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Fatigue following COVID-19 infection is not associated with autonomic dysfunction
BACKGROUND: 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, r...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906457/ https://www.ncbi.nlm.nih.gov/pubmed/33630906 http://dx.doi.org/10.1371/journal.pone.0247280 |
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author | Townsend, Liam Moloney, David Finucane, Ciaran McCarthy, Kevin Bergin, Colm Bannan, Ciaran Kenny, Rose-Anne |
author_facet | Townsend, Liam Moloney, David Finucane, Ciaran McCarthy, Kevin Bergin, Colm Bannan, Ciaran Kenny, Rose-Anne |
author_sort | Townsend, Liam |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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. 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. CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-7906457 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-79064572021-03-03 Fatigue following COVID-19 infection is not associated with autonomic dysfunction Townsend, Liam Moloney, David Finucane, Ciaran McCarthy, Kevin Bergin, Colm Bannan, Ciaran Kenny, Rose-Anne PLoS One Research Article BACKGROUND: 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. METHODS: 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. 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. CONCLUSIONS: 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. Public Library of Science 2021-02-25 /pmc/articles/PMC7906457/ /pubmed/33630906 http://dx.doi.org/10.1371/journal.pone.0247280 Text en © 2021 Townsend et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Townsend, Liam Moloney, David Finucane, Ciaran McCarthy, Kevin Bergin, Colm Bannan, Ciaran Kenny, Rose-Anne Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title | Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title_full | Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title_fullStr | Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title_full_unstemmed | Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title_short | Fatigue following COVID-19 infection is not associated with autonomic dysfunction |
title_sort | fatigue following covid-19 infection is not associated with autonomic dysfunction |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906457/ https://www.ncbi.nlm.nih.gov/pubmed/33630906 http://dx.doi.org/10.1371/journal.pone.0247280 |
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