P006 Case study: Dancing eyes post COVID-19 vaccination

INTRODUCTION: We describe a case of rapid eye movements in NREM sleep in a patient who had Guillain-Barre Syndrome (GBS) post AstraZeneca ( AZ) COVID-19 vaccine. This has not been reported previously. METHOD: An 81-year-old male with recent diagnosis of GBS secondary to AZ COVID-19 vaccination was referred of investigation of sleep disordered breathing. A Level 2 PSG showed rapid eye movements in the absence of atonia predominantly during N1 sleep. A second study one month later confirmed the persistence of the eye movements. RESULTS: Study 1 revealed mild supine and REM-predominant obstructive sleep apnoea (AHI = 14.9/hr) with reduced REM latency (44.5 minutes) & slow wave sleep (1.6%). Study 2 showed normal REM latency (61.5 minutes). REM indices were 0.33 per minute of N1 sleep and 0.12 for N2 sleep. REM density was 3% during N1 and 0.55% in N2. DISCUSSION: COVID-19 vaccinations have been associated with various side-effects, some of which have been attributed to autoimmune response. A previous study on GBS patients reported sleep architecture abnormalities including sleep onset REM periods and abnormal eye movements in NREM sleep, during acute phase attributed to autonomic dysfunction and transitory hypocretin-1 transmission reduction . Our patient had almost completely recovered from GBS when we performed Study 1. We believe this to be the first case of abnormal eye movements in sleep being identified on polysomnography in a patient with GBS following AZ Covid-19 vaccination