Face mask use tied to cardiovascular symptoms

Use of face masks remains an effective method in preventing COVID-19 transmission, but a recent study in Singapore has found that wearing of face masks is also associated with more self-reported cardiovascular symptoms.

“Our findings raise awareness among healthcare providers, researchers, and policymakers regarding face mask-associated symptoms and their potential implications on health-seeking behaviours of patients,” the researchers said.

A total of 1,001 Singapore residents, who participated in a self-administered questionnaire between 25 April 2020 and 4 May 2020, were included in this cross-sectional study. The research team collected data on symptom severity before and during mask use, as well as health-seeking behaviour information.

Dyspnoea, fatigue, and palpitations were the most reported symptoms during mask use. Specifically, N95 masks were found to contribute to worse symptoms when compared to surgical masks. [Singapore Med J 2023;64:609-615]

After adjusting for age, sex, healthcare worker status, and presence of comorbidities, the following factors independently predicted self-reported cardiovascular symptoms during mask use: moderate-to-high physical activity (odds ratio [OR], 1.634, 95 percent confidence interval [CI], 1.176‒2.270; p=0.003), duration of mask use for ≥3 hours (OR, 1.672, 95 percent CI, 1.189‒2.352; p=0.003), and type of mask.

Participants who reported at least three worsening symptoms or worsening dyspnoea, palpitations, fatigue, and dizziness were more likely to seek medical attention.

A previous study reported physiological responses in heart rate as another symptom during mask use. A significant increase in heart rate of 9.4 beats per minute was observed in people wearing surgical masks relative to those without. [Respir Physiol Neurobiol 2012;181:29-35]

“This is in keeping with our present findings of an increased perception of palpitations during face mask use,” the researchers said.

N95 face masks

Of note, worsened self-reported severity of cardiovascular symptoms while wearing a face mask appeared to be driven by prolonged duration of use and the use of high breathing resistance face mask, according to the researchers.

In studies involving healthcare workers wearing different types of face masks while performing usual work duties over a 7-hour period, N95 masks were found to be more strongly associated with perceptions of heat and moisture relative to surgical face masks. [Respir Physiol Neurobiol 2012;181:29-35; J Fiber Bioeng Inform 2009;2:126-136; Respir Care 2010;55:569-577]

In another study, the investigators found that use of N95 face masks correlated with PPE-associated headaches when the mask and the protective eyewear were used for ≥4 hours per day. These headaches affected the perceived overall performance of healthcare workers. [Headache 2020;60:864-877]

“Although our current findings revealed an association of increased self-reported cardiovascular symptoms with face mask use, it is crucially important to emphasize that face mask use remains an effective strategy in dampening the COVID-19 pandemic curve,” the investigators said.

“Future prospective studies are needed to examine the association between self-reported worsening cardiovascular-related symptoms due to face mask use and underlying cardiovascular disease,” they added.