Tamariz L; School of Medicine, Miami, Florida USA,
Rozenfeld I; Iglesias R; Bast E; et al

Clinical Medicine & Research. 24(1):28-34, 2026 Mar.

Background: Long COVID presents with a variety of symptoms, some of which
could be related to autonomic dysfunction. Our aim was to evaluate the
prevalence of autonomic dysfunction in long COVID patients. Methods: We
conducted a cross-sectional study and included all consecutive patients
enrolled in several clinical research studies. We performed the following
autonomic dysfunction markers: heart rate variability, heart rate,
systolic and diastolic blood pressure changes during NASA Lean Test,
cardiopulmonary exercise testing and a Composite-Autonomic-Symptom-Score
(COMPASS)-31 scale. We used linear regression to calculate the
contribution of each dysautonomia measure on symptom burden as measured by
the modified COVID-19 Yorkshire scale. Results: We included 100 patients
for this study. Our sample population had a mean age of 56+/-11 years,
included 53% minorities, and 32% were women. Dysautonomia, as defined by
an abnormal COMPASS-31, was seen in 82% (95% confidence interval [CI]
72-89) of our study population, while cardiovascular resting dysautonomia,
as represented by an abnormal heart rate variability, was seen in 60% (95%
CI 48-70) of our study population. Orthostatic hypotension was observed in
12% of our study population, and postural orthostatic tachycardia syndrome
(POTS) was found in 10% of our study population. In our adjusted analysis,
we found that the beta coefficient for the COMPASS-31 score (0.37) was
significant on changes in a self-reported long COVID symptom burden. The
orthostatic intolerance and gastrointestinal domains of the COMPASS-31
were associated with the highest long COVID symptom burden. Conclusion:
Dysautonomia is common in long COVID patients and contributes to the
overall symptoms seen in long COVID. Identifying dysautonomia has
important diagnostic and therapeutic implications.