SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

ABSTRACT

SESSION TITLE Uncommon Presentations and Complications of Chest Infections SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/18/2022 1015 am - 1110 am INTRODUCTION: The correlation between long-haul Coronavirus 2019 (COVID-19) and sleep disorders remains poorly understood. In this report, we present a case of newly diagnosed central sleep apnea (CSA) and symptoms starting after a COVID-19 infection as part of a long-haul COVID-19 presentation. CASE PRESENTATION A 69-year-old male presented to a sleep medicine clinic for evaluation of hypersomnia. He had a history of hypertension and pulmonary embolism. He contracted COVID-19 eight months prior to his presentation. He was not hospitalized, but received Remdesivir and prednisone. He complained of long-haul COVID-19 symptoms since his infection which included headaches, fatigue, cough, dyspnea, anosmia, poor appetite, dysgeusia, and memory impairment. He also started noticing nocturnal apneic episodes that frightened him and woke him up from sleep. His symptoms started after his infection and were not present prior. He went to the emergency department for evaluation and no etiology was identified. He was then referred to sleep medicine for further evaluation. A home sleep apnea test was done and showed severe sleep apnea with an Apnea-Hypopnea Index of 35.7 events per hour. His sleep apnea was predominantly central with a central apnea index of 15.3 events per hour. Cardiac testing showed no evidence of ischemia or cardiomyopathy with an ejection fraction of 52%. A CT angiogram showed no evidence of PE. Brain MRI showed no acute abnormalities. He was started on positive airway pressure therapy but could not tolerate it so he was sent for a phrenic nerve stimulator implantation. DISCUSSION: Long-term sequelae of COVID-19 infection have been increasingly recognized. However, the etiology and pathophysiology is poorly understood (1). Symptoms of long-haul COVID-19 include fatigue, dyspnea, cognitive manifestations, thrombosis and sleep disturbances (1). Sleep apnea was found in some studies to be a risk factor for severe COVID-19 illness and worse outcomes (2). The relationship between COVID-19 and sleep apnea in the post-viral syndrome remains unknown. Only few case reports have found obstructive sleep apnea as a new diagnosis and a possible cause of fatigue in post COVID-19 infection (3). There is no report of a relationship between CSA and COVID-19 in the literature. It is hypothesized that long-COVID can lead to brainstem dysfunction and dysautonomia, which can affect the ventilatory control mechanisms and lead to an unstable respiration (4–6). Our patient's nocturnal symptoms started after his infection as part of long-haul COVID-19. While we cannot determine if CSA was a result of COVID-19 infection or not, it is important to evaluate for sleep disordered breathing (SDB) in patients presenting with long-COVID symptoms to better understand the association. CONCLUSIONS: More research is need to better understand the correlation between SDB and long-haul COVID-19. Reference #1 1. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022 Feb;23(2)194–202. 2. Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Medicine Reviews. 2021 Feb;55101382. Reference #2 3. Koczulla AR, Stegemann A, Gloeckl R, Winterkamp S, Sczepanski B, Boeselt T, et al. Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue two case reports. J Med Case Reports. 2021 Dec;15(1)211. 4. Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep. 2021 Dec;11(1)14042. Reference #3 5. Yong SJ. Persistent Brainstem Dysfunction in Long-COVID A Hypothesis. ACS Chem Neurosci. 2021 Feb 17;12(4)573–80. 6. White DP. Pathogenesis of Obstructive and Central Sleep Apnea. Am J Respir Crit Care Med. 2005 Dec;172(11)1363–70. DISCLOSURES No relevant relationships by Amer Als ekh Mousa No relevant relationships by University of Arizona at Banne Institute No relevant relationships by Joyce Lee-Iannotti No relevant relationships by Anas Rihawi No relevant relationships by Amr Salem No relevant relationships by Mohanad Soliman No relevant relationships by Kristen Trimble