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. 2025 Jun;35(3):453-464.
doi: 10.1007/s10286-025-01111-1. Epub 2025 Feb 5.

Chronic autonomic symptom burden in long-COVID: a follow-up cohort study

Ella F Eastin  1 , Jannika V Machnik  1 , Lauren E Stiles  1 , Nicholas W Larsen  1 , Jordan Seliger  1 , Linda N Geng  2 , Hector Bonilla  2 , Phillip C Yang  2 , Mitchell G Miglis  3
Affiliations

Chronic autonomic symptom burden in long-COVID: a follow-up cohort study

Ella F Eastin et al. Clin Auton Res. 2025 Jun.

Erratum in

Abstract

Purpose: Autonomic dysfunction is a common and often debilitating feature of long-COVID (LC), however, studies evaluating frequency and severity of chronic autonomic dysfunction in LC are limited. We utilized an established online cohort of participants with LC to assess duration and severity of autonomic dysfunction, impact on quality of life, risk factors of autonomic diagnoses including postural tachycardia syndrome (POTS), and efficacy of common treatments.

Methods: Our international cohort included 526 adults with LC aged 20-65 years who previously completed baseline evaluations of LC symptoms, autonomic symptom burden, and quality of life. Participants repeated survey instruments and completed new instruments assessing risk factors and symptom mitigation strategies. A subset of individuals completed a 10-min active stand test. Multivariable logistic regression identified predictors of autonomic symptom burden and incident autonomic diagnoses including POTS.

Results: A total of 71.9% of participants with LC had a Composite Autonomic Symptom Score-31 (COMPASS-31) score ≥ 20, suggestive of moderate-to-severe autonomic dysfunction. The median symptom duration was 36 [30-40] months, and 37.5% of participants could no longer work or had to drop out of school due to their illness. In addition, 40.5% of individuals with autonomic dysfunction were newly diagnosed with POTS, representing 33% of the total LC cohort. Female sex and joint hypermobility were associated with an increased risk of autonomic dysfunction.

Conclusions: Evidence of chronic moderate-to-severe autonomic dysfunction was seen in most participants with LC in our cohort and was significantly associated with reduced quality of life and functional disability. POTS was the most common post-COVID autonomic diagnosis.

Keywords: Autonomic dysfunction; Dysautonomia; Long-COVID; Post-acute sequalae of COVID-19 (PASC); Postural orthostatic tachycardia syndrome (POTS).

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Conflict of interest statement

Declarations. Conflict of interest: M.G. Miglis has received research support from the NIH, Embr Wave, and Argenx Pharmaceuticals; consulting fees from Jazz pharmaceuticals, 2nd MD, Infinite MD, and Guidepoint LLC; and royalties from Elsevier Inc. L.N. Geng received research funding from Pfizer, Inc.; H. Bonilla received research funding from Pfizer, Inc., the NIH, and AHRQ; P.C. Yang received funding from AHRQ; and E. Eastin, J. Machnik, J. Seliger, and L. Stiles have no disclosures to report.

References

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