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Dysautonomia following COVID-19 is not associated with subjective limitations or symptoms but is associated with
Peter Ladlow1, Oliver O'Sullivan2, Andrew Houston2
1Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, United Kingdom; Department for Health, University of Bath, Bath, United Kingdom.
Insights
Post-COVID-19 patients with dysautonomia show objective functional limitations, but symptoms do not correlate with this condition. This finding impacts understanding long COVID recovery and autonomic dysfunction.
Area of Science:
- Cardiology and Exercise Physiology
- Autonomic Nervous System Function
- Post-Infectious Syndromes
Background:
- Persistent symptoms following COVID-19 infection are common, impacting daily life.
- Autonomic dysfunction, or dysautonomia, may contribute to long COVID symptoms.
- Heart rate (HR) patterns during cardiopulmonary exercise testing (CPET) can reveal dysautonomia.
Purpose of the Study:
- To investigate the association between subjective symptoms and dysautonomia in post-COVID-19 patients.
- To identify objective differences in exercise capacity between patients with and without dysautonomia.
Main Methods:
- Patients referred to a post-COVID-19 service underwent clinical assessment, including symptom questionnaires and CPET.
- Dysautonomia was defined by specific resting HR, exercise HR increase, and HR recovery criteria during CPET.
- Anonymized data were analyzed to determine associations between symptoms, dysautonomia, and CPET outcomes.
Main Results:
- Twenty-five percent (51/205) of patients exhibited dysautonomia.
- No significant association was found between subjective symptoms or perceived limitations and dysautonomia.
- Patients with dysautonomia showed significantly reduced work rate, peak oxygen consumption, and less efficient ventilation.
Conclusions:
- Dysautonomia is linked to objective functional impairments in individuals recovering from COVID-19.
- Subjective symptoms do not reliably indicate the presence or severity of dysautonomia in this population.
- CPET-derived HR profiles are valuable for identifying objective functional limitations associated with post-COVID-19 dysautonomia.
Background:
Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide insight into the presence and impact of dysautonomia on functional ability.
Objective:
Using an active, working-age, post-COVID-19 population, the purpose of this study was to (1) determine and characterize any association between subjective symptoms and dysautonomia; and (2) identify objective exercise capacity differences between patients classified "with" and those "without" dysautonomia.
Methods:
Patients referred to a post-COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET, and secondary care investigations when indicated. Resting HR >75 bpm, HR increase with exercise <89 bpm, and HR recovery <25 bpm 1 minute after exercise were used to define dysautonomia. Anonymized data were analyzed and associations with symptoms, and CPET outcomes were determined.
Results:
Fifty-one of the 205 patients (25%) reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (P >.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219 ± 37 W vs 253 ± 52 W; P <.001) and peak oxygen consumption (V̇o2: 30.6 ± 5.5 mL/kg/min vs 35.8 ± 7.6 mL/kg/min; P <.001); and a steeper (less efficient) V̇e/V̇co2 slope (29.9 ± 4.9 vs 27.7 ± 4.7; P = .005).
Conclusion:
Dysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.
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