Dados do Trabalho

Título

Central Sleep Hypersomnia after Covid-19 infection. Serial case reports.

Introdução

Despite public health concerns about the acute effects of the recent pandemic viral infection, SARS-COV2, chronic broad-spectrum manifestations draw attention.
Similar to post-viral syndromes described in survivors of other virulent coronavirus epidemics.

Objetivo

We described three patient thats reported a significant hypersomnia after COVID-19 infection with a good response to modafinil and methylphenidate.

Métodos

We carried out a longitudinal follow-up of the three patients, through regular consultations, evaluation and response to prescribed medications.

Resultados

We report 3 patients, 2 females and 1 male diagnosed whit Central Sleep Hypersomnia after Covid-19 infection. The median age of the cases was 34 years. Covid-19 infection in March, November and December 2020.

Three to five months after initial symptoms, the patients continued reporting fatigue, cognitive complaints and excessive sleepiness with naps occurring frequently in inappropriate situations, as on work desk and non-restorative sleep of 8 to 12 hours.
Before the infection, the patients were a regular of sleep pattern, with 5 to 6 hours of restorative sleep per night.

Physical examination: The median Epworth Sleepiness Scale (ESS) scored 21 out of 24.
The neurological exam : showed hyposmia in one of the patients

Complementary exams: Brain MRI showed signs of olfactory bulb atrophy/hypoplasia in one case.
Laboratory tests were normal.
Polysomnography and multiple sleep latency test (MSLT) revealed a reduction of sleep onset latency in 5 out of 5 tests of MSLT in all patients, with an average sleep onset latency of 1.9 minutes. Early onset REM sleep was evidenced at every opportunity in the TMLS in one of our patients. Compatible with the diagnosis of Narcolepsy.
The all patients started treatment with modafinil 200mg/day. After one month of treatment, the patient improved with a decrease in the daily sleep time (median ESS = 15). The dose of modafinil was increased to 400mg/day, but in one patient reported headache. We returned modafinil to previous dose and added methylphenidate 10mg/day. The ESS average was 8, after optimized treatment.

Conclusões

As far as we know, persistent hypersomnia has not been previously reported in patients with post COVID-19 infection.
The temporal association between the onset of somnolence and the COVID-19 suggests a possible correlation.
Central hypersomnia may expand thespectrum of post-COVID sleep disturbances.

Palavras -chave

narcolepsy, covid-19, Hypersomnia