tetano
Editor, Senior Moderator
Clin Med Res
. 2026 Mar;24(1):28-34.
doi: 10.3121/cmr.2025.2054.
Dysautonomia in Long COVID is Prevalent and Could Explain the Frequency of Symptoms
Leonardo Tamariz[SUP] 1 [/SUP], Irina Rozenfeld[SUP] 2 [/SUP], Rafael Iglesias[SUP] 2 [/SUP], Elizabeth Bast[SUP] 3 [/SUP], Santiago Avecillas[SUP] 3 [/SUP], Lina Shehadeh[SUP] 4 [/SUP], Nancy Klimas[SUP] 2 [/SUP], Ana Palacio[SUP] 5 [/SUP]
Affiliations
Background: Long COVID presents with a variety of symptoms, some of which could be related to autonomic dysfunction. Our aim was to evaluate the prevalence of autonomic dysfunction in long COVID patients.Methods: We conducted a cross-sectional study and included all consecutive patients enrolled in several clinical research studies. We performed the following autonomic dysfunction markers: heart rate variability, heart rate, systolic and diastolic blood pressure changes during NASA Lean Test, cardiopulmonary exercise testing and a Composite-Autonomic-Symptom-Score (COMPASS)-31 scale. We used linear regression to calculate the contribution of each dysautonomia measure on symptom burden as measured by the modified COVID-19 Yorkshire scale.Results: We included 100 patients for this study. Our sample population had a mean age of 56+/-11 years, included 53% minorities, and 32% were women. Dysautonomia, as defined by an abnormal COMPASS-31, was seen in 82% (95% confidence interval [CI] 72-89) of our study population, while cardiovascular resting dysautonomia, as represented by an abnormal heart rate variability, was seen in 60% (95% CI 48-70) of our study population. Orthostatic hypotension was observed in 12% of our study population, and postural orthostatic tachycardia syndrome (POTS) was found in 10% of our study population. In our adjusted analysis, we found that the beta coefficient for the COMPASS-31 score (0.37) was significant on changes in a self-reported long COVID symptom burden. The orthostatic intolerance and gastrointestinal domains of the COMPASS-31 were associated with the highest long COVID symptom burden.Conclusion: Dysautonomia is common in long COVID patients and contributes to the overall symptoms seen in long COVID. Identifying dysautonomia has important diagnostic and therapeutic implications.
Keywords: Dysautonomia; Long COVID; Symptomss.
. 2026 Mar;24(1):28-34.
doi: 10.3121/cmr.2025.2054.
Dysautonomia in Long COVID is Prevalent and Could Explain the Frequency of Symptoms
Leonardo Tamariz[SUP] 1 [/SUP], Irina Rozenfeld[SUP] 2 [/SUP], Rafael Iglesias[SUP] 2 [/SUP], Elizabeth Bast[SUP] 3 [/SUP], Santiago Avecillas[SUP] 3 [/SUP], Lina Shehadeh[SUP] 4 [/SUP], Nancy Klimas[SUP] 2 [/SUP], Ana Palacio[SUP] 5 [/SUP]
Affiliations
- PMID: 41951431
- DOI: 10.3121/cmr.2025.2054
Background: Long COVID presents with a variety of symptoms, some of which could be related to autonomic dysfunction. Our aim was to evaluate the prevalence of autonomic dysfunction in long COVID patients.Methods: We conducted a cross-sectional study and included all consecutive patients enrolled in several clinical research studies. We performed the following autonomic dysfunction markers: heart rate variability, heart rate, systolic and diastolic blood pressure changes during NASA Lean Test, cardiopulmonary exercise testing and a Composite-Autonomic-Symptom-Score (COMPASS)-31 scale. We used linear regression to calculate the contribution of each dysautonomia measure on symptom burden as measured by the modified COVID-19 Yorkshire scale.Results: We included 100 patients for this study. Our sample population had a mean age of 56+/-11 years, included 53% minorities, and 32% were women. Dysautonomia, as defined by an abnormal COMPASS-31, was seen in 82% (95% confidence interval [CI] 72-89) of our study population, while cardiovascular resting dysautonomia, as represented by an abnormal heart rate variability, was seen in 60% (95% CI 48-70) of our study population. Orthostatic hypotension was observed in 12% of our study population, and postural orthostatic tachycardia syndrome (POTS) was found in 10% of our study population. In our adjusted analysis, we found that the beta coefficient for the COMPASS-31 score (0.37) was significant on changes in a self-reported long COVID symptom burden. The orthostatic intolerance and gastrointestinal domains of the COMPASS-31 were associated with the highest long COVID symptom burden.Conclusion: Dysautonomia is common in long COVID patients and contributes to the overall symptoms seen in long COVID. Identifying dysautonomia has important diagnostic and therapeutic implications.
Keywords: Dysautonomia; Long COVID; Symptomss.