Dysautonomia symptoms and quality of life in non-hospitalized neurology outpatients with post-acute sequelae of COVID-19
Samarah Ahmed1, Sara Hyman1, Rachel Kenney2, Sherry Fung3, Azizi Seixas4, Girardin Jean-Louis4, Steven Galetta5, Laura Balcer6, Sujata Thawani7
1NYU Grossman School of Medicine, 2Vanderbilt School of Medicine, 3NYU Langone, 4University of Miami, 5NYU Langone Medical Center, 6NYU School of Medicine, 7NYU Neurology Associates
Objective:

 

The aim of the current study is to assess dysautonomia symptoms and quality of life in patients with PASC recruited from a neurology outpatient setting. 

 

 

Background:
Dysautonomia symptoms are often reported in association with COVID-19. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. 
Design/Methods:

In a follow-up study of a baseline cohort of SARS-CoV-2 laboratory-positive patients evaluated for PASC between November, 2020 and August, 2021, 49.5% (46/93) participants completed follow-up phone questionnaires examining quality of life, neurologic and autonomic symptoms.

 

Results:

Questionnaires at 1-year follow-up were completed by 46 participants (63% females, average age of 51±17 years), of which 95% were vaccinated against COVID-19. Of these, 42 participants completed the COMPASS-31 scale. A COMPASS-31 raw-score>17 indicating autonomic dysfunction was found in 69% of subjects. Median COMPASS-31 score was 26.6 (SD=17.1, range=0.89-56.9). A greater COMPASS-31 score was associated at 1-year follow-up with Neuro-QoL-Anxiety T-score (p=0.031, linear regression adjusting for age, sex, race/ethnicity, and Neuro-QoL-Fatigue T-score (p=0.003), but not Neuro-QoL-Depression (p=0.117) Baseline Neuro-QoL-Depression T-scores were associated with greater COMPASS-31 scores at follow-up (p=0.017), while Neuro-QoL-Anxiety (p=0.152) and Neuro-QoL-Fatigue (p=0.083) were not.

Patients who reported persistent lightheadedness/dizziness had greater COMPASS-31 scores at 1-year follow-up (p<0.0001 adjusting for age, sex, race/ethnicity). Those reporting light-headedness/dizziness at follow-up also had a mean COMPASS-31 raw score of 20.6 points higher than those not reporting this symptom.  Lightheaded symptoms at  baseline study visit were not associated with 1-year follow-up COMPASS-31 scores (p=0.694)

 

Conclusions:
This study supports the importance of monitoring autonomic symptoms as a possible complication of PASC that may persist longitudinally in neurology clinic-based populations. The greater COMPASS-31 raw scores may be informed by persistence of lightheadedness.
10.1212/WNL.0000000000204322