Characterization of autonomic symptom burden in long COVID: A global survey of 2,314 adults

Abstract

BackgroundAutonomic dysfunction is a known complication of post-acute sequelae of SARS-CoV-2 (PASC)/long COVID, however prevalence and severity are unknown.ObjectiveTo assess the frequency, severity, and risk factors of autonomic dysfunction in PASC, and to determine whether severity of acute SARS-CoV-2 infection is associated with severity of autonomic dysfunction.DesignCross-sectional online survey of adults with PASC recruited through long COVID support groups between October 2020 and August 2021.Participants2,413 adults ages 18–64 years with PASC including patients who had a confirmed positive test for COVID-19 (test-confirmed) and participants who were diagnosed with COVID-19 based on clinical symptoms alone.Main measuresThe main outcome measure was the Composite Autonomic Symptom 31 (COMPASS-31) total score, used to assess global autonomic dysfunction. Test-confirmed hospitalized vs. test-confirmed non-hospitalized participants were compared to determine if the severity of acute SARS-CoV-2 infection was associated with the severity autonomic dysfunction.Key resultsSixty-six percent of PASC patients had a COMPASS-31 score >20, suggestive of moderate to severe autonomic dysfunction. COMPASS-31 scores did not differ between test-confirmed hospitalized and test-confirmed non-hospitalized participants [28.95 (15.62, 46.60) vs. 26.4 (13.75, 42.10); p = 0.06].ConclusionsEvidence of moderate to severe autonomic dysfunction was seen in 66% of PASC patients in our study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the PASC population and independent of the severity of acute COVID-19 illness.

Long COVID: major findings, mechanisms and recommendations

“…POTS is associated with G protein-coupled adrenergic receptor and muscarinic acetylcholine receptor autoantibodies, platelet storage pool deficiency, small fibre neuropathy and other neuropathologies 118 . Both POTS and small fibre neuropathy are commonly found in long COVID 111 , 119 , with one study finding POTS in 67% of a cohort with long COVID 120 .…”

“…1 ). Long COVID encompasses multiple adverse outcomes, with common new-onset conditions including cardiovascular, thrombotic and cerebrovascular disease 8 , type 2 diabetes 9 , myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 10 , 11 and dysautonomia, especially postural orthostatic tachycardia syndrome (POTS) 12 (Fig. 2 ).…”

COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

“…These antibodies cause peripheral vasoconstriction to be less effective and eventually cause reflex tachycardia. It has been observed that many patients with COVID-19 infection develop POTS as a delayed manifestation [9][10][11]19,22]. Some of these patients have never experienced any symptoms of POTS before.…”

“…Its pathophysiology is postulated to include virus-or immune-mediated damage to the autonomic nervous system. Autonomic dysfunction, of which POTS is an important subset, has been noted in more than half the patients with COVID-19 as post-acute sequelae in some studies [19]. Understanding these critical sequelae of COVID-19 for early diagnosis and effective management is essential.…”

A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2

“… 95 In a survey of 2413 adults between 18 and 64 years of age with PASC after confirmed positive testing for SARS-CoV-2, 66% had a Composite Autonomic Symptom Score-31 >20 suggesting moderate-severe autonomic dysfunction independent of the severity of acute infection and requirement of hospitalization. 96 …”