Autonomic function test during the COVID-19 pandemic: the Stanford experience

Sinn, Dong In; Muppidi, Srikanth; Miglis, Mitchell G.; Jaradeh, Safwan

doi:10.1007/s10286-020-00752-8

Cited by 7 publications

(7 citation statements)

References 4 publications

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“…In countries without access to structured and standardized autonomic function laboratories, this may often represent the only available autonomic diagnostic option [15, 20]. During the acute COVID‐19 phase, on the other hand, autonomic function testing for self‐limiting reflex syncope may not have been indicated because the patient in question was deemed unfit for testing or because colleagues did not consider it appropriate to test a COVID‐19‐positive individual due to the risk of viral transmission [38, 39]. At the beginning of the pandemic, many laboratories were also closed or there were significant travel restrictions, which likely prevented a significant proportion of individuals from accessing specialized diagnostic testing and treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection – A systematic review

Carneiro

Rocha

Habek

et al. 2023

Euro J of Neurology

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Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered.Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function. Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared. Results: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002).Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.

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Section: Discussionmentioning

confidence: 99%

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection – A systematic review

Carneiro

Rocha

Habek

et al. 2023

Euro J of Neurology

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“…All testing procedures complied with the local hand hygiene, sanitation, personal protective equipment (PPE), and research training protocols. We also considered international best practice recommendations for autonomic testing during the COVID-19 pandemic (Figueroa et al, 2020;Guaraldi et al, 2020;Sinn et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

et al. 2022

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In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres® NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HRnadir: 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOHAS) orthostatic hypotension, but neither correlated with OIAS. Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OItilt). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOHtilt (2 to HR > 120 bpm), but six did not report OItilt. In conclusion, OIAS was associated with a higher initial HR on AS, which after 1 min equalised with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).

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“…[66][67][68][69][70][71][72][73][74][75][76][77]; not acute COVID-19 population-Refs. [78][79][80][81][82][83][84][85][86][87][88][89][90]; not in English or Italian-Refs. [49,50]; study design-Refs.…”

Section: Study Selectionmentioning

confidence: 99%

“…Reports excluded: Not formal assessment of dysautonomia-Refs [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][49,50]…”

mentioning

confidence: 99%

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

Scala

Rizzo

Bellavia

et al. 2022

JCM

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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.

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Autonomic function test during the COVID-19 pandemic: the Stanford experience

Cited by 7 publications

References 4 publications

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection – A systematic review

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID‐19 infection – A systematic review

Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

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

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