Cognition and objective sleep quality in post-COVID-19 patients

F on ie s in Psychology 01 on ie sin.o g
Cogni ion and objec i e sleep
quali y in pos -COVID-19 pa ien s
AnnaCa nes-Vend ell
1, Ge a dPiñol-Ripoll
1*, Ad ianoTa ga
2,
Nu iaTahan
1, Ma A iza
3, NeusCano
3,4, Ba ba aSegu a
5,6,7,8,
Ca meJunque
5,6,7,8, Ja ie Béja
9, C is ianBa ue
9, Nau ilus
P ojec Collabo a i e G oup and Mai eGa ole a
3,10
1 Cogni i e Diso de s Uni , Cogni ion and Beha iou S udy G oup, Hospi al Uni e si a i San a Ma ia,
Lleida, Spain, 2 T ansla ional Resea ch in Respi a o y Medicine, Hospi al Uni e si a i A nau de Vilano a-
San a Ma ia, IRBLleida, Lleida, Spain, 3 Clinical Resea ch G oup o B ain, Cogni ion and Beha iou ,
Conso ci Sani a i de Te assa, Te assa, Spain, 4 Depa amen de Ciències Bàsiques, Uni e si a
In e nacional de Ca alunya (UIC), Ba celona, Spain, 5 Medical Psychology Uni , Depa men o
Medicine, Uni e si a de Ba celona, Ba celona, Spain, 6 Ins i u e o Neu osciences, Uni e si y o
Ba celona, Ba celona, Spain, 7 Ins i u d’In es igacions Biomèdiques Augus Pi iSunye (IDIBAPS),
Ba celona, Spain, 8 Cen o de In es igación Biomédica en Red sob e En e medades
Neu odegene a i as (CIBERNED), Ba celona, Spain, 9 Facul y o In o ma ics o Ba celona (FIB),
Poly echnic Uni e si y o Ca alonia, Ba celona, Spain, 10 Neu opsychology Uni , Conso ci Sani a i de
Te assa, Te assa, Spain
In he cu en s udy, weaimed (i) o e alua e sleep quali y ia w is ac ig aphy
moni o ing o nonhospi alized and hospi alized pos -COVID-19 condi ion (PCC)
pa icipan s; (ii) o co ela e ac ig aphy measu es wi h subjec i e measu es o sleep
quali y, such as he Pi sbu gh Sleep Quali y Index (PSQI); and (iii) o in es iga e
whe he o al sleep ime o sleep e iciency could a ec PCC cogni i e pe o mance.
Weincluded 49 indi iduals wi h PCC om he NAUTILUS P ojec (NCT05307549
and NCT05307575) who we e moni o ed o 1 week ia ac ig aphy and who we e
also assessed wi h a comp ehensi e neu opsychological ba e y and he PSQI.
We ound ha he e we e signi ican di e ences be ween nonhospi alized PCCs
and hospi alized PCCs in he numbe o awakenings. Wealso ound a co ela ion
be ween he o al sleep ime o bo h measu es (ac ig aphy and PSQI), bu wedid
no obse e co ela ions be ween objec i e and subjec i e pa ame e s o la ency
and sleep e iciency. Rega ding cogni ion and ac ig aphy measu es, he e was a
end o s a is ical signi icance in he pe o mance o immedia e isual memo y,
a en ion span and social cogni ion acco ding o sleep e iciency. In conclusion,
esul s indica e ha al hough he PSQI p o ides clinically ele an indica o s o sleep,
he e a e di e gen esul s be ween sel - epo ed and objec i e sleep measu es
(ac ig aphy). Fu he mo e, we ound a endency owa d s a is ical signi icance in
cogni i e pe o mance in PCC pa icipan s acco ding o hei sleep e iciency which
could indica e ha is mo e impo an o cogni i e unc ion o pos -COVID-19
pa ien s han o al sleep ime.
