The University of Southampton
University of Southampton Institutional Repository

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study

Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study
Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study
Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea.Methods: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107).
Findings: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect.
Interpretation: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition.
Funding: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.
2213-2600
673-684
Jackson, Callum
ad7873ea-d54f-4419-8e70-e29cadf4a504
Stewart, Iain D
df3cda37-6cfd-4f8b-8aef-731140fd6668
Plekhanova, Tatiana
c88afa3d-cbf0-4dcc-8eeb-c03032472b3a
Cunningham, Peter S
040765a3-7e06-4d0e-91ec-92477dd71f23
Hazel, Andrew L
d22956f0-aa8d-4749-8cc1-bcca1ccc3c43
Al-Sheklly, Bashar
be80fb91-2bc2-4ac3-83e6-22ec6530780d
Aul, Raminder
3b3f6241-1abb-4068-b4f3-cc6af5c964af
Chalder, Trudie
92c0e2d7-ce12-4733-9591-baa33bede15f
Chalmers, James D
7796c9e2-3dce-407b-acdb-d3712e3fe9da
Chaudhuri, Nazia
21496f8d-8b7b-4275-ac86-7a494871c9e1
Docherty, Annemarie B
0b579461-1b7a-456a-aa13-09f229c7a9d8
Donaldson, Gavin
48128ec1-2e2d-4ad8-9183-5eb8e70b0cd0
Edwardson, Charlotte L
822b133c-63cd-4461-a9cc-be402c5982bb
Elneima, Omer
727194c9-1800-41ae-b17a-b0831c3e2eaa
Greening, Neil J
76d837b2-cbf1-4dab-8b9c-73b1c789a655
Harris, Victoria C
d01608ae-e2bf-4603-9c10-ed5b41bcc925
Harrison, Ewen M
6e9fdc8e-928d-4135-b8d1-9547783025f1
Ho, Ling-Pei
78fd2483-d7c2-4244-8ffe-e3c8a2d27e32
Houchen-Wolloff, Linzy
bf70a477-0d66-4e8d-a02e-53174a4350dc
Howard, Luke S
99500f2b-a447-4b90-862c-298729706006
Jolley, Caroline J
93b78f9b-ff55-4894-9e8e-e0eaf8683b92
Leavy, Olivia C
31fedd8a-9d66-42a3-bf92-0ea370a8aaee
Lewis, Keir E
85dc5ef3-2137-4a7f-bda3-14b124b89fe2
Lone, Nazir I
c45a0850-9684-481c-8098-e3de4eaa311f
Marks, Michael
91d7c45a-1af5-408a-b966-4c29dae6e8af
McAuley, Hamish J C
35d122ef-8fb4-4e0e-af6d-ed6033520da8
McNarry, Melitta A
41b60ac5-2ab3-43a5-9379-64be21517863
Poinasamy, Krisnah
a28b1b07-547d-4c11-9c02-d7fe05f75133
Raman, Betty
7cbeb9a8-17fe-4a2d-8416-738945b667b9
Richardson, Matthew
0549bcf9-39ad-4e28-9ecb-45b177e1f914
Rivera-Ortega, Pilar
6319eb89-7631-4990-ab08-29d8908cb4be
Rowland-Jones, Sarah L
b3b72ad7-5884-4d80-9163-f4faa1075f34
Rowlands, Alex V
881cca19-ef16-40b6-880e-4de367a2ade8
Saunders, Ruth M
ba589ba7-7d17-4bdf-93ca-f2c3ae883cd4
Scott, Janet T
1802059f-9dba-47f4-af37-2a08dfea4232
Sereno, Marco
9116563f-1b96-4cbe-beb4-cc51b1a9fe4b
Shah, Ajay M
20c6e370-6389-46f5-9673-c68712df43a1
Shikotra, Aarti
f14d8109-212a-4f9e-bd74-85145248f7cd
Singapuri, Amisha
329da062-1999-4021-bf7f-e361bb2a49a4
Stanel, Stefan C
477040b3-e4bc-4fd7-915c-391e42875661
Thorpe, Mathew
8979108d-9c65-4b75-a1a0-e5b922df215a
Wootton, Daniel G
e8f15bfe-9f98-4dbf-9fd6-e05d45a9f436
Yates, Thomas
dce0546a-5b14-41b5-b1a2-b78a9057389b
Gisli Jenkins, R
b3905990-e7fc-4835-93e4-85eb669b1b72
