0969 Severe persistent specific sleep disorders in post-acute sequelae of SARS-CoV-2

Abstract

Abstract Introduction Viral infections have long been associated with sleep disorders, especially hypersomnia following the acute phase The Covid-19 epidemic has resulted in a post-viral syndrome called post-acute sequelae of SARS-CoV-2 (PASC), or Long-Covid. Sleep has been reported to be severely disturbed during acute Covid-19 infection, and is a major feature of PASC. Much of the subjective data is based on questionnaires, with a paucity of objective sleep evaluations including polysomnography. We share our early experience with diagnosis and management of sleep disorders in PASC. Methods PASC patients are seen in a dedicated Long-Covid clinic at the Beth Israel Deaconess Medical Center for a comprehensive evaluation. The patients presented with new onset persistent sleep impairments shortly following acute COVID-19 infection, without pre-existing sleep impairments, in association with a clinical diagnosis of long covid. Sleep symptoms (excessive sleepiness, hypersomnia/long sleep, and insomnia) are identified and those who consider these a key symptom are referred to the Covid Sleep Clinic, for formal sleep evaluation by RJT. Diagnostic evaluations include polysomnography (extended for hypersomnia diagnosis), Multiple Sleep Latency Test for excessive daytime sleepiness, and home sleep apnea test for suspected sleep apnea. Sleep logs and sleep quality using a Ring oximeter-based SleepImage system complements evaluation of sleep-wake instability. Standard management is offered based on the ensuing diagnosis. Results Twenty-six patients (age range 22 to 58 years, 16 females) have been evaluated in this sleep pathology enriched pathway. Specific new sleep disorders diagnosis so far have included narcolepsy without cataplexy (3), hypersomnia with long sleep (3), hypersomnia without long sleep (3), rapid eye movement sleep disorder (2), persistent insomnia (3), a sleep-wake instability syndrome we call cyclical insomnia (2), and sleep apnea (7). Treatment has included CPAP, stimulants, modafinil, and sodium oxybate. Clinical responses to treatment have so far been as expected. One patient with cyclical insomnia has had a marked subjective and objective improvement with low dose (250 mg) sodium valproate. Conclusion PASC/Long-Covid can induce specific sleep syndromes. These include narcolepsy, hypersomnia, persistent insomnia, sleep-wake instability, and REM-behavior disorder. Support (if any)