KEYWORDS
ac ig aphy, cogni ion, pos -COVID-19 condi ion, sleep e iciency, sleep quali y, o al
sleep ime
1 In oduc ion
Sleep quali y has been widely s udied in pos -COVID-19 condi ion (PCC) pa icipan s. I
has been p o en ha sleep dis u bances a e among he mos p e alen symp oms in PCC
pa ien s, along wi h cogni i e (Ziauddeen e al., 2022; Ga cía-Sánchez e al., 2022; Delgado-
Alonso e al., 2022; Ma ias-Guiu e al., 2022; Da is e al., 2021; Guo e al., 2022; A iza e al.,
2022) and emo ional al e a ions (Bou mis o a e al., 2022; Vindegaa d and Ben os, 2020). In
OPEN ACCESS
EDITED BY
Khaled T abelsi,
Uni e si y o S ax, Tunisia
REVIEWED BY
Sangchoon Jeon,
Yale Uni e si y, Uni edS a es
Je Dyche,
James Madison Uni e si y, Uni edS a es
*CORRESPONDENCE
Ge a d Piñol-Ripoll
[email p o ec ed]
RECEIVED 16 Ap il 2024
ACCEPTED 21 Janua y 2025
PUBLISHED 03 Feb ua y 2025
CITATION
Ca nes-Vend ell A, Piñol-Ripoll G, Ta ga A,
Tahan N, A iza M, Cano N, Segu a B,
Junque C, Béja J, Ba ue C, Nau ilus P ojec
Collabo a i e G oup and Ga ole a M (2025)
Cogni ion and objec i e sleep quali y in
pos -COVID-19 pa ien s.
F on . Psychol. 16:1418602.
doi: 10.3389/ psyg.2025.1418602
COPYRIGHT
© 2025 Ca nes-Vend ell, Piñol-Ripoll, Ta ga,
Tahan, A iza, Cano, Segu a, Junque, Béja ,
Ba ue, Nau ilus P ojec Collabo a i e G oup
and Ga ole a. This is an open-access a icle
dis ibu ed unde he e ms o he C ea i e
Commons A ibu ion License (CC BY). The
use, dis ibu ion o ep oduc ion in o he
o ums is pe mi ed, p o ided he o iginal
au ho (s) and he copy igh owne (s) a e
c edi ed and ha he o iginal publica ion in
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accep ed academic p ac ice. No use,
dis ibu ion o ep oduc ion is pe mi ed
which does no comply wi h hese e ms.
TYPE B ie Resea ch Repo
PUBLISHED 03 Feb ua y 2025
DOI 10.3389/ psyg.2025.1418602
Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 02 on ie sin.o g
ac , many s udies ha e shown ha he e is a educ ion in sleep quali y
bo h in hospi alized and nonhospi alized pa ien s (Akıncı and Melek
Başa , 2021; Samushiya e al., 2022; Al-Ame i e al., 2022; Malik e al.,
2022; Ka imi e al., 2022). Howe e , acco ding o ou p e ious s udy,
he e is no signi ican di e ence in he se e i y o he disease (Ca nes-
Vend ell e al., 2024). Howe e , mos o he s udies included only
subjec i e sleep quali y measu es, such as he Pi sbu gh Sleep Quali y
Index (PSQI), because o i s ease o adminis a ion and due o he ac
ha i equi es less ime.
Wi h objec i e measu es such as w is -ac ig aphy, i is possible o
desc ibe he sleep pa e ns o he pa icipan s in a mo e ealis ic
manne . Thus, i allows o simul aneous ecological assessmen o
sleep wi h nonin asi e moni o ing, as opposed o polysomnog aphy,
which usually equi es an o e nigh s ay in he hospi al and hen an
expensi e sleep e alua ion. Acco ding o he Academy o Sleep
Medicine, he ac ig aphy p o ide use ul in o ma ion and i may
becos -e ec i e me hod o assessing speci ic sleep diso de s (Ancoli-
Is ael e al., 2003).
To da e, se e al s udies ha e been published using ac ig aphy
me hods o analyze sleep pa e ns and ci cadian hy hms du ing he
COVID-19 lockdown. In ac , a sys ema ic e iew was published in
2023 o summa ize he p e ious li e a u e in his ield (Fe ei a-Souza
e al., 2023). They concluded ha ac ig aphy should beincluded as
pa o he sleep hygiene s a egy, as i may be he bes ins umen o
ob aining da a abou sleep pa e ns. Howe e , only one o he included
15 s udies in ol ed COVID-19 pa ien s, and he emaining s udies
in ol ed he gene al popula ion (medical s a , child en, and s uden s,
among o he s).
The e is a la ge amoun o e idence ha sleep plays a undamen al
ole in he egula ion o emo ions and adequa e cogni i e unc ioning.
In ac , a lack o adequa e sleep is a majo sou ce o many ha m ul
diseases ela ed o he hea , he b ain, psychological changes, high
blood p essu e, diabe es, and/o weigh gain (Belal e  al., 2020;
Salehinejad e al., 2022). P e ious indings in olde adul s suppo he
idea ha educed sleep quali y can con ibu e o poo cogni i e
pe o mance (Lim e al., 2013; Naismi h e al., 2010; Lambiase e al.,
2014; Blackwell e al., 2006; Blackwell e al., 2011; Ya e e al., 2014).