Jones, Mark
a6fd492e-058e-4e84-a486-34c6035429c1
Singh, Sally J
9437b6cf-fd73-44e3-9618-7dec5dbac138
Man, William D-C
ef30a187-66e3-4781-b835-b034dbd1efda
Brightling, Christopher E
b3f869e5-2e62-4a1f-868c-2de15875f55e
Wain, Louise V
3fa0e39c-3251-4095-b99d-5bc224dbb7ae
PHOSP-COVID Study Collaborative Group
Jackson, Callum
ad7873ea-d54f-4419-8e70-e29cadf4a504
Stewart, Iain D
df3cda37-6cfd-4f8b-8aef-731140fd6668
Plekhanova, Tatiana
c88afa3d-cbf0-4dcc-8eeb-c03032472b3a
Cunningham, Peter S
040765a3-7e06-4d0e-91ec-92477dd71f23
Hazel, Andrew L
d22956f0-aa8d-4749-8cc1-bcca1ccc3c43
Al-Sheklly, Bashar
be80fb91-2bc2-4ac3-83e6-22ec6530780d
Aul, Raminder
3b3f6241-1abb-4068-b4f3-cc6af5c964af
Chalder, Trudie
92c0e2d7-ce12-4733-9591-baa33bede15f
Chalmers, James D
7796c9e2-3dce-407b-acdb-d3712e3fe9da
Chaudhuri, Nazia
21496f8d-8b7b-4275-ac86-7a494871c9e1
Docherty, Annemarie B
0b579461-1b7a-456a-aa13-09f229c7a9d8
Donaldson, Gavin
48128ec1-2e2d-4ad8-9183-5eb8e70b0cd0
Edwardson, Charlotte L
822b133c-63cd-4461-a9cc-be402c5982bb
Elneima, Omer
727194c9-1800-41ae-b17a-b0831c3e2eaa
Greening, Neil J
76d837b2-cbf1-4dab-8b9c-73b1c789a655
Harris, Victoria C
d01608ae-e2bf-4603-9c10-ed5b41bcc925
Harrison, Ewen M
6e9fdc8e-928d-4135-b8d1-9547783025f1
Ho, Ling-Pei
78fd2483-d7c2-4244-8ffe-e3c8a2d27e32
Houchen-Wolloff, Linzy
bf70a477-0d66-4e8d-a02e-53174a4350dc
Howard, Luke S
99500f2b-a447-4b90-862c-298729706006
Jolley, Caroline J
93b78f9b-ff55-4894-9e8e-e0eaf8683b92
Leavy, Olivia C
31fedd8a-9d66-42a3-bf92-0ea370a8aaee
Lewis, Keir E
85dc5ef3-2137-4a7f-bda3-14b124b89fe2
Lone, Nazir I
c45a0850-9684-481c-8098-e3de4eaa311f
Marks, Michael
91d7c45a-1af5-408a-b966-4c29dae6e8af
McAuley, Hamish J C
35d122ef-8fb4-4e0e-af6d-ed6033520da8
McNarry, Melitta A
41b60ac5-2ab3-43a5-9379-64be21517863
Poinasamy, Krisnah
a28b1b07-547d-4c11-9c02-d7fe05f75133
Raman, Betty
7cbeb9a8-17fe-4a2d-8416-738945b667b9
Richardson, Matthew
0549bcf9-39ad-4e28-9ecb-45b177e1f914
Rivera-Ortega, Pilar
6319eb89-7631-4990-ab08-29d8908cb4be
Rowland-Jones, Sarah L
b3b72ad7-5884-4d80-9163-f4faa1075f34
Rowlands, Alex V
881cca19-ef16-40b6-880e-4de367a2ade8
Saunders, Ruth M
ba589ba7-7d17-4bdf-93ca-f2c3ae883cd4
Scott, Janet T
1802059f-9dba-47f4-af37-2a08dfea4232
Sereno, Marco
9116563f-1b96-4cbe-beb4-cc51b1a9fe4b
Shah, Ajay M
20c6e370-6389-46f5-9673-c68712df43a1
Shikotra, Aarti
f14d8109-212a-4f9e-bd74-85145248f7cd
Singapuri, Amisha
329da062-1999-4021-bf7f-e361bb2a49a4
Stanel, Stefan C
477040b3-e4bc-4fd7-915c-391e42875661
Thorpe, Mathew
8979108d-9c65-4b75-a1a0-e5b922df215a
Wootton, Daniel G
e8f15bfe-9f98-4dbf-9fd6-e05d45a9f436
Yates, Thomas
dce0546a-5b14-41b5-b1a2-b78a9057389b
Gisli Jenkins, R
b3905990-e7fc-4835-93e4-85eb669b1b72
Jones, Mark
a6fd492e-058e-4e84-a486-34c6035429c1
Singh, Sally J
9437b6cf-fd73-44e3-9618-7dec5dbac138
Man, William D-C
ef30a187-66e3-4781-b835-b034dbd1efda
Brightling, Christopher E
b3f869e5-2e62-4a1f-868c-2de15875f55e
Wain, Louise V
3fa0e39c-3251-4095-b99d-5bc224dbb7ae

