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Research Article
Alexandre Vallée
Hôpital Foch
Corresponding Author
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Background: Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as “long COVID” infection.
Methods: 39 participants were included from December 2020 to January 2021for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL™ index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200TM pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups.
Results: A significant NOL index dissociation over time between post-COVID-19 participants with fatigue and control participants was observed (p=0.046). A trend towards significant NOL index dissociation over time was observed between post-COVID-19 participants without fatigue and control participants (p=0.109). No difference over time was observed between the two groups of post-COVID-19 participants (p=0.904).
Conclusions: Post-COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in post-COVID-19 patients, such as fatigue and hypoxia.
Keywords
COVID-19, dysautonomia, long COVID, heart rate variability
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No competing interests reported.
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Alexandre Vallée
Hôpital Foch
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 10 Mar, 2021
No community comments so far
Reviewer #1 agreed
On 03 Apr, 2021
Reviewer #5 agreed
On 03 Apr, 2021
Reviewers invited
Invitations sent on 15 Mar, 2021
Editor assigned
On 15 Mar, 2021
Editor invited
On 15 Mar, 2021
Submission checks complete
On 09 Mar, 2021
First submitted
On 12 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Increasing numbers of COVID-19 patients, continue to experience symptoms months after recovering from mild cases of COVID-19. Amongst these symptoms, several are related to neurological manifestations, including fatigue, anosmia, hypogeusia, headaches and hypoxia. However, the involvement of the autonomic nervous system, expressed by a dysautonomia, which can aggregate all these neurological symptoms has not been prominently reported. Here, we hypothesize that dysautonomia, could occur in secondary COVID-19 infection, also referred to as “long COVID” infection.
Methods: 39 participants were included from December 2020 to January 2021for assessment by the Department of physical medicine to enhance their physical capabilities: 12 participants with COVID-19 diagnosis and fatigue, 15 participants with COVID-19 diagnosis without fatigue and 12 control participants without COVID-19 diagnosis and without fatigue. Heart rate variability (HRV) during a change in position is commonly measured to diagnose autonomic dysregulation. In this cohort, to reflect HRV, parasympathetic/sympathetic balance was estimated using the NOL™ index, a multiparameter artificial intelligence-driven index calculated from extracted physiological signals by the PMD-200TM pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups.
Results: A significant NOL index dissociation over time between post-COVID-19 participants with fatigue and control participants was observed (p=0.046). A trend towards significant NOL index dissociation over time was observed between post-COVID-19 participants without fatigue and control participants (p=0.109). No difference over time was observed between the two groups of post-COVID-19 participants (p=0.904).
Conclusions: Post-COVID-19 participants with fatigue may exhibit a dysautonomia characterized by dysregulation of the HRV, that is reflected by the NOL index measurements, compared to control participants. Dysautonomia may explain the persistent symptoms observed in post-COVID-19 patients, such as fatigue and hypoxia.
Figure 1
This preprint is available for download as a PDF.
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