Howe e , o ou knowledge, he ela ionship be ween sleep quali y
and cogni ion in he PCC has no been s udied.
The e o e, in he cu en s udy, weaimed (i) o e alua e sleep
quali y h ough w is ac ig aphy moni o ing o nonhospi alized and
hospi alized pos -COVID-19 condi ion (PCC) pa icipan s; (ii) o
co ela e ac ig aphy measu es wi h subjec i e measu es o sleep
quali y, such as he Pi sbu gh Sleep Quali y Index (PSQI); and (iii) o
in es iga e whe he o al sleep ime o sleep e iciency could a ec
PCC pa icipan s’ cogni i e pe o mance.
2 Me hods
2.1 Pa icipan s
We included 49 pa icipan s om he Nau ilus P ojec
(ClincalT ials.go IDs: NCT05307549 and NCT05307575), 35 o
whom we e nonhospi alized, which means ha only showed mild
COVID-19 symp oms in he acu e phase and s ayed a home, and 14
o whom we e hospi alized (p esen ing mode a e o se e e symp oms
o he disease). The samples we e collec ed a Hospi al Uni e si a i
San a Ma ia (Lleida, SPAIN) and Hospi al Uni e si a i A nau de
Vilano a (Lleida, SPAIN).
The inclusion c i e ia o he PCC g oup we e a con i med
diagnosis o COVID-19 acco ding o he WHO c i e ia wi h signs and
symp oms o he disease obse ed du ing he acu e phase, a pe iod o
a leas 12 weeks a e in ec ion, and age be ween 18 and 65 yea s. The
exclusion c i e ia we e an es ablished diagnosis o a psychia ic
diso de , neu ological diso de , neu ode elopmen al diso de , o
sys emic pa hology known o cause cogni i e de ici s be o e
COVID-19 in ec ion and mo o o senso y al e a ions ha could
in e e e wi h he neu opsychological assessmen .
2.2 P ocedu e
Pa icipan s we e ec ui ed a he Cogni i e Diso de Uni o
Hospi al Uni e si a i San a Ma ia (Lleida, SPAIN) and Hospi al
Uni e si a i A nau de Vilano a (Lleida, SPAIN). Weob ained w i en
in o med consen om all o he pa icipan s be o e inclusion.
We collec ed da a on sociodemog aphic cha ac e is ics, p e ious
como bidi ies and COVID-19 symp oms in he i s session. A he
second isi , a neu opsychological assessmen was pe o med.
Di e en cogni i e domains we e assessed wi h an ex ensi e and
comp ehensi e neu opsychological ba e y ha was desc ibed in a
p e ious s udy (Ca nes-Vend ell e al., 2024). All o he e alua ions
we e pe o med by ained neu opsychologis s. The pa icipan s we e
also asked o comple e di e en ques ionnai es, including he
Pi sbu gh Sleep Quali y Index (PSQI), which allowed us o assess
sleep quali y. Finally, he pa icipan s we e moni o ed o 7 days wi h
a w is -moun ed ac ig aph (Ac iwa ch 2, Philips Respi onics,
Mu ys ille, PA). Weob ained he ollowing a iables: o al sleep ime
(hou s), ime in bed (hou s), sleep e iciency (%, de ined as he a io
be ween o al sleep ime and he ime spen in bed), sleep la ency
(minu es, de ined as he ime spen awake un il he i s sleep episode),
ime spen awake a e sleep onse (WASO (minu es), and numbe
o awakenings).
The pa icipan s’ anonymi y and con iden iali y we e gua an eed.
The Scien i ic E hics Commi ee o he Hospi al Uni e si a i A nau de
Vilano a app o ed bo h he s udy and he consen p ocedu e (CEIC
2384), as did he D ug Resea ch E hics Commi ee (CEIm) o
Conso ci Sani a i de Te assa (CEIm code: 02–20–107-070) and he
E hics Commi ee o he Uni e si y o Ba celona (IRB00003099).
Addi ionally, he in es iga ion was conduc ed in acco dance wi h he
la es e sion o he Decla a ion o Helsinki.
