Case Presentation:

Chief Complaints

A 33-year-old woman presented to the outpatient neurology clinic complaining from episodes of falling asleep during the daytime despite about 8.5 hours of sleep per night.

History of Present Illness

She was a psychologist and she noticed that she could not concentrate on the statements of her clients and that she sometimes saw some dream-like images around them. She also noted increasing lethargy, drowsiness and an irresistible urge to fall asleep many times a day even during conversations, while at work, or driving her car. All of her symptoms had begun immediately after recovery from COVID-19 about nine months before her presentation to neurology clinic. She reported that her symptoms of COVID-19 included fatigue, diarrhea, myalgia, hyposmia and hypogeusia without respiratory symptoms. She had recovered from COVID-19 with supportive and symptom-based treatment.
The patient also complained of frightening visual and auditory hallucinations while falling asleep at night as well as daytime. She had frequently experienced episodes of paralysis in which she was unable to move her body for a few seconds after awakening. She also complained from a sense of muscle weakness associated with drooping of eyelids, brought on by extreme emotions (e.g. laughing, shouting or any severe mental stress).

History of Past Illness

Her medical history was unremarkable. There was no history of chronic sleep disorders, restless leg syndrome, sleep apnea, and head trauma or medication abuse.

Personal and Family History

She did not use any substance or drugs. There was no history of sleep disorders in her family history.

Physical Examination

Upon physical examination, she was a young woman with average body habitus (60 kg, 160 cm and BMI23.4 kg/m 2). She did not appear ill or drowsy during the history taking and physical examination. The pharyngeal lumen was patent. There were no craniofacial risk factors for sleep apnea such as retrognathia. She had neither ptosis, nor weakness of facial or limb muscles. The remainder of general physical and neurological examinations were unremarkable.

Laboratory and Imaging Studies

In addition, routine blood tests and brain magnetic resonance imaging (MRI) revealed no significant pathology. The patient was referred for a polysomnograhic study at a sleep clinic the results of which are presented in table 1.