1171 Hypersomnia Secondary to Long Covid

Abstract Introduction Recognition of Long Covid is increasing. In a recent meta-analysis in youth with Long Covid, the most prevalent clinical symptoms were mood (16.50%), fatigue (9.66%), and sleep disorders (8.42%). However, there is a paucity of data in the management of these symptoms. Report of case(s) We present a case of severe hypersomnolence after a mild Covid-19 infection in a 13 year-old female with no significant history, an acceptable age-appropriate sleep-wake schedule without nighttime awakenings or sleepiness prior to infection. Post-infection, she developed a one year history of sleep onset and maintenance insomnia, significant circadian delays, sleep inertia, brain fog and headaches. She was referred to sleep medicine and responded to treatment for a circadian rhythm disorder with sleep-wake restructuring, melatonin, and strict sleep hygiene. Sleep fragmentation, unrefreshing sleep, and hypersomnolence persisted; ESS=15/24. Sleep duration was often ≥12 hours in a 24 hour period. The patient could not wake easily, and often missed school or left early for sleepiness and headaches. A trial of gabapentin 200mg at bedtime failed. Sleep diagnostics were performed. Polysomnography showed no sleep disruptors, 8 hours of sleep, and some delayed slow wave sleep periods. Mean sleep latency testing (MSLT) showed MSL of 15.4min; 1 SOREM (nap #1). With a working diagnosis of hypersomnia due to medical condition vs. idiopathic hypersomnia, methylphenidate up to 36mg ER was trialed with some improvement. A recent adult case with Long Covid and ADHD-like syndrome also responded to stimulant use, though no guidelines are established for Long Covid. Oxybate was later added up to 2g once nightly which helped resolve sleep inertia, improve sleep quality and reduce sleepiness(ESS=4/24). She was able to return to school full time and reached normal functioning. Conclusion While the pathophysiology of Long Covid is still under investigation, symptom management of sleepiness can impact functioning. This case demonstrates a successful treatment of a patient with Long Covid and hypersomnolence with resolution of excessive sleepiness, morning inertia, and sleep fragmentation with a treatment approach similar to that of idiopathic hypersomnia, using an oxybate along with daytime stimulant use. Support (if any)