Considerable research has already been conducted which shows that the COVID pandemic has resulted in significant impact on sleep health, especially in terms of sleep deprivation. In the current pandemic, the phrase “coronasomnia” or “COVID-somnia” has been coined to describe this phenomenon.4^,14 It is well known that restorative sleep is essential for proper mental and physical health while lack of sleep is highly associated with impaired psychologic functioning and decision-making. Direct evidence for the spike in insomnia incidence has been gathered over the last year by researchers worldwide, mainly via surveys conducted at large and in smaller communities, e.g. college and university campuses. Unsurprisingly concurrent stress, depression, and uncertainty regarding the COVID—both the effects of the pandemic and fear of direct infection—were frequently cited by respondents as causes of their insomnia.15

Impact of “Coronasomnia” on Immunity

A lesser-appreciated but particularly salient point in the context of the current pandemic is the fact that sleep also plays a vital role in the maintenance of immunity, especially since disruptions in sleep quality are known to be associated with decreased immune response to vaccines and increased vulnerability to infectious disease.20 Indeed, studies have revealed both higher rates of opportunistic and community-spread infection as well as increased carcinogenesis in those with disrupted circadian rhythm and sleep deprivation.21 Mechanistically speaking, disruption of critical messaging by the suprachiasmatic nucleus is known to negatively impact circadian rhythms, thereby leading to worsened immune function. This is true of the population at large but is an especially sobering fact considering that HCWs and other essential workers may be at higher risk of disease because their sleep may be compromised.22^,23

In the current environment, therefore, ensuring adequate sleep and proper treatment of sleep-limiting conditions such as obstructive sleep apnea (OSA), stress, and anxiety takes on additional significance. This is particularly challenging in the current environment since the uncertainties brought on by the COVID pandemic—particularly the fear of severe disease or death—have entered into toxic combination with the politicization of public health measures—heated and sometimes violent debate over mask use in public facilities and schools—school closures, and curtailment of sports and recreational activities. It is perhaps an understatement to say this has led to widespread and high levels of anxiety, stress, and anger. Poor sleep health in this environment seems an inevitability, yielding a greater responsibility for physicians- particularly primary care providers (PCPs) and sleep specialists—to emphasize the need for restorative sleep to their patients while ensuring their sleep-related issues are properly evaluated and treated.24

Direct Impact of COVID on Sleep Health and the Unfortunate Synergy with OSA

Evidence is very limited concerning the direct physical and psychosocial toll on sleep health imposed by contracting COVID. A small study in Australia reported actigraphy-assessed sleep parameters of four subacute COVID patients as they began the rehabilitative stage of recovery, finding impaired sleep quality in three patients (defined by Pittsburg Sleep Quality Index > 5).25 Obstructive sleep apnea is thought to cause hypertension by RAAS dysregulation as well, an example of potentially destructive synergy we will touch on in more depth further in this article.26 And finally, what about the impact of COVID on OSA, already well-known to disrupt restorative sleep? Recall that OSA is known to induce a pro-inflammatory state and is directly linked to higher rates of hypertension, diabetes mellitus, cardiovascular, and cerebrovascular diseases.27 Since COVID infection is known to induce a highly inflammatory state it can be hypothesized that an infected patient with pre-existing OSA has a higher risk of worsening the inflammatory response.28 Further, since COVID is now a known risk factor for pulmonary fibrosis—itself a risk factor for future development of OSA—the emerging relationship between these two entities is becoming known as both bi-directional and (unfortunately) synergistic.29 PCPs evaluating and managing patients recovering from COVID should aggressively monitor and screen for subsequent OSA development with a low threshold for polysomnography and referral to sleep medicine specialists. PCPs and hospitalists can consider melatonin as a relatively benign but efficacious adjuvant treatment of COVID based on recent studies citing its anti-inflammatory and anti-oxidative properties as well as its anti-anxiety and mild sedative effects which can improving sleep quality in critical care patients.30 Regarding outcomes in those with OSA who develop COVID, it is difficult to disentangle the two entities—risk factors for OSA are known as predictors of poor COVID outcomes. It has not been possible (yet) to establish OSA as an independent risk factor for poor outcomes in COVID. A recent study of factors such as age, OSA under treatment, and microvascular or macrovascular complications concluded these are independently associated with risk of death at day seven of COVID disease, but more studies will be necessary to fully investigate the impact of OSA on COVID outcomes more thoroughly.31^,32 In the meantime the American Academy for Sleep Medicine (AASM) recommends OSA patients who develop COVID continue using Positive Airway Pressure (PAP) therapies at home with the caveat that individuals should isolate in a separate bedroom due to aerosolization concerns.33 And finally, the aforementioned International COVID Sleep Study (ICOSS)—a multinational survey-based effort with the aim of gathering more systematic information on the effects of the COVID pandemic on sleep-wake rhythms—will hopefully provide more answers. Among its aims are to examine the relationship of sleep problems with demographic, environmental, and health-related factors, and further delineate how OSA, insomnia, nightmares, fatigue, exhaustion, and REM Sleep Behavior Disorder may be caused directly by COVID or to what degree it is associated with irksome confinement, anxiety, and other psychosocial factors brought on by the pandemic.34^,35

