Künstler Erika C S, Menrad Solveig, Utech Isabelle, Finke Kathrin, Rupprecht Sven
Department of Neurology, Jena University Hospital, Jena, Germany.
Interdisciplinary Centre for Sleep and Ventilatory Medicine, Jena University Hospital, Jena, Germany.
J Sleep Res. 2024 Dec 2:e14406. doi: 10.1111/jsr.14406.
Excessive daytime sleepiness is a possible symptom of post-COVID syndrome and is also the cardinal symptom of narcolepsy, a rare life-long sleep disorder with a possible autoimmune background. Recent reports indicate that COVID-19 infection may trigger narcolepsy. However, it remains unclear how best to identify and treat such cases. A 25-year-old male developed daytime sleepiness after COVID-19 infection. A diagnosis of narcolepsy type II was made based on pathologically shortened sleep latencies in polysomnography and multiple sleep latency tests (MSLT) together with several sleep-onset REM-sleep periods (SOREMs). Pupillography and neuropsychological testing revealed reduced alertness levels. Hypocretin levels in the cerebrospinal fluid were borderline. Based on the postulated autoimmune background of narcolepsy, we performed an intravenous high-dose corticosteroid pulse therapy with methylprednisolone. Narcoleptic symptoms immediately and consistently remitted after the corticosteroid pulse. Follow-up after 4 months revealed normalisation of sleep latencies, no further SOREMs in the MSLT, and increased alertness in pupillography and neurocognitive testing. No further wakefulness promoting drug therapy was required. Narcolepsy should be considered in the differential diagnosis of post-COVID syndrome with leading symptoms of daytime sleepiness. Furthermore, immunosuppressive therapy may offer a treatment option in managing an otherwise lifelong disorder in select cases.
日间过度嗜睡是新冠后综合征的一个可能症状，也是发作性睡病的主要症状，发作性睡病是一种罕见的终身性睡眠障碍，可能有自身免疫背景。最近的报告表明，新冠病毒感染可能引发发作性睡病。然而，如何最好地识别和治疗此类病例仍不清楚。一名25岁男性在感染新冠病毒后出现日间嗜睡。基于多导睡眠图和多次睡眠潜伏期测试（MSLT）中病理性缩短的睡眠潜伏期以及多个睡眠起始快速眼动睡眠期（SOREMs），做出了II型发作性睡病的诊断。瞳孔描记法和神经心理学测试显示警觉性水平降低。脑脊液中下丘脑分泌素水平处于临界值。基于发作性睡病假定的自身免疫背景，我们用甲泼尼龙进行了静脉高剂量皮质类固醇脉冲疗法。皮质类固醇脉冲治疗后，发作性睡病症状立即且持续缓解。4个月后的随访显示睡眠潜伏期恢复正常，MSLT中无进一步的SOREMs，瞳孔描记法和神经认知测试中的警觉性提高。无需进一步的促觉醒药物治疗。在以日间嗜睡为主要症状的新冠后综合征的鉴别诊断中应考虑发作性睡病。此外，免疫抑制疗法可能为某些病例中这种原本终身性的疾病提供一种治疗选择。