2.3 S a is ical analysis
Desc ip i e analyses we e pe o med on PCC pa ien s
(nonhospi alized s. hospi alized). Fo ca ego ical a iables,
equencies and pe cen ages we e ob ained, and o quan i a i e
a iables, he means and s anda d de ia ions o medians and
in e qua ile anges (IQRs) we e ob ained. Fo he sociodemog aphic
and clinical p o iles, quan i a i e a iables we e compa ed be ween
se e i y g oups by using S uden ’s es o he Mann–Whi ney es ,
acco ding o no mali y ( e i ied by using he Shapi o–Wilk es ). Fo
ca ego ical a iables, g oups we e compa ed by using Pea son’s
chi-squa ed es s (o he Fishe ’s exac es , i applicable).
Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 03 on ie sin.o g
To analyze he ela ionship be ween he PSQI sco e and he
ac ig aphy pa ame e s (sleep la ency, sleep e iciency and o al sleep
ime), Spea man’s ho co ela ions we e used, gi en he nonno mali y
o he pa ame e s.
To analyze he ela ionships be ween cogni i e pa ame e s and
ac ig aphy pa ame e s ( o al sleep ime and sleep e iciency),
nonpa ame ic Pea son’s chi-squa ed es s we e used (o he Fishe ’s exac
es was applied, i app op ia e). Bo h o al sleep ime and sleep e iciency
we e dicho omized acco ding o he median, and cogni ion a iables we e
con e ed in o dicho omous a iables depending on whe he he esul
indica ed cogni i e impai men (−1 s anda d de ia ion om he mean).
The s a is ical signi icance le el ha was used in he analyses was
5% (α = 0.05). All o he analyses we e pe o med wi h IBM SPSS
s a is ics 26.
3 Resul s
O he 49 PCC pa ien s, 35 we e no hospi alized, and he mean
(M) age was 48.80 yea s (s anda d de ia ion [SD]: 8.75); 14 we e
hospi alized, wi h a mean age o 55.14 yea s (SD: 5.86), and his
di e ence was signi ican (p = 0.016). In he nonhospi alized-PCC
g oup, he majo i y o pa icipan s we e emale (77.11%) and had
mo e yea s o educa ion (M: 14.79; SD: 2.33) (p = 0.042). Pa icipan s
in he hospi alized PCC g oup had mo e como bidi ies, such as high
blood p essu e (42.9%), dyslipidaemia (35.7%), and obesi y (42.9%).
Table1 shows he clinical and sociodemog aphic cha ac e is ics o
he sample.
In e ms o sleep quali y, he hospi alized PCC pa icipan s
ob ained a mean PSQI o al sco e o 9.50 (SD: 4.50), and he
TABLE1 Clinical and sociodemog aphic cha ac e is ics o he sample.
Non-hospi ali zed PCC Hospi alized PCC p alue
n= 35 n= 14
Age (yea s) (SD) 48.80 (8.75) 55.14 (5.86) 0.016*
Female (%) 77.11% 42.9% 0.021*
Yea s o educa ion (SD) 14.79 (2.33) 13.14 (2.85) 0.042*
Days since COVID-19 (SD) 453.91 (287.82) 363.21 (134.52) 0.141
MoCA (SD) 25.79 (2.58) 25.43 (2.38) 0.65
BMI (SD) 26.56 (5.34) 28.66 (3.97) 0.192
Tobacco smoking (%) 5.9% 14.3% 0.338
Alcohol consump ion (%) 50.0% 21.4% 0.068
P e ious como bidi ies
Hea disease (%) 0.0% 0.0% -
Respi a o y disease (%) 14.7% 0.0% 0.13
Ch onic kidney disease (%) 0.0% 0.0% -
High blood p essu e (%) 11.8% 42.9% 0.016*
Dyslipidemia (%) 14.7% 35.7% 0.103
Diabe es melli us (%) 2.9% 7.1% 0.508
Obesi y (%) 17.6% 42.9% 0.067
Ch onic li e disease (%) 0.0% 0.0% -
Ch onic pain (%) 2.9% 0.0% 0.517
Quali y o sleep
PSQI o al sco e 8.70 (3.20) 9.50 (4.50) 0.803
Poo quali y o sleep (>5) 81.8% 78.6% 0.796
Ac ig aphy a iables
To al sleep ime, hou s (Mdn, IQR) 6.73 (5.93–7.48) 6.78 (6.15–7.27) 0.851
Time in bed, hou s (Mdn, IQR) 8.27 (7.77–8.72) 7.96 (7.67–8.60) 0.432
Sleep e iciency, % (Mdn, IQR) 84.99 (77.69–88.24) 85.62 (81.21–87.45) 0.298
Sleep la ency, minu es (Mdn, IQR) 14.00 (9.00–22.00) 15.00 (12.00–23.00) 0.565
WASO, minu es (Mdn, IQR) 45.00 (27.00–61.00) 44.00 (25.00–52.00) 0.507
Numbe o awakenings (Mdn, IQR) 36.33 (28.71–43.86) 25.84 (18.67–34.71) 0.008*
Unless o he wise speci ied, esul s a e p esen ed as mean (s anda d de ia ion).
