Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Abstract

Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.

Cardiac Changes Related to COVID-19 in Athletes: A Brief Review

“…Future studies should investigate the criteria for scanning cardiac changes, as well as new approaches such as cardiac autonomic assessment. Some studies suggest that cardiac autonomic impairment is also involved during COVID-19 infection and is related to worse prognosis [ 23 ]. The study of cardiac autonomic modulation can be easily performed through non-invasive assessment based on heart rate variability, which is a predictor index of morbidity and mortality in patients with cardiovascular disease.…”

“…The study of cardiac autonomic modulation can be easily performed through non-invasive assessment based on heart rate variability, which is a predictor index of morbidity and mortality in patients with cardiovascular disease. A recent study suggested that the cardiac autonomic nervous system imbalance, assessed by heart rate variability, may be a prominent feature of acute COVID-19 [ 23 ]. However, to the best of my knowledge, there are no studies on this relationship in athletes infected with COVID-19.…”

Historic and Prehistoric Epidemics: An Overview of Sources Available for the Study of Ancient Pathogens

“…Cheshire et al have argued that the etiological agent of sweating disease would likely be a virus affecting the autonomic nervous system [ 172 ]. Interestingly, autonomic dysfunction, sometimes with hyperhidrosis, is a prominent feature of acute SARS-CoV-2 infection [ 178 , 179 ]. Rhabdoviruses, a virus family to which for instance rabies virus belongs, may likewise be a possibility to be considered.…”

Historic and Prehistoric Epidemics: An Overview of Sources Available for the Study of Ancient Pathogens

“…Cheshire et al have argued that the etiological agent of sweating disease would likely be a virus affecting the autonomic nervous system [166]. Interestingly, autonomic dysfunction, sometimes with hyperhidrosis, is a prominent feature of acute SARS-CoV-2 infection [172,173]. Rhabdoviruses, a virus family to which for instance rabies virus belongs, may likewise be a possibility to be considered.…”