Conclusion

Based on the findings of our review the evidence already amassed for COVID producing negative impacts on sleep health due to the disease itself and its associated stressors brought on by the pandemic in general is significant. At the time of this writing in December 2021, the pandemic is nearing its second birthday. Many specific COVID and sleep-related questions (e.g. impact of already-diagnosed OSA on COVID outcomes) remain only partially answered at present and will require more studies. Moving forward, it is incumbent upon clinicians to ensure patients with sleep health-related problems in the context of COVID receive up-to-date education, optimal treatment, and support. Since poor sleep is a stand-alone risk factor for suicidal ideation, suicide attempts, and suicide death, the health community must take steps to ensure patients are screened and treated for these problems appropriately.36 Prioritizing good sleep and diet for patients, especially healthcare workers and children is more vital than ever in the current climate. Physicians should caution parents to limit screen time for themselves and their children during times of social distancing and work or school from home scenarios as this plays a crucial role in sleep hygiene and quality. Clinicians should be aggressive advocates for healthy sleep hygiene practices while providing high-quality education/information about various sleep-related resources (handouts, online platforms, etc.) as an avenue to promote physical, emotional, and mental health. Nonpharmacological approaches like Cognitive Behavioral Therapy for Insomnia (CBT-I) and progressive muscle relaxation (PMR) have been shown to improve sleep in the context of COVID disease/pandemic and should be considered in the appropriate clinical context.37^,38 Regarding governmental support, long COVID is now recognized as a physical and/or mental impairment by the US Department of Health and Human Services (HHS), enabling long COVID patients to qualify for disability under federal civil rights laws and receive accommodations and services.39 Hospital administrators should prioritize the sleep health of their healthcare workers because it directly influences fatigue, burnout rates, and immune status. Ensuring adequate time off for sleep by promoting flexibility in work hours as well as promoting feelings of self-value and purpose have been shown to mitigate pandemic-related burnout.12^,40

Our present understanding and knowledge about the acute and long-term effects of COVID will evolve as extensive ongoing research is currently underway, which is the primary limiting factor of this article. Further prospective studies will be essential to elucidate the long-term effects of COVID disease on sleep health. For example, tracing the effect of COVID disease on new incidence or worsening of OSA and progression to chronic insomnia by those experiencing the “coronasomnia” phenomenon. Other avenues of research include prospective studies to uncover the relationship of COVID with other sleep-related problems such as hypoventilation and parasomnias such as nightmare disorder or posttraumatic stress disorder (PTSD).

Footnotes

COVID-19 Pandemic and Its Impact on Sleep Health: A Rapid Review (1)

Tracy L. Bezner, MD, (above), Department of Neurology, and Manjamalai Sivaraman, MD, Associate Professor of Neurology are at the University of Missouri - Columbia School of Medicine, Columbia, Missouri.

Disclosure

None reported.

