Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients

“…Importantly, the observed higher association with neuropsychiatric complications in severe COVID-19 may inform the persistence of neuropsychiatric sequelae in Long-COVID patients following acute SARS-CoV-2 infection. 32…”

“…Importantly, the observed higher association with neuropsychiatric complications in severe COVID-19 may inform the persistence of neuropsychiatric sequelae in Long-COVID patients following acute SARS-CoV-2 infection. 32 One of the best severity-predictive lab markers at admission and throughout hospitalization was albumin, with the lowest level in TG4 and highest in TG1A. Although hypoalbuminemia is known to be a marker of infection, inflammation, acute and chronic illness, 33 likely due to reduced liver synthesis, increased catabolism, or vascular permeability, 34 albumin is not part of current COVID-19 risk-stratification algorithms.…”

Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID

“…When long COVID patients complain of fatigue during their visits, it is essential first to investigate psychological/emotional factors, medications, sleep disorders, and exposure to toxins that could contribute to the fatigue. Additionally, conducting a detailed medical history and physical examination to assess the presence of underlying conditions that may be associated with fatigue, sequelae from severe COVID-19, or other organic causes is also important [ 63 ]. Assessment of hospitalization treatment for patients who have had COVID-19, including evaluation of hospitalization duration and admission to the ICU, is necessary.…”

“…According to international guidelines, sleep disorder evaluations should include: 1) assessing sleep quantity and quality, challenges with sleep initiation, maintenance, or early waking, napping, daytime sleepiness, attention, concentration, memory, and decision-making, as well as the severity of symptoms (employing a sleep diary for a minimum of two weeks to record specific sleep and wake patterns); 2) reviewing reports of sleep disturbances, including nightmares (indicative of PTSD), sleep apnea, restless legs syndrome, pain (muscle cramps and neuralgia), parasomnias, or daytime sleep episodes; 3) investigating additional factors that may disrupt sleep, such as exercise routines, physical activity limited by exertion, polypharmacy (use of four or more medications), high caffeine consumption, new supplement usage, increased alcohol intake, and anxiety; 4) evaluating current sleep habits through the use of sleep aids, hypnotics, blue light exposure, behavioral strategies, etc. ; 5) additionally, considering sleep actigraphy as an objective assessment tool; 6) reviewing medications that can cause insomnia, including alcohol, antidepressants, beta-blockers, caffeine, chemotherapy drugs, cold and allergy medicines containing pseudoephedrine, diuretics, cocaine and other stimulants, nicotine, and stimulant laxatives; 7) assessing sleep patterns using tools such as the Epworth Sleepiness Scale, Stanford Sleepiness Scale, Patient-Reported Outcomes Measurement Information System, sleep scale surveys, and Insomnia Severity Index; 8) evaluating sleep apnea risk with the STOP-BANG questionnaire [ 63 ].…”

“…In cases where musculoskeletal abnormalities or inflammatory myopathies are detected, an orthopedic surgeon or rheumatologist should be consulted. For patients where no other organic cause of fatigue is identified, rehabilitation treatments such as muscle strengthening, stretching, balance training, gait training, aquatic therapy, yoga, and physical therapy can be considered [ 63 ]. Additionally, occupational therapy may be performed.…”