Dados do Trabalho

Título

Central hypersomnia and chronic insomnia: expanding the spectrum of sleep disorders in long COVID syndrome - a prospective cohort study.

Resumo

Introduction: Long-onset COVID syndrome has been described in patients with COVID-19 infection with persistence of symptoms or development of sequelae beyond 4 weeks after the onset of acute symptoms, a medium- and long-term consequence of COVID-19. This syndrome can affect up to 32% of affected individuals.

Objective:The present study aimed to characterize and evaluate the prevalence of sleep symptoms in patients with long COVID syndrome.

Methodology: A total of 207 patients with post-COVID symptoms were evaluated through clinical evaluation with a neurologist, cognitive and sleep test and specific exams in the subgroup complaining of excessive sleepiness (ES).
Results: Among 189 patients included in the long COVID sample, 48 (25.3%) had sleep-related symptoms. Insomnia was reported by 42 patients (22.2%), and excessive sleepiness was reported by 6 patients (3.17%). Four patients with ES were evaluated with polysomnography and test, multiple sleep latencies test, and Actigraphic data. Of a total of 4 patients with ES, 3 fulfilled the clinical criteria for central hypersomnia, and one reported symptoms of ES that resolved spontaneously after 6 months without intervention. We observed a high prevalence of cognitive complaints in these patients.

Discussion: This study demonstrated a high prevalence of sleep symptoms in a cohort of long-term COVID-19 patients with persistent sleep disorders up to 18 months after infection. Insomnia was the most frequent sleep disorder in these patients. To the best of our knowledge, we have reported the first cases of central hypersomnia after COVID. One of our patients fulfilled clinical and polysomnographic criteria for narcolepsy. All patients with ES responded to wakefulness-promoting agents.
We have reported three patients with documented central hypersomnia after COVID-19. All 3 patients were young and had no sleep disorders prior to COVID infection, suggesting a strong association with SARS-CoV-2 infection. To our knowledge, this is the first report of this association in the literature. In addition to the possibility of direct viral infection, hypersomnia after COVID might be related to immune and inflammatory hyperactivation resulting in hypothalamic infiltration by CD4+ and CD8+ T cells leading to neuronal damage.

Conclusion: Sleep disorders are common in patients with long COVID syndrome, particularly insomnia. Chronic insomnia and central hypersomnia may expand the spectrum of post-COVID sleep disturbances.

Palavras Chave

long-COVID; narcolepsy, insomnia