Volume 10, pages 169–180, (2024), Elliott K Lee & R. Robert Auger
Abstract
Purpose of Review
Post Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2), also known as PASC, and frequently referred to as “long-COVID,” is estimated to afflict over 65 million people worldwide. Sleep disturbances and fatigue are some of the most frequently cited PASC symptoms, and most debilitating. The following text will explore known associations and overlaps between PASC and conditions associated with sleep disturbances, including restless legs syndrome, chronic fatigue syndrome/myalgic encephalitis (CFS/ME), fibromyalgia (FM), and postural orthostatic tachycardia syndrome (POTS). Subsequent discussion will provide a rationale for Sleep Medicine pharmacotherapeutic options for the treatment of sleep disturbances in PASC, with specific reviews of melatonin, prazosin, stimulants (including methylphenidate, dextroamphetamine, lisdexamfetamine, and modafinil), ɣ-aminobutyric acid (GABA)ergic drugs (sodium oxybate and baclofen), and serotonergic drugs (including fluvoxamine, sertraline, and vortioxetine).
Recent Findings
Current studies suggest multifactorial involvement for PASC, with neuroinflammation, hypercoagulability, and latent reactivation of dormant viruses likely playing a role. Symptoms range in severity from mild fatigue to significant debilitation. Sleep disorders and fatigue are prominent symptoms of PASC. Poor sleep quality has been associated with increased severity of psychiatric symptoms, including anxiety, depression, and post-traumatic stress disorder symptoms. Since there is a dearth of treatment options for these patients, it behooves health care providers to find novel remedies to alleviate suffering and health care expenditures for this small but growing segment of the population.
Summary
Fatigue and sleep disturbances have been some of the most cited symptoms for patients with PASC. Significant research has highlighted a high degree of synchrony and/or comorbidity with several other clinical conditions that may share similar pathologies and are associated with disturbed sleep, including sleep deprivation, circadian disturbances, CFS/ME, FM, POTS, and RLS. The sleep medicine community may be able to offer novel options to mitigate the debilitating effects of PASC.