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Título

Central Sleep Hypersomnia after Covid-19 infection ? Case report: an unprecedented clinical diagnose.

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

Highlight persistent symptoms in covid-19

Métodos

A 34-year-old woman with a previous history depression, in remission, using sertraline 100mg daily. Covid-19 infection in March. After twenty days, the patient improved the symptoms with persistence of excessive sleepiness and fatigue. Five months after initial symptoms, the patient continued reporting fatigue, cognitive complaints and excessive sleepiness with naps occurring frequently in inappropriate situations, as on her work desk. She had a non-restorative sleep of 8 to 12 hours. Before the infection, the patient had a regular of sleep pattern, with 5 to 6 hours of restorative sleep per night.
Fisical examination: The Epworth Sleepiness Scale (ESS) scored 21 out of 24.
The fatigue compromised her physical exercise, with difficulty on climbing stairs.
The neurological exam showed hyposmia.
Complementary exams:
Brain MRI showed signs of olfactory bulb atrophy/hypoplasia.
Serum electrolytes, thyroid tests, and serology were normal. Polysomnography and multiple sleep latency test (MSLT) revealed a reduction of sleep onset latency in 5 out of 5 tests of MSLT with an average sleep onset latency of 1.9 minutes.
The patient started treatment with modafinil 200mg/day. After one month of treatment, the patient improved with a decrease in the daily sleep time (ESS = 17). The dose of modafinil was increased to 400mg/day, but the patient reported headache. We returned modafinil to previous dose and added methylphenidate 10mg/day with improvement in somnolence (ESS = 9).

Resultados

The central disorders of hypersomnolence are a group of disorders manifesting primarily as excessive daytime sleepiness. As far as we know, hypersomnia has not been previously reported in patients with post COVID-19 infection. However, hypersomnia and circadian disorders have already been described in infectious diseases.
The pathophysiological mechanisms are uncertain. Some possibilities, such as direct viral toxicity; endothelial damage and microvascular injury; dysregulation of the immune system and stimulation of a hyperinflammatory state; or their overlap

Conclusões

The temporal association between the onset of somnolence and the COVID-19 suggests a possible correlation.

Palavras-chave

COVID-19; Sleep; Hypersomnia, long-COVID

Área

Relato de Caso

Instituições

Universidade Federal do Ceará - Ceará - Brasil

Autores

Alissa Elen Formiga Moura, Danilo Nunes Oliveira, Danielle Mesquita Torres, Patricia Gomes Damasceno, Pedro Braga Neto, Manoel Alves Sobreira Neto