Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study.

Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study.

Publication date: Apr 01, 2024

The post-COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%-10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35-51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean +/- standard deviation]: 2. 4 +/- 0. 97mm2 vs. 2 +/- 0. 52mm2 vs. 1. 9 +/- 0. 73 mm2; p 0. 08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0. 02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0. 13), and hiatal hernia (25% vs. 0% vs. 7%; p 0. 05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0. 007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0. 001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC.

Concepts Keywords
51years Long-COVID
Gastroesophageal Phrenic nerve
Pcc Post–COVID-19 condition
Pilot SARS-CoV-2
Women Vagus nerve


Type Source Name
disease MESH COVID-19
drug DRUGBANK Factor IX Complex (Human)
disease MESH syndrome
disease MESH dysphonia
disease MESH dysphagia
disease MESH tachycardia
disease MESH orthostatic hypotension
disease MESH cognitive dysfunction
drug DRUGBANK Ciclosporin
disease MESH gastroesophageal reflux
disease MESH hiatal hernia

Original Article

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