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Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome.
MedLine Citation:
PMID:  23206180     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: A significant proportion of patients with chronic fatigue syndrome (CFS) also have postural orthostatic tachycardia syndrome (POTS). We aimed to characterise these patients and differentiate them from CFS patients without POTS in terms of clinical and autonomic features. METHODS: A total of 179 patients with CFS (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Health-funded CFS clinical services were included in the study. Outcome measures were: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing. RESULTS: CFS patients with POTS (13%, n=24) were younger (29±12 vs. 42±13 years, P<0.0001), less fatigued (Chalder fatigue scale, 8±4 vs. 10±2, P=0.002), less depressed (HADS-D, 6±4 vs. 9±4, P=0.01) and had reduced daytime hypersomnolence (ESS, 7±6 vs. 10±5, P=0.02), compared with patients without POTS. In addition, they exhibited greater orthostatic intolerance (OGS, 11±5; P<0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS ≤9 and OGS ≥9 identifies accurately CFS patients with POTS with 100% positive and negative predictive values. CONCLUSIONS: The presence of POTS marks a distinct clinical group of CFS patents, with phenotypic features differentiating them from those without POTS. A combination of validated clinical assessment tools can determine which CFS patients have POTS with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate. © 2012 The Association for the Publication of the Journal of Internal Medicine.
Authors:
Ieuan Lewis; Jessie Pairman; Gavin Spickett; Julia L Newton
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-4
Journal Detail:
Title:  Journal of internal medicine     Volume:  -     ISSN:  1365-2796     ISO Abbreviation:  J. Intern. Med.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Association for the Publication of the Journal of Internal Medicine.
Affiliation:
Institute for Ageing & Health, Newcastle University, Newcastle, UK.
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