Diet and environment: unexplored influences on sleep quality in postural orthostatic tachycardia syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by an excessive increase in heart rate upon standing, accompanied by symptoms such as dizziness, fatigue, palpitations, cognitive impairment, and sleep disturbances. Sleep dysfunction is increasingly recognized as a significant contributor to symptom burden and reduced quality of life among individuals with POTS. Emerging evidence suggests that patients with POTS may experience heightened sympathetic activity during sleep, leading to disrupted autonomic regulation and fragmented sleep patterns. While the pathophysiological mechanisms underlying sleep disturbances in POTS are multifactorial, modifiable lifestyle factors - including dietary habits and environmental exposures - may play an underexplored role. Dietary factors such as high-fat meals or specific dietary patterns may influence sleep architecture and nocturnal awakenings, whereas interventions such as gluten-free diets have shown potential benefits in alleviating certain gastrointestinal and vasomotor symptoms associated with POTS. Environmental determinants, including chronic noise exposure and light pollution, can further disrupt circadian rhythms by impairing melatonin secretion and altering sleep quality. These disruptions may exacerbate autonomic imbalance, perpetuating daytime symptoms such as tachycardia and fatigue. Despite plausible mechanistic links, targeted research examining the influence of diet and environmental factors on sleep quality in POTS remains limited. Addressing these modifiable factors may provide novel lifestyle-based strategies to complement pharmacological management and improve patient outcomes.