Evaluating Long-Term Autonomic Dysfunction and Functional Impacts of Long COVID: A Follow-Up Study
Ella Eastin1, Jannika Machnik1, Nicholas Larsen1, Lauren Stiles3, Jordan Seliger1, Linda Geng2, Hector Bonilla2, Phillip Yang2, Mitchell Miglis1
1Neurology and Neurological Sciences, 2Medicine, Stanford University, 3Stony Brook University
Objective:
In this study, we aimed to better understand the duration and severity of autonomic dysfunction in adults with Long COVID (LC) and evaluate its impact on function and quality of life. We also sought to assess risk factors of moderate to severe autonomic dysfunction in LC as well as the risk of developing postural tachycardia syndrome (POTS).
Background:
Autonomic dysfunction is a common complication of LC, however, longitudinal prevalence and autonomic symptom burden in Long COVID patients is not well-established.
Design/Methods:
We utilized a cohort of LC patients, initially recruited in 2020-2021 for a prior study on autonomic dysfunction. Participants completed an online battery of questionnaires, including the COMPASS-31 for autonomic symptom severity and the RAND-36 for quality of life assessment. Multivariable logistic regression identified predictors of moderate-to-severe autonomic dysfunction and risk factors for developing postural tachycardia syndrome (POTS).
Results:
526 adults (median age 48.5 [41-56] years, 88.8% female) were included in the final analysis, with a median symptom duration of 36 [30-40] months. 71.9% of participants had a COMPASS-31 score ≥ 20, indicating moderate to severe autonomic dysfunction. Significant predictors of COMPASS-31 scores ≥ 20 included female sex and joint hypermobility. 33.4% reported a new POTS diagnosis following SARS-CoV-2 infection, with significant predictors being age (OR=0.97, p=0.001) and joint hypermobility (OR=1.99, p=0.001). 37.5% of LC patients had to quit their job or drop out of school due to their LC illness.
Conclusions:
Evidence of persistent autonomic dysfunction was seen in 71.9% of LC participants in our study up to 3.5 years after initial SARS-CoV-2 infection, suggesting that chronic autonomic dysfunction is common in LC, with POTS being the most common autonomic diagnosis reported. Moderate to severe autonomic dysfunction was significantly correlated with impaired function and capacity, highlighting the need to address autonomic dysfunction as a key component of Long COVID management.
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