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Orthostatic instability in a population-based study of chronic fatigue syndrome

Jones JF, Nicholson A, Nisenbaum R, Papanicolaou DA, Solomon L, Boneva R, Heim C, Reeves WC
Orthostatic instability in a population-based study of chronic fatigue syndrome
American Journal of Medicine 118:1415.e19-1415.e28, 2005.

Summary

Autonomic nervous system dysregulation may account for some cases of chronic fatigue syndrome ( CFS) and this may be manifest as orthostatic intolerance. Several investigators have evaluated the association between orthostatic intolerance and CFS; however, there unfortunately is almost complete disagreement among studies. This may reflect recruitment of patients from referral clinics, varying degrees of precision applying the case definition, and incomplete consideration of confounding variables, such as age and medication use. In this study, we identified persons with CFS from the general population of Wichita, so they are representative of all those suffering CFS not just those in specialty clinics. We defined CFS through standardized, validated, and reproducible criteria and defined orthostatic instability through a standard head-up tilt test. We carefully controlled for confounding variables. We documented orthostatic instability in 30% of participants with CFS and in 48% of healthy controls. These findings suggest that autonomic nervous system dysfunction is not a major factor in the pathogenesis of CFS.

Abstract

Purpose : Autonomic nervous system dysfunction has been suggested as involved in the pathophysiology of chronic fatigue syndrome. This population-based case control study addressed the potential association between orthostatic instability (one sign of dysautonomia) and chronic fatigue syndrome.

Subjects and Methods : Fifty-eight subjects who fulfilled criteria of the 1994 chronic fatigue syndrome research case definition and 55 healthy controls participated in a 2-day inpatient evaluation. Subjects had been identified during a 4-year population-based chronic fatigue syndrome surveillance study in Wichita, Kan. The present study evaluated subjects’ current medical and psychiatric status, reviewed past medical/psychiatric history and medication use, used a stand-up test to screen for orthostatic instability, and conducted a head-up tilt table test to diagnose orthostatic instability.

Results : No one manifested orthostatic instability in the stand-up test. The head-up tilt test elicited orthostatic instability in 30% of eligible chronic fatigue syndrome subjects (all with postural orthostatic tachycardia) and 48% of controls (50% with neurally mediated hypotension); intolerance was present in only nonfatigued (n = 7) subjects. Neither fatigue nor illness severity were associated with outcome.

Conclusions : Orthostatic instability was similar in persons with chronic fatigue syndrome and nonfatigued controls subjects recruited from the general Wichita population. Delayed responses to head-up tilt tests were common and may reflect hydration status. These findings suggest reappraisal of primary dysautonomia as a factor in the pathogenesis of chronic fatigue syndrome.

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