Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome, 2024, Chien et al.

Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome
Claudia Chien; Josephine Heine; Ahmed Khalil; Lars Schlenker; Tim J. Hartung; Fabian Boesl; Katia Schwichtenberg; Rebekka Rust; Judith Bellmann-Strobl; Christiana Franke; Friedemann Paul; Carsten Finke

OBJECTIVES
Persisting neurological symptoms after COVID-19 affect up to 10% of patients and can manifest in fatigue and cognitive complaints. Based on recent evidence, we evaluated whether cerebral hemodynamic changes contribute to post-COVID syndrome (PCS).

METHODS
Using resting-state functional magnetic resonance imaging, we investigated brain perfusion and oxygen level estimates in 47 patients (44.4 ± 11.6 years; F:M = 38:9) and 47 individually matched healthy control participants. Group differences were calculated using two-sample t-tests. Multivariable linear regression was used for associations of each regional perfusion and oxygen level measure with cognition and sleepiness measures. Exploratory hazard ratios were calculated for each brain metric with clinical measures.

RESULTS
Patients presented with high levels of fatigue (79%) and daytime sleepiness (45%). We found widespread decreased brain oxygen levels, most evident in the white matter (false discovery rate adjusted-p-value (p- FDR ) = 0.038) and cortical grey matter (p- FDR = 0.015). Brain perfusion did not differ between patients and healthy participants. However, delayed patient caudate nucleus perfusion was associated with better executive function (p- FDR = 0.008). Delayed perfusion in the cortical grey matter and hippocampus were associated with a reduced risk of daytime sleepiness (hazard ratio (HR) = 0.07, p = 0.037 and HR = 0.06, p = 0.034). Decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22, p = 0.019). Meanwhile, lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29, p = 0.017).

INTERPRETATION
Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function. These hemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.

Link | PDF (Annals of Clinical and Translational Neurology) [Open Access]

 

I don't think the cohort constitutes a specific "LC subgroup" that has been commonly studied or resembles ME/CFS in any way, or at least dysosmia seems rather high (at 48.9% of patients) and so does daytime sleepiness (at 33% of patients). Would be interesting to know how patients were selected at the neurology department of the Charite and whether there are correlations to duration of illness.

It seems one should compare this paper to Structural brain changes in patients with post-COVID fatigue: a prospective observational study which is also part of the "CAMINO study" as it appears that the patients are the same or at least there is a larger overlap (in said study 29% of patients met IOM criteria for ME/CFS).

It's nice to see that the Charite is doing research completely independently of the work of Scheibenbogen, such that her name isn't even on this paper.