In this issue, we will discuss a case of sleep disorder caused by COVID-19.
I believe that it is a valuable opportunity for medical professionals to learn about cases.There are many things we don't know about COVID-19, but we can gradually learn from these cases.
We will also present an explanation of how COVID-19 is related to sleep disorders. I will also introduce the explanation of how it is related to sleep disorders.
Case
A 49-year-old woman (healthcare worker)
History of ischemic heart disease with hypertension, diabetes mellitus, and paroxysmal atrial fibrillation
She was transferred to the isolated emergency department of a university hospital because she had fever, dry cough, tachypnea, watery diarrhea, malaise, arthralgia, and myalgia.
During her stay at the previous hospital, she developed a fever of 38.5-39°C, a dry cough with a burning sensation in the nasopharynx and sore throat, causing severe and painful aches and pains throughout her body, especially in the joints and muscles of her upper limbs.
In response, treatment with antibiotics, antipyretics, and antitussives was offered.
After starting the medication, she developed epistaxis, bloody sputum, severe anorexia, and loss of sense of taste and smell.
She also reported experiencing sleep disturbances during that time.
She experienced poor sleep quality due to insomnia, which was somewhat improved by moving her legs, and signs of restless legs syndrome were identified.
She was transferred to the hospital mentioned at the beginning of this article at her own will.When she was transferred to the isolation ward, she had a fever of 39°C and tachypnea, so a thorough examination was done.
According to clinical findings, there were no abnormalities or neurological abnormalities.
CT scan showed bilateral interstitial alveolar pneumonitis, and laboratory analysis revealed a slightly elevated erythrocyte sedimentation rate and normal other values except for a decreased hemoglobin level.
Levels of ferritin, D-dimer, and C-reactive protein are now normal, and oxygen saturation is 97%.
To prevent further exposure, EEG and polysomnography were ruled out.
During hospitalization, the patient was treated with oseltamivir 75 mg, zinc vitamins, and 5 ounces of vitamin C (each every 12 hours) for 10 days, with repeated PCR testing every 48 hours, and insomnia improved on the fourth day of treatment.
After 5 days, the patient was discharged with clinical improvement and negative results in successive PCR tests.
Discussion
The interaction between sleep disorders and COVID-1 has not yet been elucidated.
This case represents a COVID-19 infection presenting with sleep disturbance.
Sleep is a fundamental phenomenon that is regulated by complex interactions between neurotransmitters, immunologically active peptides, and hormones.
Sleep and the immune system are bi-directionally linked, but the mechanisms by which they are affected are not fully understood.
Some hypotheses suggest that changes in sleep during infection are a component of the acute phase response, possibly through mechanisms involving cytokines and interleukins and their receptors, as well as receptors of the innate immune system, to promote recovery during illness.
The resulting secretion of these immunological mediators is accompanied by responses by the endocrine and nervous systems, such as the secretion of cortisol and epinephrine.
These substances may cross the blood-brain barrier to reach receptors on various neural structures or have vagal inputs that modulate responses that maintain homeostasis.
Abeer Abdelhady Tony, a, ∗ Effat Abdelhady Tony, b Shazly B. Ali, c Azza M. Ezzeldin, d and Amal A. Mahmoud d
Conclusion
In this case, we present a case of COVID-19 infection with a combination of sleep disturbances due to itchy leg syndrome and insomnia.
The patient had regained a normal sleep pattern and improved general condition on the fourth day of hospitalization after treatment with a combination of oseltamivir and azithromycin.
This was possibly due to the fact that oseltamivir may reduce cellular and cytokine inflammatory responses, block viral replication, and prevent the induction of immune response dysregulation.