Mdn, median; IQR, in e qua ile ange.
Bold alues mean le el o s a is ical signi icance = *p < 0.05, **p < 0.01, ***p < 0.001.
PCC, Pos -COVID-19 Condi ion; MoCA, Mon eal Cogni i e Assessmen ; BMI, Body Mass Index; WASO, wake a e sleep onse .
Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 04 on ie sin.o g
nonhospi alized PCC pa icipan s ob ained a mean sco e o 8.70 (SD:
3.20); howe e , his di e ence was no signi ican (p = 0.803). The
nonhospi alized-PCC g oup had a pe cen age o pa icipan s wi h a
sco e abo e 5 on he PSQI which indica es poo e sleep quali y (81.8%
s. 78.6%, espec i ely), wi h no signi ican di e ences be ween he
g oups (p = 0.796) (Table1).
Acco ding o he ac ig aphy a iables, he e we e only signi ican
di e ences in he numbe o awakenings (p = 0.008) be ween
nonhospi alized PCCs (M: 36.33; IR: 28.71–43.86) and hospi alized
PCCs (M: 25.84; IR: 18.67–34.71) (Table1). Wedid no obse e
signi ican di e ences in he emaining ac ig aphy a iables, such as
sleep la ency and e iciency, ime in bed o o al sleep ime, be ween
he nonhospi alized and hospi alized PCC pa ien s.
Rega ding he co ela ion be ween subjec i e and objec i e
measu es o sleep a iables, wee alua ed he co ela ion o sleep la ency,
sleep e iciency and o al sleep ime acco ding o he PSQI and
ac ig aphy. We ound a co ela ion be ween o al sleep ime and bo h
measu es (p = 0.009; Rho Spea man: −0.447) in he nonhospi alized
PCC g oup (Table2). This nega i e co ela ion should bein e p e ed
conside ing ha he highe he PSQI sco e (which indica es wo se sleep
quali y), he ewe he hou s o o al sleep ime acco ding o he ac ig aph.
Finally, wee alua ed he cogni ion pa ame e s acco ding o he
o al sleep ime and sleep e iciency o he whole sample (Table3).
We did no obse e signi ican di e ences in cogni ion be ween
g oups in e ms o o al sleep ime o sleep e iciency. The e was a
end owa d s a is ical signi icance in he pe o mance o immedia e
isual memo y (p = 0.054), a en ion span (p = 0.056) and social
cogni ion (p = 0.062) acco ding o sleep e iciency; speci ically, a lowe
sleep e iciency co esponded o a wo sened cogni i e pe o mance.
4 Discussion
Ou s udy demons a ed signi ican di e ences only in he
numbe o awakenings be ween nonhospi alized and hospi alized
PCC pa ien s. The e o e, o he emaining ac ig aph pa ame e s, PCC
pa icipan s had he same esul s ega dless o he se e i y o
PCC. When weco ela ed he w is -ac ig aphy esul s wi h sel -
epo ed a iables (PSQI), we ound a signi ican co ela ion wi h o al
sleep ime. Finally, when we analyzed he ela ionships be ween
cogni i e pe o mance and o al sleep ime and sleep e iciency,
we ound a endency owa d s a is ical signi icance in isual memo y,
a en ion and social cogni ion acco ding o sleep e iciency.
Some p e ious esea ch has shown simila esul s in e ms o
subjec i e and objec i e measu emen s o sleep quali y. Di e en
s udies ha we e pe o med only wi h nonhospi alized PCC
pa icipan s ha e ob ained esul s simila o ou esul s o he
ac ig aph pa ame e s (Reid e al., 2024; Hen íquez-Bel án e al.,
2022). In addi ion, ou esul s a e compa able o hose o p e ious
s udies ha included only samples o hospi alized PCC pa ien s
(Bení ez e al., 2022; Ta ga e al., 2022; Jackson e al., 2023; Hen íquez-
Bel án e al., 2022). To ou knowledge, he e is only one s udy ha
included nonhospi alized and hospi alized PCC pa icipan s and
compa ed he ac ig aphy pa ame e s be ween hem. In ha s udy, he
au ho s did no obse e a signi ican di e ence among PCC
pa icipan s acco ding o he se e i y o he disease (Tański e al.,
2024). Thus, ou esul s con i m he absence o a ela ionship be ween
he se e i y o PCC and ac ig aphy pa ame e s.