References

1.WHO. WHO CORONAVIRUS (COVID-19) DASHBOARD. [Accessed 5 November, 2021]. https://covid19.who.int.
2.Ahmad FB, Anderson RN. The Leading Causes of Death in the US for 2020. JAMA. 2021 May 11;325(18):1829–1830. doi: 10.1001/jama.2021.5469. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Liu L, Ni SY, Yan W, et al. Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine. 2021 Oct;40:101111. doi: 10.1016/j.eclinm.2021.101111. [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Semyachkina-Glushkovskaya O, Mamedova A, Vinnik V, et al. Brain Mechanisms of COVID-19-Sleep Disorders. Int J Mol Sci. 2021 Jun 28;22(13) doi: 10.3390/ijms22136917. [DOI] [PMC free article] [PubMed] [Google Scholar]
5.Bellan M, Soddu D, Balbo PE, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open. 2021 Jan 4;4(1):e2036142. doi: 10.1001/jamanetworkopen.2020.36142. [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Ramos-Casals M, Brito-Zeron P, Mariette X. Systemic and organ-specific immune-related manifestations of COVID-19. Nat Rev Rheumatol. 2021 Jun;17(6):315–332. doi: 10.1038/s41584-021-00608-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Gasmi A, Peana M, Pivina L, et al. Interrelations between COVID-19 and other disorders. Clin Immunol. 2021 Mar;224:108651. doi: 10.1016/j.clim.2020.108651. [DOI] [PMC free article] [PubMed] [Google Scholar]
8.Adeloye D, Elneima O, Daines L, et al. The long-term sequelae of COVID-19: an international consensus on research priorities for patients with pre-existing and new-onset airways disease. The Lancet Respiratory Medicine. 2021 doi: 10.1016/s2213-2600(21)00286-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Augustin M, Schommers P, Stecher M, et al. Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021 Jul;6:100122. doi: 10.1016/j.lanepe.2021.100122. [DOI] [PMC free article] [PubMed] [Google Scholar]
10.Huang Y, Pinto MD, Borelli JL, et al. COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler: Looking for Clarity in the Haze of the Pandemic. medRxiv. 2021 Mar 5; doi: 10.1101/2021.03.03.21252086. [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 2021 Aug;38:101019. doi: 10.1016/j.eclinm.2021.101019. [DOI] [PMC free article] [PubMed] [Google Scholar]
12.Prasad K, McLoughlin C, Stillman M, et al. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinicalMedicine. 2021 May;35:100879. doi: 10.1016/j.eclinm.2021.100879. [DOI] [PMC free article] [PubMed] [Google Scholar]
13.Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020;395(10227):912–920. doi: 10.1016/s0140-6736(20)30460-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
14.Gupta R, Pandi-Perumal SR. COVID-Somnia: How the Pandemic Affects Sleep/Wake Regulation and How to Deal with it? Sleep Vigil. 2020 Dec 3;:1–3. doi: 10.1007/s41782-020-00118-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Kokou-Kpolou CK, Megalakaki O, Laimou D, Kousouri M. Insomnia during COVID-19 pandemic and lockdown: Prevalence, severity, and associated risk factors in French population. Psychiatry Res. 2020 Aug;290:113128. doi: 10.1016/j.psychres.2020.113128. [DOI] [PMC free article] [PubMed] [Google Scholar]
16.Kocevska D, Blanken TF, Van Someren EJW, Rosler L. Sleep quality during the COVID-19 pandemic: not one size fits all. Sleep Med. 2020 Dec;76:86–88. doi: 10.1016/j.sleep.2020.09.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
17.Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020 Aug 15;16(8):1417–1418. doi: 10.5664/jcsm.8524. [DOI] [PMC free article] [PubMed] [Google Scholar]
18.Liguori C, Pierantozzi M, Spanetta M, et al. Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection. Brain Behav Immun. 2020 Aug;88:11–16. doi: 10.1016/j.bbi.2020.05.037. [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Voitsidis P, Gliatas I, Bairachtari V, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Research. 2020:289. doi: 10.1016/j.psychres.2020.113076. [DOI] [PMC free article] [PubMed] [Google Scholar]
