Long-distance COVID drivers experience abnormal breathing and unrefreshing sleep


Sleep Health | Sleep Review

Many COVID-19 long-distance patients have chronic fatigue syndrome, breathing problems and sleep problems months after their first COVID-19 diagnosis, as a study in JACC shows: heart failure.

Chronic fatigue syndrome is a disease that often occurs after a viral infection and causes fever, pain, and persistent fatigue and depression. Many COVID-19 patients, some of whom were never hospitalized, have reported persistent symptoms after recovering from their original COVID-19 diagnosis. These patients have PASC (post-acute consequences of a SARS-CoV-2 infection), but are more often referred to as “long-distance drivers”.

Severe fatigue, cognitive difficulties, unrefreshing sleep, and myalgia (muscle aches and pains) were all viewed as major symptoms for PASC patients, similar to what researchers did after the 2005 SARS-CoV-1 epidemic, which affected 27% of patients Criteria met in myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) after four years.

In this study, the researchers looked at 41 patients (23 women, 18 men) aged 23 to 69 years. Patients were referred to the prospective study by pulmonologists or cardiologists and all had normal pulmonary function tests, chest x-rays, chest CT scans, and echocardiograms. Patients had previously been diagnosed with acute COVID-19 infection for three to 15 months before undergoing the cardiopulmonary exercise test (CPET) and continued to experience unexplained shortness of breath.

“Recovery from acute COVID infection can be associated with residual organ damage,” said Donna M. Mancini, MD, professor in the department of cardiology at the Icahn School of Medicine on Mount Sinai and lead author of the study in a statement. “Many of these patients have reported shortness of breath, and the cardiopulmonary stress test is often used to determine the underlying cause. The CPET results reveal several abnormalities, including decreased exercise capacity, an excessive respiratory response, and abnormal breathing patterns that would interfere with their normal daily activities. “

Prior to the training, the patients were subjected to interviews to assess ME / CFS. They were asked to rate how much fatigue had reduced their activity at work, in their private life and / or at school over the past six months; and how often they have had a sore throat, tender lymph nodes, headache, muscle pain, joint stiffness, unrestful sleep, difficulty concentrating, or worsening symptoms after light exertion. ME / CFS was considered to be present if at least one of the first criteria was rated as severely impaired and at least four symptoms of the second criterion were rated as moderate or higher. Almost half (46%) of the patients met the criteria for ME / CFS.

While connected to an electrocardiogram, pulse oximeter, and blood pressure cuff, patients sat on a stationary bike and used a disposable mouthpiece to measure exhaled gases and other ventilation parameters. After a short period of rest, the patients began exercises, the degree of difficulty of which increased by 25 watts every three minutes. The peak oxygen consumption (VO2), the CO2 production and the respiratory rate as well as the volume were measured.

Almost all of the patients, 88%, had abnormal breathing patterns known as dysfunctional breathing. Dysfunctional breathing is most commonly seen in asthmatics and is defined as rapid, shallow breathing. The patients also had low CO2 levels at rest and during exercise, which indicates chronic hyperventilation. In addition, most of the patients, 58%, showed signs of circulatory impairment to impair maximum exercise capacity due to either cardiac dysfunction and / or abnormal pulmonary or peripheral blood flow.

“These results suggest that a subset of long distance riders may have hyperventilation and / or dysfunctional breathing underlying their symptoms. This is important because these abnormalities can be addressed with breathing exercises or “retraining”, “said Mancini.

According to the authors, there are several limitations to this study. This is a small, single center, observational study. Selection bias may have occurred as the researchers studied patients with mostly unexplained dyspnea. A correlation of the findings with the lung and cardiac imaging must also be carried out.

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