Clinical characterization of dysautonomia in long COVID-19 patients

Abstract

Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as “long COVID” infection. 39 participants were included from December 2020 to January 2021 for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long COVID-19 participants with fatigue and control participants was observed (p = 0.046). A trend towards significant NOL index dissociation over time was observed between long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in long COVID-19 patients, such as fatigue and hypoxia. Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.

Symptom Persistence Despite Improvement in Cardiopulmonary Health – Insights from longitudinal CMR, CPET and lung function testing post-COVID-19

“…Postural orthostatic tachycardia and other manifestations of dysautonomia have frequently been described among patients post-COVID-19 [39 , 40] . Here, we showed that at 2-3 months, heart rate recovery on CPET, an indirect measure of autonomic health, was impaired in patients compared to controls [41] .…”

High prevalence of post COVID-19 fatigue in patients with type 2 diabetes: A case-control study

“…One of the causes of PCS has been hypothesised as ‘dysautonomia’, It has been shown that participants with PCS and fatigue had dysregulation of heart rate variability ( 20 ). The authors stated that such dysautonomia could lead to fatigue and hypoxia.…”

Did the COVID-19 Pandemic Increase the Incidence of Acute Macular Neuroretinopathy?

“…Apart from the sometimes fatal respiratory syndrome, COVID-19 leads to multi-visceral complications associated with inappropriate immune and inflammatory response [ 2 ], endothelial dysfunction and thromboembolic disorders [ 3 ]. Damage to the central and peripheral nervous system [ 4 , 5 ] was reported, including the autonomous nervous system that showed dysregulation at the early [ 6 ] and late phases of the disease [ 7 , 8 ].…”