Sex-specific differences in physiological parameters related to SARS-CoV-2 infections among a national cohort (COVI-GAPP study)

Publication date: Sep 17, 2023

Considering sex as a biological variable in modern digital health solutions, we investigated sex-specific differences in the trajectory of four physiological parameters across a COVID-19 infection. A wearable medical device measured breathing rate, heart rate, heart rate variability, and wrist skin temperature in 1163 participants (mean age = 44.1 years, standard deviation [SD]=5.6; 667 [57%] females). Participants reported daily symptoms and confounders in a complementary app. A machine learning algorithm retrospectively ingested daily biophysical parameters to detect COVID-19 infections. COVID-19 serology samples were collected from all participants at baseline and follow-up. We analysed potential sex-specific differences in physiology and antibody titres using multilevel modelling and t-tests. Over 1.5 million hours of physiological data were recorded. During the symptomatic period of infection, men demonstrated larger increases in skin temperature, breathing rate and heart rate as well as larger decreases in heart rate variability than women. The COVID-19 infection detection algorithm performed similarly well for men and women. Our study belongs to the first research to provide evidence for differential physiological responses to COVID-19 between females and males, highlighting the potential of wearable technology to inform future precision medicine approaches. This work has received support from the Princely House of the Principality of Liechtenstein, the government of the Principality of Liechtenstein, the Hanela Foundation in Switzerland, and the Innovative Medicines Initiative (IMI) 2 Joint Undertaking under grant agreement No 101005177. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.

Concepts Keywords
Cardiology Algorithm
Females Cov
Grobbee1415 Covid
Python Days


Type Source Name
disease MESH SARS-CoV-2 infections
disease MESH infection
disease VO device
disease IDO algorithm
pathway REACTOME Metabolism
disease VO USA
disease VO population
disease VO Canada
drug DRUGBANK Nonoxynol-9
drug DRUGBANK Angiotensin II
disease IDO susceptibility
disease IDO symptom
disease MESH asymptomatic infection
disease VO time
disease IDO blood
disease VO protocol
drug DRUGBANK Ethanol
drug DRUGBANK Hyaluronic acid
disease VO vaccine
disease MESH Seroconversion
disease VO ANOVA
disease MESH hypertension

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