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A population-based study of the clinical course of chronic fatigue syndrome.
Nisenbaum R, Jones JF, Unger ER, Reyes M, Reeves WC.A population-based study of the clinical course of chronic fatigue syndrome.
BioMed Central Health Quality of Life Outcomes 2003;1:49.
Summary
Using data from the longitudinal population-based study of fatiguing illnesses in Wichita, we characterized the clinical course of CFS. Sixty-five CFS subjects were identified and followed for up to 3 years. We evaluated changes in CFS classification (partial or total remission, alternative medical or psychiatric diagnoses), CFS case-defining criteria, wellness scores, hours of activities and sleep, and treatments used to reduce fatigue. Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models. Only 20% - 33% of the subjects were classified as having CFS at follow-up, 56.9% ever experienced partial or total remission, 10% sustained total remission, and 23.1% received alternative diagnoses, of which 20% were sleep disorders. Higher fatigue severity scores and total number of symptoms was negatively associated with ever remitting. Duration of illness #2 years was positively associated with sustained remission. Unrefreshing sleep persisted in more than 80% of the subjects across all periods but, as with most of the CFS symptoms, tended to be less frequent over time. The number of activities affected by fatigue decreased over time, while wellness scores increased. More than 35% of subjects reporting reduced fatigue used complementary and alternative medicine therapies, and of those subjects, 50% believed the therapies were responsible for reducing their fatigue. Findings confirm the intermittent pattern of CFS relapse and remission. Remission estimates were similar to those reported in clinical studies. The persistence of sleep complaints and identification of sleep disorders suggest that sleep studies might be essential in determining differential diagnoses in CFS subjects. A manuscript describing the clinical course has been submitted for publication.
Because of the importance and timeliness of these findings for health care professionals, we chose to publish in BioMed Central Health Quality of Life Outcomes. This is an online journal so, if accepted following review by rigorously selected subject matter experts, articles are immediately published and indexed by the National Library of Medicine. In addition, all research articles are "open access" allowing immediate free re-use and re-distribution in any medium provided that the original source is cited and material is not used commercially.
Abstract
Background: Chronic fatigue syndrome (CFS) presents a challenge for patients, health care professionals, and health insurance groups because of its incapacitating nature, unknown cause, and poorly understood prognosis. We conducted a longitudinal population-based study to characterize the clinical course of CFS.
Methods: Sixty-five CFS subjects were identified from a random-digit-dialing survey of Wichita, Kansas residents and followed for up to 3 years. We evaluated changes in CFS classification (partial or total remission, alternative medical or psychiatric diagnoses), CFS case-defining criteria, wellness scores, hours of activities and sleep, and treatments used to reduce fatigue. Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models.
Results: Only 20%-33% of the subjects were classified as having CFS at follow-up, 56.9% ever experienced partial or total remission, 10% sustained total remission, and 23.1% received alternative diagnoses, of which 20% were sleep disorders. Higher fatigue severity scores and total number of symptoms were negatively associated with ever remitting. Duration of illness #2 years was positively associated with sustained remission. Unrefreshing sleep persisted in more than 80% of the subjects across all periods but, as with most of the CFS symptoms, tended to be less frequent over time. The number of activities affected by fatigue decreased over time, while wellness scores increased. At any follow-up, more than 35% of subjects reporting reduced fatigue used complementary and alternative medicine therapies, and of those subjects, at least 50% thought these therapies were responsible for reducing their fatigue.
Conclusions: The clinical course of CFS was characterized by an intermittent pattern of relapse and remission. Remission rates documented by our population-based study were similar to those reported in clinical studies. Shorter illness duration was a significant predictor of sustained remission, and thus early detection of CFS is of utmost importance. The persistence of sleep complaints and identification of sleep disorders suggest that CFS subjects be evaluated for sleep disturbances, which could be treated.
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