Jackson, Callum, Stewart, Iain D, Plekhanova, Tatiana and Jones, Mark , PHOSP-COVID Study Collaborative Group (2023) Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study. The Lancet Respiratory Medicine, 11 (8), 673-684. (doi:10.1016/S2213-2600(23)00124-8).

Record type: Article

Abstract

Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea.Methods: CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107).
Findings: 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect.
Interpretation: Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition.
Funding: UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.

Text
Manuscript v5 - Accepted Manuscript
Restricted to Repository staff only
Request a copy
Text
1-s2.0-S2213260023001248-main - Version of Record
Available under License Creative Commons Attribution.
Download (2MB)

More information

Accepted/In Press date: 29 March 2023
e-pub ahead of print date: 15 April 2023
Published date: 15 April 2023
Additional Information: Funding Information: CJ is funded by an Engineering and Physical Sciences Research Council (EPSRC) Mathematics Doctoral Training Partnership (EP/W523884/1). L-PH is supported in part by the Oxford NIHR Biomedical Research Centre. PLM is supported by an Action for Pulmonary Fibrosis Mike Bray Fellowship and an Asthma + Lung UK Chair in Respiratory Research. KP-H receives funding from Innovate UK (TS/T013028/1) and the UK Medical Research Council (MRC; MR/W006111/1). JCP receives funding from the NIHR University College London Hospitals Biomedical research centre and Breathing Matters charity. BR is funded by the British Heart Foundation Oxford Centre of Research Excellence (RE/18/3/34214). ABD is funded by a Wellcome fellowship (216606/Z/19/Z). AART is supported by a British Heart Foundation intermediate clinical fellowship (FS/18/13/33281). LVW is supported by the GlaxoSmithKline/Asthma + Lung UK Chair in Respiratory Research (C17-1). DGW is funded by an NIHR Advanced Fellowship (NIHR300669). RGJ is supported by a NIHR Research Professorship (RP-2017-08-ST2-014). JFB and PSC are supported by an MRC transition support fellowship (MR/T032529/1). IDS is supported by a fellowship funded by The Rayne Foundation. The work was also supported by an Asthma + Lung UK Malcolm Walleans Grant. This work was supported by the NIHR Manchester Biomedical Research Centre (grant number NIHR203308; JFB, MKR, and AH). The study was also funded by UK Research and Innovation and National Institute of Health Research (grant references: EP/V051490/1, MR/V027859/1, MR/W006111/1, and COV0319). PHOSP-COVID is jointly funded by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 grant references above. The views expressed in the publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health and Social Care. This study would not be possible without all the participants who gave their time and support. We thank all the participants and their families. We thank the many research administrators, health-care and social-care professionals who contributed to setting up and delivering the study at all the 65 NHS trusts and health boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, the Health Research Authority, the Research Ethics Committee, Department of Health and Social Care, Public Health Scotland, and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. This research was done with the UK Biobank Resource under application number 6818. We thank the participants and researchers from the UK Biobank who contributed or collected data. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well the NIHR Office for Clinical Research Infrastructure (NOCRI) for coordinating this work. We are grateful to all the charities that provided insights for this study: Action Pulmonary Fibrosis, Alzheimer's Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and Long Covid Support. We also thank the reviewers whose thoughtful comments improved the quality of the Article. Funding Information: CJ is funded by an Engineering and Physical Sciences Research Council (EPSRC) Mathematics Doctoral Training Partnership (EP/W523884/1). L-PH is supported in part by the Oxford NIHR Biomedical Research Centre. PLM is supported by an Action for Pulmonary Fibrosis Mike Bray Fellowship and an Asthma + Lung UK Chair in Respiratory Research. KP-H receives funding from Innovate UK (TS/T013028/1) and the UK Medical Research Council (MRC; MR/W006111/1). JCP receives funding from the NIHR University College London Hospitals Biomedical research centre and Breathing Matters charity. BR is funded by the British Heart Foundation Oxford Centre of Research Excellence (RE/18/3/34214). ABD is funded by a Wellcome fellowship (216606/Z/19/Z). AART is supported by a British Heart Foundation intermediate clinical fellowship (FS/18/13/33281). LVW is supported by the GlaxoSmithKline/Asthma + Lung UK Chair in Respiratory Research (C17-1). DGW is funded by an NIHR Advanced Fellowship (NIHR300669). RGJ is supported by a NIHR Research Professorship (RP-2017-08-ST2-014). JFB and PSC are supported by an MRC transition support fellowship (MR/T032529/1). IDS is supported by a fellowship funded by The Rayne Foundation. The work was also supported by an Asthma + Lung UK Malcolm Walleans Grant. This work was supported by the NIHR Manchester Biomedical Research Centre (grant number NIHR203308; JFB, MKR, and AH). The study was also funded by UK Research and Innovation and National Institute of Health Research (grant references: EP/V051490/1, MR/V027859/1, MR/W006111/1, and COV0319). PHOSP-COVID is jointly funded by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 grant references above. The views expressed in the publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR, or the Department of Health and Social Care. This study would not be possible without all the participants who gave their time and support. We thank all the participants and their families. We thank the many research administrators, health-care and social-care professionals who contributed to setting up and delivering the study at all the 65 NHS trusts and health boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, the Health Research Authority, the Research Ethics Committee, Department of Health and Social Care, Public Health Scotland, and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. This research was done with the UK Biobank Resource under application number 6818. We thank the participants and researchers from the UK Biobank who contributed or collected data. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well the NIHR Office for Clinical Research Infrastructure (NOCRI) for coordinating this work. We are grateful to all the charities that provided insights for this study: Action Pulmonary Fibrosis, Alzheimer's Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and Long Covid Support. We also thank the reviewers whose thoughtful comments improved the quality of the Article. Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Identifiers

