Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

Abstract

The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

“…In post-COVID patients with suspected dysautonomia, the Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire can be a sensitive tool to test the likelihood of autonomic dysfunction [85]. This questionnaire has been previously implemented in COVID-19 survivors, showing significantly higher scores than controls [86] with an optimal cut-point for rule-out of CVAD of 13.25 [86,87].…”

The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers

“…Following the onset or worsening of chest pain, tachycardia or dyspnea in the weeks after hospital discharge, a consultation with a cardiologist is warranted for COVID-19 patients in order to investigate possible long-term cardiovascular complications which might require additional work-up and/or treatment 123 . This is particularly relevant for younger individuals, especially athletes, who might also develop exercise-induced arrhythmias, including Postural Orthostatic Tachycardia Syndrome (POTS), due to involvement of the autonomic nervous system 127 , 128 , 129 .…”

Long COVID-19 and Postural Orthostatic Tachycardia Syndrome- Is Dysautonomia to Be Blamed?

“…From a cardiovascular point of view, recent papers have highlighted an association between orthostatic intolerance (OI), including orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS), with long COVID ( 17 – 19 ). OH is defined by a systolic or diastolic blood pressure decrease of 20 mmHg or 10 mHg, respectively, within 3 min of standing and it is the most common autonomic manifestation of long COVID ( 18 , 20 , 21 ).…”

“…OH is defined by a systolic or diastolic blood pressure decrease of 20 mmHg or 10 mHg, respectively, within 3 min of standing and it is the most common autonomic manifestation of long COVID ( 18 , 20 , 21 ). Studies suggest the prevalence of OH with long COVID may range between 10% ( 17 ) up to 41% ( 20 , 21 ). Furthermore, tachycardia has been found to be a common symptom associated with long COVID, with 25–50% of patients in a tertiary post-COVID multidisciplinary team clinic reporting persistent tachycardia or palpitations ( 22 ).…”