20.Silva E, Ono B, Souza JC. Sleep and immunity in times of COVID-19. Rev Assoc Med Bras. 1992;2020;66(Suppl 2):143–147. doi: 10.1590/1806-9282.66.S2.143. [DOI] [PubMed] [Google Scholar]
21.Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151–161. doi: 10.2147/NSS.S134864. [DOI] [PMC free article] [PubMed] [Google Scholar]
22.Logan RW, Sarkar DK. Circadian nature of immune function. Mol Cell Endocrinol. 2012 Feb 5;349(1):82–90. doi: 10.1016/j.mce.2011.06.039. [DOI] [PubMed] [Google Scholar]
23.Bryson WJ. Circadian rhythm sleep-wake disorders and the COVID-19 pandemic. J Clin Sleep Med. 2020 Aug 15;16(8):1423. doi: 10.5664/jcsm.8540. [DOI] [PMC free article] [PubMed] [Google Scholar]
24.Sharma M, Aggarwal S, Madaan P, Saini L, Bhutani M. Impact of COVID-19 pandemic on sleep in children and adolescents: a systematic review and meta-analysis. Sleep Med. 2021 Aug;84:259–267. doi: 10.1016/j.sleep.2021.06.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Vitale JA, Perazzo P, Silingardi M, Biffi M, Banfi G, Negrini F. Is disruption of sleep quality a consequence of severe Covid-19 infection? A case-series examination. Chronobiol Int. 2020 Jul;37(7):1110–1114. doi: 10.1080/07420528.2020.1775241. [DOI] [PubMed] [Google Scholar]
26.Ekiz T, Inonu Koseoglu H, Pazarli AC. Obstructive sleep apnea, renin-angiotensin system, and COVID-19: possible interactions. J Clin Sleep Med. 2020 Aug 15;16(8):1403–1404. doi: 10.5664/jcsm.8576. [DOI] [PMC free article] [PubMed] [Google Scholar]
27.Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. The Lancet. 2009;373(9657):82–93. doi: 10.1016/s0140-6736(08)61622-0. [DOI] [PubMed] [Google Scholar]
28.Salles C, Mascarenhas Barbosa H. COVID-19 and obstructive sleep apnea. J Clin Sleep Med. 2020 Sep 15;16(9):1647. doi: 10.5664/jcsm.8606. [DOI] [PMC free article] [PubMed] [Google Scholar]
29.Pazarli AC, Ekiz T, Ilik F. Coronavirus disease 2019 and obstructive sleep apnea syndrome. Sleep Breath. 2021 Mar;25(1):371. doi: 10.1007/s11325-020-02087-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Zhang R, Wang X, Ni L, et al. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci. 2020 Jun 1;250:117583. doi: 10.1016/j.lfs.2020.117583. [DOI] [PMC free article] [PubMed] [Google Scholar]
31.Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Med Rev. 2021 Feb;55:101382. doi: 10.1016/j.smrv.2020.101382. [DOI] [PMC free article] [PubMed] [Google Scholar]
32.Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020 Aug;63(8):1500–1515. doi: 10.1007/s00125-020-05180-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
33.AASM. Coronavirus FAQs: CPAP tips for sleep apnea patients. American Academy of Sleep Medicine; [Accessed November 4, 2021]. https://aasm.org/coronavirus-covid-19-faqs-cpap-sleep-apnea-patients/ [Google Scholar]
34.Partinen M, Bjorvatn B, Holzinger B, et al. Sleep and circadian problems during the coronavirus disease 2019 (COVID-19) pandemic: the International COVID-19 Sleep Study (ICOSS) J Sleep Res Feb. 2021;30(1):e13206. doi: 10.1111/jsr.13206. [DOI] [PubMed] [Google Scholar]
35.Partinen M. Sleep research in 2020: COVID-19-related sleep disorders. The Lancet Neurology. 2021;20(1):15–17. doi: 10.1016/s1474-4422(20)30456-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020 Jun;70:124. doi: 10.1016/j.sleep.2020.04.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
37.Altena E, Baglioni C, Espie CA, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. J Sleep Res Aug. 2020;29(4):e13052. doi: 10.1111/jsr.13052. [DOI] [PubMed] [Google Scholar]
38.Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract. 2020 May;39:101132. doi: 10.1016/j.ctcp.2020.101132. [DOI] [PMC free article] [PubMed] [Google Scholar]
39.Stephenson J. New Federal Guidance Says COVID-19’s Long-term Effects Can Qualify as a Disability. JAMA Health Forum. 2021;2(8) doi: 10.1001/jamahealthforum.2021.2820. [DOI] [PubMed] [Google Scholar]
40.Datta K, Tripathi M. Sleep and Covid-19. Neurol India. 2021 Jan-Feb;69(1):26–31. doi: 10.4103/0028-3886.310073. [DOI] [PubMed] [Google Scholar]