Mos o he p e ious s udies ha also used w is -ac ig aphy and
he PSQI did no pe o m co ela ion analyses. Wedemons a ed a
co ela ion be ween objec i e and subjec i e measu emen s in e ms
o o al sleep ime. Tański e al. (2024) also ound he same co ela ion,
bu hey used he Epwo h Sleepiness Scale (ESS), which is used o
assess day ime sleepiness. Thei esul s also demons a ed co ela ions
be ween he ESS sco e and o al ime in bed and wake ulness a e
sleep onse . Gi en he absence o p e ious s udies ha analyze he
co ela ion be ween objec i e and subjec i e sleep da a, i is no
possible o d aw any conclusions o he han hose desc ibed. Pe haps
he ac ha sel - epo ed and subjec i e measu es do no enjoy he
same eliabili y as objec i e ones can make ha many esea che s do
no conside analyzing his co ela ion.
Finally, we in es iga ed whe he cogni i e pe o mance is
ela ed o ac ig aphy pa ame e s such as o al sleep ime and sleep
e iciency. Based on p e ious s udies ha demons a ed he
impo ance o good-quali y sleep o good cogni i e unc ioning,
weanalyzed hese wo a iables. Unexpec edly, wedid no obse e
signi ican esul s. Howe e , his may bedue o he small sample
size because we did obse e a endency owa d s a is ical
signi icance in isual memo y, a en ion and social cogni ion
acco ding o sleep e iciency. To ou knowledge, only one p e ious
ecen s udy has analyzed cogni i e pe o mance and sleep quali y
in COVID-19 pa ien s. The au ho s also ound ha lowe sleep
e iciency was associa ed wi h lowe a en ion and p ocessing speed
(Reid e al., 2024). In s udies ocusing on he ole o sleep o
cogni ion bu no in COVID-19 popula ion, i is said ha sleep is
c ucial o cogni ion, specially in elde ly people. Sleep
TABLE2 Co ela ions be ween objec i e and subjec i es sleep measu es.
To al PCC sample Non-hospi alized PCC Hospi alized PCC
n= 49 n= 35 n= 14
Sleep la ency −0.074 −0.034 −0.208
p= 0.622 p= 0.850 p= 0.475
Sleep e iciency −0.013 −0.009 0.017
p= 0.930 p= 0.960 p= 0.955
To al sleep ime −0.396 −0.447 −0.370
p= 0.006** p= 0.009** p= 0.193
Spea man’s Rho co ela ion.
Bold alues mean le el o s a is ical signi icance = *p < 0.05, **p < 0.01, ***p < 0.001.
Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 05 on ie sin.o g
agmen a ion and absence o deep sleep has been associa ed wi h
wo se cogni i e unc ion in olde people (Lim e al., 2013; Naismi h
e al., 2010; Ya e e al., 2014; Ta ga e al., 2021).
The s eng hs o he s udy include he use o bo h objec i e and
sel - epo ed measu es o sleep quali y, such as he PSQI and w is -
ac ig aphy. In addi ion, wepe o med a comp ehensi e cogni i e
assessmen , which allowed us o explo e he possible e ec s o sleep
quali y on all cogni i e domains. Howe e , se e al limi a ions should
beconside ed. Fi s , ou ela i ely small sample size may ha e limi ed
ou abili y o achie e s a is ically signi ican esul s. Second, he
absence o a heal hy con ol g oup p e en ed us om ex ending ou
conclusions o he gene al popula ion. Finally, wecanno o ge ha
his is a c oss-sec ional s udy; hus, a longi udinal ollow-up would
be necessa y o obse e he e olu ion o sleep quali y and i s
TABLE3 G oup compa ison o cogni i e pe o mance in PCC pa icipan s acco ding o o al sleep ime and sleep e iciency.
