Long term outcomes of hyperbaric oxygen therapy in post covid condition: longitudinal follow-up of a randomized controlled trial

Abstract

In our previous randomized controlled trial, we documented significant improvements in cognitive, psychiatric, fatigue, sleep, and pain symptoms among long Coronavirus disease 2019 (COVID) patients who underwent hyperbaric oxygen therapy (HBOT). The primary objective of the present study was to evaluate the enduring 1 year long term effects of HBOT on long COVID syndrome. This longitudinal long-term follow-up included 31 patients with reported post COVID-19 cognitive symptoms, who underwent 40 daily sessions of HBOT. Participants were recruited more than one year (486 ± 73) after completion of the last HBOT session. Quality of life, assessed using the short form-36 (SF-36) questionnaire revealed, that the long-term results exhibited a similar magnitude of improvement as the short-term outcomes following HBOT across most domains. Regarding sleep quality, improvements were observed in global score and across five sleep domains with effect sizes of moderate magnitude during the short-term evaluation, and these improvements persisted in the long-term assessment (effect size (ES1) = 0.47-0.79). In the realm of neuropsychiatric symptoms, as evaluated by the brief symptom inventory-18 (BSI-18), the short-term assessment following HBOT demonstrated a large effect size, and this effect persisted at the long-term evaluation. Both pain severity (ES1 = 0.69) and pain interference (ES1 = 0.83), had significant improvements during the short-term assessment post HBOT, which persisted at long term. The results indicate HBOT can improve the quality of life, quality of sleep, psychiatric and pain symptoms of patients suffering from long COVID. The clinical improvements gained by HBOT are persistent even 1 year after the last HBOT session.

Figure 1

SF-36 General health score changes. Data are presented in a violin plot. Paired t-tests: P1: short term post HBOT compared with base line; P2: long term compared to short term post HBOT; SF-36: Quality of Life questionnaire.

Figure 2

PSQI total score changes. Data are presented in a violin plot. Paired t-tests: P1; short term post HBOT compared with base line; P2: long term compared to short term post HBOT; PSQI: The Pittsburgh Sleep Quality Index.

Figure 3

BSI-18 total score changes. Data are presented in a violin plot. Paired t-tests: P1: short term post HBOT compared with base line; P2: long term compared to short term post HBOT; BSI-18: Brief Symptoms Inventory.

Figure 4

HBOT mechanisms in Long Covid-19 pathophysiology.

Figure 5

Patients’ flowchart.