Coronavirus-19 (COVID-19), the infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has wreaked havoc across the globe since its emergence in December 2019. Reports of patients presenting with syncope and pre-syncope, as well as hypoxemia without symptoms of dyspnea (“silent hypoxemia”), have led researchers to speculate whether SARS-CoV-2 can alter autonomic nervous system function. As viral infections are commonly reported triggers of altered autonomic control, we must consider whether SARS-CoV-2 can also interfere with autonomic activity, at least in some patients. As we are still in the early stages of understanding COVID-19, we still do not know whether syncope and silent hypoxemia are more strongly associated with COVID-19 compared to any other viral infections that severely compromise gas exchange. Therefore, in this perspective we discuss these two intriguing clinical presentations, as they relate to autonomic nervous system function. In our discussion, we will explore COVID-specific, as well as non-COVID specific mechanisms that may affect autonomic activity and potential therapeutic targets. As we move forward in our understanding of COVID-19, well-designed prospective studies with appropriate control and comparator groups will be necessary to identify potential unique effects of COVID-19 on autonomic function.

冠状病毒 19 (COVID-19) 是由严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 病毒引起的传染病，自 2019 年 12 月出现以来在全球范围内造成严重破坏。报告出现晕厥和晕厥前兆以及没有呼吸困难症状的低氧血症（“无症状低氧血症”）使研究人员推测 SARS-CoV-2 是否可以改变自主神经系统功能。由于病毒感染是自主神经控制改变的常见诱因，因此我们必须考虑 SARS-CoV-2 是否也会干扰自主神经活动，至少在某些患者中如此。由于我们仍处于了解 COVID-19 的早期阶段，我们仍然不知道与严重损害气体交换的任何其他病毒感染相比，晕厥和无症状低氧血症是否与 COVID-19 的相关性更强。因此，我们从这个角度讨论这两个有趣的临床表现，因为它们与自主神经系统功能有关。在我们的讨论中，我们将探索可能影响自主活动和潜在治疗靶点的 COVID 特异性和非 COVID 特异性机制。随着我们对 COVID-19 的理解不断推进，设计良好的前瞻性研究以及适当的对照组和比较组将是必要的，以确定 COVID-19 对自主神经功能的潜在独特影响。在我们的讨论中，我们将探索可能影响自主活动和潜在治疗靶点的 COVID 特异性和非 COVID 特异性机制。随着我们对 COVID-19 的理解不断推进，设计良好的前瞻性研究以及适当的对照组和比较组将是必要的，以确定 COVID-19 对自主神经功能的潜在独特影响。在我们的讨论中，我们将探索可能影响自主活动和潜在治疗靶点的 COVID 特异性和非 COVID 特异性机制。随着我们对 COVID-19 的理解不断推进，设计良好的前瞻性研究以及适当的对照组和比较组将是必要的，以确定 COVID-19 对自主神经功能的潜在独特影响。