To al sleep ime Sleep e iciency
Memo y
RAVLT o al sco e Chi-squa e 1.742 0.17
Sig. 0.187 0.68
RAVLT immedia e ecall Chi-squa e 1.38 0.294
Sig. 0.24 0.588
RAVLT delayed ecall Chi-squa e 1.557 0.34
Sig. 0.212 0.56
ROCF immedia e ecall Chi-squa e 3.714 3.714
Sig. 0.099 0.054
ROCF delayed ecall Chi-squa e 0.903 0.903
Sig. 0.342 0.342
A en ion and p ocessing speed
Digi span o wa d Chi-squa e 1.557 3.657
Sig. 0.212 0.056
Digi span backwa d Chi-squa e 1.002 1.002
Sig. 0.609 0.609
Digi Symbol Chi-squa e 2.002 2.002
Sig. 0.490 0.490
TMT A Chi-squa e 0.903 0.903
Sig. 0.342 0.342
TMT B Chi-squa e 0.003 0.003
Sig. 1.000 1.000
Execu i e unc ions
S oop colo wo d Chi-squa e 0.523 0.294
Sig. 0.47 0.588
Ve bal luency_P Chi-squa e 0.405 0.005
Sig. 0.725 1.000
Ve bal luency_M Chi-squa e 3.329 3.329
Sig. 0.110 0.068
Ve bal luency_R Chi-squa e 0.504 0.699
Sig. 0.702 0.375
Language
Seman ic luency Chi-squa e 0.091 0.091
Sig. 1.000 1.000
BNT Chi-squa e 0.699 0.004
Sig. 0.463 1.000
P axis ROCF copy ial Chi-squa e 0.008 0.294
Sig. 0.928 0.588
Social cogni ion Eye es Chi-squa e 0.525 3.496
Sig. 0.469 0.062
Pea son’s Chi squa e esul s.
Le el o s a is ical signi icance = *p < 0.05, **p < 0.01, ***p < 0.001.
PCC, Pos -COVID-19 Condi ion; RAVLT, Rey Audi o y Ve bal Lea ning Tes ; ROCF, Rey–Os e ie h Complex Figu e Tes ; TMT, T ail Making Tes ; BNT, Bos on Naming Tes .

Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 06 on ie sin.o g
al e a ions in PCC pa icipan s o de e mine how hey e ol e
o e ime.
Despi e he end o he pandemic, COVID-19 is s ill p esen in
he popula ion, and he disease may ha e a long-las ing impac on
heal h due o pe sis en COVID-19 symp oms, such as sleep and
emo ional dis u bances, as well as cogni i e impai men . Ou
esul s con i m ha PCC pa icipan s su e om poo sleep quali y,
which has been co obo a ed bo h wi h objec i e and subjec i e
measu es, and ha his may a ec hei cogni i e pe o mance,
especially in memo y, a en ion, and social cogni ion asks.
Al hough ou s udy did no show signi ican esul s o many
a iables, as weexpec ed, webelie e ha i is ele an because o i s
implica ions. The apeu ic s a egies ocused on sleep quali y may
imply imp o emen s in di e en a eas, such as cogni ion and
psychological p ocesses.
Da a a ailabili y s a emen
The aw da a suppo ing he conclusions o his a icle will
bemade a ailable by he au ho s, wi hou undue ese a ion.
E hics s a emen
The Scien i ic E hics Commi ee o he Hospi al Uni e si a i
A nau de Vilano a app o ed bo h he s udy and he consen p ocedu e
(CEIC 2384), as did he D ug Resea ch E hics Commi ee (CEIm) o
Conso ci Sani a i de Te assa (CEIm code: 02-20-107-070) and he
E hics Commi ee o he Uni e si y o Ba celona (IRB00003099). The
pa ien s/pa icipan s p o ided w i en in o med consen o pa icipa e
in he s udy. The s udies we e conduc ed in acco dance wi h he local
legisla ion and ins i u ional equi emen s. The pa icipan s p o ided
hei w i en in o med consen o pa icipa e in his s udy.
Au ho con ibu ions
AC-V: Concep ualiza ion, Me hodology, P ojec adminis a ion,
Valida ion, W i ing – o iginal d a . GP-R: Funding acquisi ion,
W i ing – e iew & edi ing. AT: Fo mal analysis, Me hodology,
W i ing– e iew & edi ing. NT: P ojec adminis a ion, W i ing–
e iew & edi ing. MA: Concep ualiza ion, Supe ision, W i ing–
e iew & edi ing. NC: Concep ualiza ion, Me hodology, P ojec
adminis a ion, W i ing– e iew & edi ing. BS: W i ing– e iew &
edi ing. CJ: W i ing– e iew & edi ing. JB: W i ing– e iew & edi ing.
CB: W i ing– e iew & edi ing. MG: Concep ualiza ion, Funding
acquisi ion, In es iga ion, W i ing– e iew & edi ing.
