Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With [POTS], 2022, Monaghan et al

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

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%).

Open access, https://www.frontiersin.org/articles/10.3389/fphys.2022.833650/full

 

"For contextualisation to our cohort, previous research showed that a CFQ score of 29 discriminated between chronic fatigue sufferers and controls in 96% of cases (Cella and Chalder, 2010); CES-D scores of 16 or greater can signal risk for clinical depression (Lewinsohn et al., 1997); and an IES-R score of 33 and above is suggestive of PTSD (Creamer et al., 2003). Even though in our regression model the HRnadir finding seemed to eclipse previously significant univariate associations with depression and fatigue/ADL inability, adverse psychological states may influence the behaviour of the autonomic nervous system (Peckerman et al., 2003; De Vos et al., 2017); furthermore, in susceptible individuals, discrepancies between predicted and experienced interoceptive signals may engender anxiety during an acute physiological arousal (such as an active stand), which may manifest as transient tachycardia (Miglis and Muppidi, 2017; Owens et al., 2018)."