Journal Article

Fatigue following COVID-19 infection is not associated with autonomic dysfunction

McCarthy, Kevin, Moloney, David, Kenny, Rose-Anne, Finucane, Ciaran, Bannan, Ciaran, Bergin, Colm, Townsend, Liam

2021

Overview

The long-term clinical and physiological consequences of COVID-19 infection remain unclear. While fatigue has emerged as a common symptom following infection, little is known about its links with autonomic dysfunction. SARS-CoV-2 is known to infect endothelial cells in acute infection, resulting in autonomic dysfunction. Here we set out to test the hypothesis that this results in persistent autonomic dysfunction and is associated with post-COVID fatigue in convalescent patients. We recruited 20 fatigued and 20 non-fatigued post-COVID patients (median age 44.5 years, 36/40 (90%) female, median time to follow up 166.5 days). Fatigue was assessed using the Chalder Fatigue Scale. These underwent the Ewing's autonomic function test battery, including deep breathing, active standing, Valsalva manoeuvre and cold-pressor testing, with continuous electrocardiogram and blood pressure monitoring, as well as near-infrared spectroscopy-based cerebral oxygenation. 24-hour ambulatory blood pressure monitoring was also conducted, and patients completed the generalised anxiety disorder-7 questionnaire. We assessed between-group differences in autonomic function test results and used unadjusted and adjusted linear regression to investigate the relationship between fatigue, anxiety, and autonomic test results. We found no pathological differences between fatigued and non-fatigued patients on autonomic testing or on 24-hour blood pressure monitoring. Symptoms of orthostatic intolerance were reported by 70% of the fatigued cohort at the time of active standing, with no associated physiological abnormality detected. Fatigue was strongly associated with increased anxiety (p <0.001), with no patients having a pre-existing diagnosis of anxiety. These results demonstrate the significant burden of fatigue, symptoms of autonomic dysfunction and anxiety in the aftermath of COVID-19 infection, but reassuringly do not demonstrate pathological findings on autonomic testing.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aging / Anxieties / Anxiety / Anxiety - physiopathology / Autonomic Nervous System - pathology / Autonomic neuropathies / Binding sites / Bioengineering / Biology and Life Sciences / Blood Pressure / Cardiac arrhythmia / Clinical medicine / Coronaviruses / Correlation analysis / COVID-19 / COVID-19 - pathology / COVID-19 - physiopathology / COVID-19 - psychology / Data analysis / Development and progression / Drafting software / Dysautonomia / Editing / Electrocardiography / Ethics / Fainting / Fatigue / Fatigue - physiopathology / Heart Rate / Hospitals / Humans / Infections / Infectious diseases / Longitudinal studies / Medicine / Medicine and Health Sciences / Methodology / Middle Aged / Pandemics / Patients / Public health / Pulse rate / Research ethics / Risk factors / Severe acute respiratory syndrome coronavirus 2 / Software / Supervision / Syncope / Translation / Viral diseases