COVID-19 Vaccine Could Trigger the Relapse of Secondary Hypersomnia

Abstract

The coronavirus disease (COVID-19) has brought significant social and economic disruptions and devastating impacts on public health, and vaccines are being developed to combat the disease. Timely vaccination may prevent complications and morbidity but may also potentially result in unforeseen outcomes in some special clinical populations. We report on a case of hypersomnia relapse after the COVID-19 vaccination, with the aim of informing the development of the guideline on vaccination in specific groups. A 19-year old female presented with persistent daytime sleepiness after receiving the COVID-19 vaccine. She had a known history of hypersomnia secondary to infectious mononucleosis but has fully recovered for 8 months. A series of examinations were performed on this patient. Neurologic and psychiatric examinations were unremarkable. Despite normal nocturnal subjective sleep quality (Pittsburgh Sleep Quality Index score = 5, Insomnia Severity Index score = 7), her Epworth sleepiness scale score (15) suggested an abnormal level of subjective sleepiness. Consistent with the subjective report, the objective assessment by Multiple Sleep Latency Test found mean sleep latency was 1.3 min with no sleep onset rapid-eye-movement (REM) period. We speculate that COVID-19 vaccine may potentially trigger the relapse of hypersomnia. The immune memory could be an explanation for the increased response to vaccine in patients with secondary hypersomnia. Caution should be warranted when administering COVID-19 vaccine in patients with hypersomnia secondary to infections.

Rheumatologists’ knowledge and perception of COVID-19 and related vaccines: the vaXurvey2 online survey

“…In this work, 200 (87.7%) Egyptian rheumatologists were vaccinated. Timely vaccination may avert complications and morbidity yet may lead to unforeseen outcomes in some special clinical populations [ 1 ]. Increasing the number of people vaccinated against COVID-19 is considered one of the most effective strategies to control the pandemic.…”

“…In this work, 16% of the subjects developed sleepliness post-vaccine. It has been speculated that the COVID-19 vaccine may be associated with and trigger hypersomnia and relentless daytime sleepiness [ 1 ].…”

“…The coronavirus disease 2019 (COVID-19) has remarkably lead to social and economic damage and a notable impact on public health, and vaccines are being developed to fight the disease [ 1 ]. Rheumatologists in Egypt are enormously expanding and mastering the tools that aid them in enhancing the management of rheumatic diseases and there is a need to boost their practice in spite the opportunities and challenges [ 2 ].…”

NEURO-COVAX: An Italian Population-Based Study of Neurological Complications After COVID-19 Vaccines

“…24 Secondly, a case of hypersomnia relapse after receiving the COVID-19 vaccine has been also reported: a case of female with previous history of hypersomnia secondary presented EDS after CoronaVac injection. 25 Finally, about 33.01% of the people affected by COVID-19 infection may experience EDS. 26 Taken together, this evidence suggest that there could be a strict relationship between the development of EDS and immune responses to vaccine/infection.…”

Reactogenic sleepiness after COVID-19 vaccination. A hypothesis involving orexinergic system linked to inflammatory signals

“…Moreover, systemic inflammatory response during COVID-19 could potentially trigger chronic autoimmune and neurodegenerative disorders like narcolepsy in susceptible individuals. Recurrence of hypersomnia after COVID-19 vaccination has been reported in a case with a history of hypersomnia secondary to infectious mononucleosis [ 88 ]. In addition to SARS-CoV-2 or other virus infections, vaccination can also cause autoimmune reactions by mechanisms such as molecular mimicry and bystander activation of T cells [ 89 ].…”