Dysautonomia and Hypermobility Features of Long COVID: A Multisite Cross-sectional Cohort Study

Research Objectives: 1) To investigate the prevalence of dysautonomia symptoms and hypermobility in Long Covid (LC) via online questionnaire. 2) To explore PMR management implications in LC based on these results.

Design: Cross-sectional cohort study; approval by Mayo Clinic IRB. Contact was made via multi-patient portal messaging to include an overview on study purposes and a link to the survey materials on REDCap. The survey remained open for up to 1 month following survey release.

Setting: Multisite academic medical center

Participants: Adult patients who have been seen in a specialty post COVID-19 clinic at Mayo Clinic in Minnesota or Florida and given a diagnosis of Post COVID-19 Condition [U09.9].

Interventions: Not applicable

Main Outcome Measures: Not applicable

Results: A total of 347 patients completed the study; the majority of which were female with LC at 187 (76%); both groups were predominantly white and well educated. Of those with LC who reported being overweight, most reported weight gain prior to COVID-19. There were 177 (57.8%) of LC subjects who reported post-exertional malaise (PEM) characterized by debilitating symptoms flaring within 48 hours of increased physical, social, and/or cognitive exertion. PEM was not reported by any controls. Dizziness was the most common symptom for LC thereafter at 155 (50.7%). There were 112 (47.3%) LC patients who reported at least one feature of hypermobility, and among all who reported a family member with hypermobility, 34 (100%) were in the LC group. Regarding orthostatic intolerance symptoms, LC patients reported much worse (12 [30.0%]) and worse (19 [47.5%]) symptoms after COVID-19.

Conclusions: It has been estimated that >10% of patients with COVID-19 will suffer from LC. This study reinforces previous findings of symptoms such as post-exertional malaise, dizziness, and hypermobility as important features of LC. This also raises the question of a possible shared pathophysiology in myalgic encephalomyelitis/chronic fatigue syndrome, postural tachycardia syndrome (POTS), hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders with LC. We discuss the implications of these potentially overlapping conditions in activity and related management that can offered by physical medicine & rehabilitation (PMR) in LC. This study will help the PMR team and other specialists to better characterize and care for these at-risk populations.

Author(s) Disclosures: All authors declare that they have no relevant or material financial interests that relate to the research described in this study.