Both sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS) are affected in DSN leading to sympathetic storm and abnormal autonomic response such as abnormal sweating, exercise intolerance, insomnia, resting tachycardia, postural hypotension, fatigue, urinary and bowel dysfunctions ( Martínez-Lavín, 2015 Murta et al., 2020).ĭSN is mainly diagnosed by the measurement of heart rate (HR) and blood pressure (BP) at lying position and three minute at standing position, however autonomic response reflexes such as sudomotor response and thermoregulatory sweat test are more diagnostic ( Sealey & Lui, 2004).

DSN could be part of neuropathic disorders, which are somatic, sensory, or mixed in different neurological disorders as in multiple system atrophy, Parkinson disease, Lewy body dementia, autonomic failure, autonomic gangliopathy, and orthostatic tachycardia syndrome ( Shoenfeld et al., 2020). DSN is of two types, the primary type, which is also called inherited or neurological type while the secondary type is acquired due to various diseases including diabetes mellitus, autoimmune disease, toxicity, and alcoholism ( Axelrod, 2004). Therefore, sympathetic and cytokine storms together with activation of Renin-Angiotensin-System are the chief final pathway involved in the development of DSN in Covid-19.ĭysautonomia (DSN) is a neurological disorder caused by dysfunction of autonomic nervous system (ANS) that affect the functions of heart, bladder, sweat gland, pupils, intestines, and other autonomic functions ( Chakraborty et al., 2020). Taken together, DSN in Covid-19 is developed due to sympathetic storm and inhibition of Parasympathetic nervous system-mediated anti-inflammatory effect with development of cytokine storm. Furthermore, SARS-CoV-2 can spread through pulmonary mechanoreceptors and chemoreceptors to medullary respiratory center in a retrograde manner resulting in sudden respiratory failure. Sympathetic over-activation in Covid-19 is correlated with increase in capillary pulmonary leakage, alveolar damage, and development of acute respiratory distress syndrome. SARS-CoV-2 infection-induced stress may activate the sympathetic nervous system (SNS) leading to neuro-hormonal stimulation and activation of pro-inflammatory cytokines with further development of sympathetic storm.

Although, the direct link between Covid-19 and DSN is still speculative, the hypothetical links are thought to be either a direct neuronal injury of the autonomic pathway or a para/post-infectious immune-induced mechanism. Herein, we present an inclusive mini-review of SARS-CoV-2-induced DNS and its associated complications. Among the plethora of debilitating neurological disorders of COVID-19 syndrome in survivors, the scope of SARS-CoV-2-induced dysautonomia (DNS) is yet to be understood, though the implications are enormous.

Sick sinus syndrome risks