Clinical characterization of dysautonomia in long COVID-19 patients.
Clinical characterization of dysautonomia in long COVID-19 patients.
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DOI：
10.1038/s41598-021-93546-5
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发表时间：
2021-07-07
影响因子：
4.6
通讯作者：
Vallée A
中科院分区：
文献类型：
--
作者：
Barizien N;Le Guen M;Russel S;Touche P;Huang F;Vallée A
越来越多的 COVID-19 患者在轻度 COVID-19 病例康复数月后仍继续出现症状。在这些症状中，有一些与神经系统表现有关，包括疲劳、嗅觉丧失、味觉减退、头痛和缺氧。然而，以自主神经功能障碍为表现的自主神经系统的受累，可以聚合所有这些神经系统症状，但尚未有显着报道。在这里，我们假设继发性 COVID-19 感染（也称为“长期 COVID”感染）可能会发生自主神经功能障碍。 2020年12月至2021年1月，物理医学部纳入了39名参与者进行评估，以增强他们的身体能力：12名被诊断为COVID-19且有疲劳的参与者，15名被诊断为COVID-19但无疲劳的参与者，12名未被诊断为COVID-19且无疲劳的对照参与者。通常测量体位变化期间的心率变异性 (HRV) 以诊断自主神经失调。在该队列中，为了反映 HRV，使用 NOL 指数估计副交感神经/交感神经平衡，NOL 指数是一种多参数人工智能驱动指数，根据 PMD-200 疼痛监测系统提取的生理信号计算得出。进行重复测量混合模型测试组效应来分析组间 NOL 指数随时间的变化。随着时间的推移，长期疲劳的 COVID-19 参与者与对照参与者之间观察到 NOL 指数显着分离 (p = 0.046)。随着时间的推移，在没有疲劳的长期 COVID-19 参与者和对照参与者之间观察到 NOL 指数显着分离的趋势 (p = 0.109)。随着时间的推移，两组长期 COVID-19 参与者之间没有观察到差异 (p = 0.904)。与对照参与者相比，长期疲劳的 COVID-19 参与者可能会表现出以 HRV 失调为特征的自主神经功能障碍，这通过 NOL 指数测量反映出来。自主神经功能障碍可以解释长期观察到的 COVID-19 患者的持续症状，例如疲劳和缺氧。 试验注册：该研究于2020年12月16日获得福煦IRB批准：IRB00012437（批准号：20-12-02）。
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. 39 participants were included from December 2020 to January 2021 for 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-200 pain monitoring system. Repeated-measures mixed-models testing group effect were performed to analyze NOL index changes over time between groups. A significant NOL index dissociation over time between long 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 long COVID-19 participants without fatigue and control participants (p = 0.109). No difference over time was observed between the two groups of long COVID-19 participants (p = 0.904). Long 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 long COVID-19 patients, such as fatigue and hypoxia. Trial registration: The study was approved by the Foch IRB: IRB00012437 (Approval Number: 20-12-02) on December 16, 2020.
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