Local EPrints ID: 478667
URI: http://eprints.soton.ac.uk/id/eprint/478667
ISSN: 2213-2600
PURE UUID: b63b0a8c-fd16-4c6b-9ca9-ab0eaca3050f
ORCID for Mark Jones: ORCID iD orcid.org/0000-0001-6308-6014

Catalogue record

Date deposited: 06 Jul 2023 16:51
Last modified: 17 Mar 2024 03:12

Export record

Altmetrics

Contributors

Author: Callum Jackson
Author: Iain D Stewart
Author: Tatiana Plekhanova
Author: Peter S Cunningham
Author: Andrew L Hazel
Author: Bashar Al-Sheklly
Author: Raminder Aul
Author: Trudie Chalder
Author: James D Chalmers
Author: Nazia Chaudhuri
Author: Annemarie B Docherty
Author: Gavin Donaldson
Author: Charlotte L Edwardson
Author: Omer Elneima
Author: Neil J Greening
Author: Victoria C Harris
Author: Ewen M Harrison
Author: Ling-Pei Ho
Author: Linzy Houchen-Wolloff
Author: Luke S Howard
Author: Caroline J Jolley
Author: Olivia C Leavy
Author: Keir E Lewis
Author: Nazir I Lone
Author: Michael Marks
Author: Hamish J C McAuley
Author: Melitta A McNarry
Author: Krisnah Poinasamy
Author: Betty Raman
Author: Matthew Richardson
Author: Pilar Rivera-Ortega
Author: Sarah L Rowland-Jones
Author: Alex V Rowlands
Author: Ruth M Saunders
Author: Janet T Scott
Author: Marco Sereno
Author: Ajay M Shah
Author: Aarti Shikotra
Author: Amisha Singapuri
Author: Stefan C Stanel
Author: Mathew Thorpe
Author: Daniel G Wootton
Author: Thomas Yates
Author: R Gisli Jenkins
Author: Mark Jones ORCID iD
Author: Sally J Singh
Author: William D-C Man
Author: Christopher E Brightling
Author: Louise V Wain
Corporate Author: PHOSP-COVID Study Collaborative Group

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×