Persistent Hypersomnolence Following Aneurysmal Subarachnoid Hemorrhage: A Case Report

Persistent excessive daytime sleepiness (EDS) following aneurysmal subarachnoid hemorrhage (SAH) is an underrecognized complication that may impair quality of life and patient safety. We report a 60-year-old man with EDS that had been present for approximately one year and progressively worsened following aneurysmal SAH despite adequately treated obstructive sleep apnea. Overnight polysomnography (PSG) demonstrated well-controlled sleep-disordered breathing, while the multiple sleep latency test (MSLT) revealed severe objective hypersomnolence, supporting a diagnosis of secondary central hypersomnia. Alternative causes of EDS were excluded through clinical evaluation and objective sleep testing. The patient experienced meaningful improvement following treatment with modafinil. This case highlights the importance of considering secondary central hypersomnia in patients with persistent EDS after aneurysmal SAH. It demonstrates the value of PSG followed by MSLT in establishing the diagnosis and guiding management.