Swiss Doctors Warn That COVID-19 Can Cause Hypersomnia

COVID-19 News: In recent times, the medical community has been extensively studying the long-term effects of COVID-19, commonly referred to as post-COVID conditions (PCC). Among these conditions, fatigue emerges as one of the most frequently reported symptoms. However, a minority of patients also suffer from excessive daytime sleepiness, a phenomenon known as hypersomnia. Recently, doctors at Hôpital du Valais, Sion-Switzerland, Geneva University Hospitals-Switzerland, and University of Geneva-Switzerland have in a recent case series study covered in this COVID-19 News report, raised concerns about the link between COVID-19 and central hypersomnia, shedding light on its potential causes, effects, and treatments.


COVID-19 Can Cause Hypersomnia
 
A number of past studies and cases reports also showed that SARS-CoV-2 infections can trigger hypersomnia.
https://link.springer.com/article/10.1007/s40675-022-00226-5

https://www.sciencedirect.com/science/article/pii/S1389945723001600?via%3Dihub
 
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-022-02940-7
 
https://www.hcplive.com/view/insomnia-hypersomnia-identified-symptoms-long-covid-syndrome
 
https://www.ajmc.com/view/how-has-long-covid-19-affected-sleep-patterns-
 
https://onlinelibrary.wiley.com/doi/10.1002/ccr3.7370
 
https://jag.journalagent.com/tjn/pdfs/TJN_27_50_43_45%5BA%5D.pdf
 
https://journals.lww.com/neurotodayonline/fulltext/2020/07090/sleep_neurologists_call_it.1.aspx
 
https://jcsm.aasm.org/doi/10.5664/jcsm.9556
 
https://www.acpjournals.org/doi/10.7326/aimcc.2022.0695
 
COVID-19 Induced Hypersomnia
Fatigue remains pervasive among individuals recovering from COVID-19, affecting over 40% of patients months after infection. This prolonged fatigue not only impacts physical and psychological well-being but also has significant socio-economic implications globally. Yet, despite its prevalence, effe ctive pharmaceutical treatments for post-COVID fatigue remain elusive. However, central hypersomnia, albeit rare, has been identified as a potential consequence of SARS-CoV-2 infection. Unlike fatigue, treatments for central hypersomnia exist, particularly for conditions such as idiopathic hypersomnia and narcolepsy. The following study delves into the detailed clinical history, sleep examination data, and treatment outcomes of four patients who developed central hypersomnia following COVID-19 infection, shedding light on potential therapeutic interventions and the broader implications for post-COVID care.
 
Case Descriptions
Patient 1, an 18-year-old male student, experienced a significant increase in sleep duration and excessive daytime sleepiness following a SARS-CoV-2 infection in November 2020. Despite his young age, his daytime functioning was severely impaired, hindering his ability to attend school. Clinical assessments and sleep studies confirmed a diagnosis of idiopathic hypersomnia, leading to the initiation of methylphenidate therapy. Remarkably, methylphenidate resulted in a substantial improvement in symptoms, allowing the patient to resume normal daily activities.
 
Patient 2, a 38-year-old female, similarly developed excessive daytime sleepiness after contracting COVID-19 in October 2020. Despite her prior good health, she struggled with increased sleep requirements and significant impairment in concentration, leading to work absences. Methylphenidate therapy, coupled with meticulous sleep studies, confirmed a diagnosis of idiopathic hypersomnia. Gradual tapering of methylphenidate following positive treatment response highlighted the potential reversibility of post-COVID central hypersomnia.
 
Patient 3, a 54-year-old male with a history of hypertension and sleep apnea syndrome, presented with dyspnea and excessive daytime sleepiness two months post-COVID-19 infection. Despite effective CPAP therapy for sleep apnea, persistent sleepiness prompted further investigation, revealing a diagnosis of type II narcolepsy. While modafinil was offered as treatment, the patient opted for observation, citing spontaneous symptom improvement over time.
 
Patient 4, an 18-year-old female student, experienced a recurrence of hypersomnia following a second COVID-19 infection. Despite a prior episode of infectious mononucleosis, her symptoms significantly worsened post-COVID-19, necessitating pharmacological intervention with methylphenidate. Notably, methylphenidate allowed for symptom control, enabling the patient to manage her studies effectively.
 
Discussion
The identification of central hypersomnia in four post-COVID patients underscores the need for heightened awareness and comprehensive evaluation of sleep disturbances in long COVID care. While methylphenidate demonstrated efficacy in symptom management, further research is warranted to elucidate the underlying pathophysiology of post-COVID central hypersomnia. The potential association between SARS-CoV-2 infection and idiopathic hypersomnia or narcolepsy suggests a broader neurological impact of the virus, implicating brainstem nuclei involved in sleep-wakefulness regulation.
 
Moreover, the parallels drawn between post-COVID central hypersomnia and other post-infectious sleep disorders, such as narcolepsy triggered by previous viral infections, highlight the need for vigilant monitoring and multidisciplinary management in affected individuals. However, the limitations of our study, including the small sample size and retrospective nature, necessitate caution in extrapolating findings to broader populations. Further longitudinal studies are imperative to elucidate the natural history, treatment response, and prognostic implications of post-COVID central hypersomnia.
 
Conclusion
In conclusion, the identification and management of central hypersomnia in post-COVID patients represent a critical aspect of comprehensive long COVID care. While the pathogenesis of post-COVID central hypersomnia remains incompletely understood, our findings underscore the potential for targeted therapeutic interventions, such as methylphenidate, in alleviating symptoms and improving patient outcomes. Moving forward, continued research efforts are essential to unraveling the complex interplay between SARS-CoV-2 infection and central hypersomnia, paving the way for enhanced diagnostic strategies and tailored treatment approaches in the post-COVID era.
 
The case series cum study was published in the peer reviewed journal: Frontiers in Neurology.
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1349486/full
 
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