Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2314 Adults

A detailed study was conducted to assess the prevalence and severity of autonomic dysfunction in individuals with Post-Acute Sequelae of SARS-CoV-2 infection (PASC), commonly known as long COVID.

Here’s a comprehensive summary:

Background and Objectives:

  • Problem Addressed: Despite growing recognition, the prevalence and severity of autonomic dysfunction in long COVID/PASC are not well understood.
  • Study Goal: The study aimed to analyze the frequency, severity, and risk factors for autonomic dysfunction in PASC patients. It also sought to investigate if the severity of acute COVID-19 infection correlates with the severity of autonomic dysfunction in PASC​​.


  • Survey Method: An online survey targeted adults who had experienced COVID-19 and had symptoms persisting beyond 30 days. Participants were recruited through support groups and social media channels from October 2020 to August 2021​​.
  • Inclusion Criteria: Adults aged 18 or older with either self-reported, clinician-diagnosed, or test-confirmed COVID-19, experiencing symptoms for more than 30 days.
  • Exclusion Criteria: Incomplete surveys, symptoms less than 30 days, symptom onset before November 2019, and participants over 65 years of age were excluded​​.

Survey Tools:

  • COMPASS-31: A questionnaire used to assess the severity of autonomic symptoms, covering various domains like orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor function. Scores above 20 indicate moderate to severe autonomic dysfunction.
  • Other Measures: Orthostatic Hypotension Questionnaire (OHQ), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Neuropathic Pain Scale (NPS), Generalized Anxiety Disorder Assessment (GAD-7), and RAND 36-Item Health Survey (RAND-36) were also utilized to assess different health aspects​​.

Key Findings:

  • Prevalence of Autonomic Dysfunction: 66% of PASC patients exhibited moderate to severe autonomic dysfunction based on COMPASS-31 scores. This prevalence was independent of whether the patients were hospitalized during their acute COVID-19 infection​​.
  • Demographic Details: The study analyzed responses from 2,314 participants from 34 countries, with most being from the USA. The majority of participants were females, aged 31-65 years​​.
  • Pre-Existing Conditions: Common pre-existing conditions included anxiety, depression, smoking/vaping history, vitamin D deficiency, asthma, allergies, obesity, hypertension, and autoimmune diseases​​.
  • Symptoms Reported: The most commonly reported symptoms were fatigue, brain fog, headache, shortness of breath, body aches, palpitations, lightheadedness, tachycardia, and difficulty sleeping​​.
  • Association with Pre-existing Conditions: Most pre-existing conditions were associated with a greater burden of autonomic symptoms. Notably, higher COMPASS-31 scores were observed in participants with a history of asthma, vitamin D deficiency, autoimmune diseases, allergies, anxiety, depression, and smoking/vaping​​.

Conclusions and Significance:

  • The study confirmed the high prevalence of autonomic dysfunction in PASC, with 66% of participants reporting moderate to severe symptoms. This dysfunction was notably prevalent irrespective of the severity of the initial COVID-19 infection and hospitalization status.
  • The findings underscore the complexity of long COVID and the need for further research and targeted healthcare strategies to manage this condition effectively​​.

This study provides valuable insights into the widespread issue of autonomic dysfunction in long COVID patients, highlighting its prevalence and association with various health factors.

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