Sleep disorder syndromes of post-acute sequelae of SARS-CoV-2 (PASC) / Long Covid, 2024, Coelho et al

Highlights:
• Sleep complaints in PASC are frequent, varying from insomnia to excessive daytime sleepiness.
• Five categories of sleep disorders syndromes were identified in PASC: obstructive sleep apnea, insomnia, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay.
• All circadian disturbances patients were infected in the Winter 20/21 wave.
• The response to therapy for hypersomnia and narcolepsy has so far been unremarkable.
• Vaccination could have influenced the incidence of PACS patients and their sleep syndromes.

Abstract
Introduction
COVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or “Long COVID”. PASC is a heterogeneous disease with higher prevalence of sleep disturbances with daytime outcomes, varying from an insomnia disorder to excessive daytime sleepiness.

Methods
Patients seen in the Covid Survivorship Program at the BIDMC, Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19 clinic, followed by diagnostic sleep testing. This report summarizes patients who completed the American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses.

Results
In 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder , primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients had idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity.

Conclusions
Specific sleep symptoms/syndromes are reported in this select group of patients with PASC. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection.

Sleep Medicine (29 Aug 2024) | https://doi.org/10.1016/j.sleep.2024.08.030 | Abstract | PDF