G oup membe s o Nau ilus P ojec
Collabo a i e G oup
Vanesa A auzo and Jose A. Be nia, Conso ci Sani a i de
Te assa (CST), Te assa, Spain. Ma a Balague-Ma maña and Be a
Valles-Pauls, Hospi al San Joan Despí Moisès B oggi, Conso ci
Sani a i In eg al. Jesús Caballe o, Hospi al Uni e si a i A nau de
Vilano a, Lleida, Spain. Es e Gonzalez-Aguado and Ca me
Tayó-Juli, Conso ci Sani a i Al Penedès-Ga a , Vila anca de
Penedés, Ba celona, Spain. E a Fo cadell-Fe e es and Sil ia
Re e e-Vila oya, Hospi al Ve ge de la Cin a, To osa, Ta agona,
Spain. Susanna Fo né, Fundació San Hospi al de la Seu d’U gell, La
Seu d’U gell, Lleida, Spain. Anna Ba es-Plans and Jo dina Muñoz-
Pad os, Conso ci Hospi ala i de Vic, Vic, Ba celona, Spain. Jose
A. Muñoz-Mo eno and Anna P a s-Pa is, Se ei de Malal ies
In eccioses, Fundació Llui a con a les In eccions – Hospi al
Uni e si a i Ge mans T ias iPujol, Badalona, Ba celona, Spain.
Inmaculada Rico and Nu ia Sabé, Hospi al Uni e si a i de Bell i ge,
L’Hospi ale de Llob ega , Ba celona, Spain. Ma a Alme ia and
Lau a Casas, Hospi al Uni e si a i Mú ua Te assa, Te assa,
Ba celona, Spain. Ma ia José Ciudad and Anna Fe é, Badalona
Se eis Assis ens, Badalona, Ba celona, Spain. Tama Ga zon and
Manuela Lozano, Ins i u d’Assis ència Sani à ia, Gi ona, Spain.
Ma a Cullell and Sonia Vega, Fundació Salu Empo dà, Figue es,
Gi ona, Spain. Síl ia Alsina, Fundació Hospi al de Puigce dà,
Puigce dà, Gi ona, Spain. Ma ia J. Maldonado-Belmon e and
Susana Vazquez-Ri e a, Hospi al Uni e si a io Cen al de la C uz
Roja San José y San a Adela, Mad id, Spain. E a Baillès and Sand a
Na a o, Se ei Ando à d’A enció Sani à ia (SAAS), Ando a.
Ayoze González He nández, Facul ad de Ciencias de la Salud,
Uni e sidad Fe nando Pessoa Cana ias. Yaiza Molina, Clínica
Uni e si a ia de Psicología, Facul ad de Ciencias de la Salud,
Uni e sidad Fe nando Pessoa Cana ias. Vic o ia Oli e,
Occupa ional Heal h Ca e Se ice, Hospi al Clínic Ba celona. Sil ia
Cañiza es, Sec ion o Clinical Psychology o Heal h, Clinical
Ins i u e o Neu osciences, Hospi al Clinic o Ba celona.
Depa men o Clinical Psychology and Psychobiology, Uni e si a
de Ba celona.
Funding
The au ho (s) decla e ha inancial suppo was ecei ed o he
esea ch, au ho ship, and/o publica ion o his a icle. This esea ch
was suppo ed by he Agency o Managemen o Uni e si y and
Resea ch G an s (AGAUR) om he Gene ali a de Ca alunya
(Pandemies, 202PANDE00053) and he La Ma a ó de TV3 Founda ion
(202111–30–31-32) o MG, he Ins i u o de Salud Ca los III de Mad id
(PI22/01687, ISCIII) and he Agency o Managemen o Uni e si y
and Resea ch G an s (2021SGR 00761) o GP-R.
Con lic o in e es
The au ho s decla e ha he esea ch was conduc ed in he
absence o any comme cial o inancial ela ionships ha could
becons ued as a po en ial con lic o in e es .
Publishe ’s no e
All claims exp essed in his a icle a e solely hose o he au ho s
and do no necessa ily ep esen hose o hei a ilia ed o ganiza ions,
o hose o he publishe , he edi o s and he e iewe s. Any p oduc
ha may bee alua ed in his a icle, o claim ha may bemade by i s
manu ac u e , is no gua an eed o endo sed by he publishe .
Ca nes-Vend ell e al. 10.3389/ psyg.2025.1418602
F on ie s in Psychology 07 on ie sin.o g
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