Associations between obesity, a composite risk score for probable long COVID, and sleep problems in SARS-CoV-2 vaccinated individuals

Pei Xue*, Ilona Merikanto, Eva A. Delale, Adrijana Bjelajac, Juliana Yordanova, Rachel N. Y. Chan, Maria Korman, Sérgio A. Mota-Rolim, Anne Marie Landtblom, Kentaro Matsui, Catia Reis, Thomas Penzel, Yuichi Inoue, Michael R. Nadorff, Brigitte Holzinger, Charles M. Morin, Colin A. Espie, Giuseppe Plazzi, Luigi De Gennaro, Frances ChungBjørn Bjorvatn, Yun Kwok Wing, Yves Dauvilliers, Markku Partinen, Christian Benedict*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review



Background: Preliminary data suggests that obesity might hasten the decline in mRNA vaccine-induced immunity against SARS-CoV-2. However, whether this renders individuals with obesity more susceptible to long COVID symptoms post-vaccination remains uncertain. Given sleep’s critical role in immunity, exploring the associations between obesity, probable long COVID symptoms, and sleep disturbances is essential. Methods: We analyzed data from a survey of 5919 adults aged 18 to 89, all of whom received two SARS-CoV-2 mRNA vaccinations. Participants were categorized into normal weight, overweight, and obesity groups based on ethnicity-specific BMI cutoffs. The probability of long COVID was evaluated using the Post-Acute Sequelae of SARS-CoV-2 (PASC) score, as our survey did not permit confirmation of acute SARS-CoV-2 infection through methods such as antibody testing. Additionally, sleep patterns were assessed through questionnaires. Results: Participants with obesity exhibited a significantly higher adjusted odds ratio (OR) of having a PASC score of 12 or higher, indicative of probable long COVID in our study, compared to those with normal weight (OR: 1.55, 95% CI: 1.05, 2.28). No significant difference was observed for overweight individuals (OR: 0.92 [95% CI: 0.63, 1.33]). Both obesity and probable long COVID were associated with increased odds of experiencing a heightened sleep burden, such as the presence of obstructive sleep apnea or insomnia (P < 0.001). However, no significant interaction between BMI and probable long COVID status was found. Conclusions: Even post-vaccination, individuals with obesity may encounter a heightened risk of experiencing prolonged COVID-19 symptoms. However, confirming our observations necessitates comprehensive studies incorporating rigorous COVID infection testing, such as antibody assays - unavailable in our anonymous survey. Additionally, it is noteworthy that the correlation between probable long COVID and sleep disturbances appears to be independent of BMI.

Original languageEnglish
JournalInternational Journal of Obesity
Publication statusAccepted/In press - May 2024


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