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Does the chronic fatigue syndrome involve the autonomic nervous system?
1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
The American Journal of Medicine
|April 1, 1997
Summary
Chronic fatigue syndrome (CFS) patients exhibit autonomic nervous system dysfunction, impacting heart rate and blood pressure regulation. This may stem from cardiovascular deconditioning or post-viral autonomic neuropathy.
Area of Science:
- Neurology
- Cardiology
- Immunology
Background:
- Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and often includes symptoms of orthostatic intolerance and neurally mediated syncope.
- The precise mechanisms underlying these symptoms in CFS remain incompletely understood, prompting investigation into the autonomic nervous system's role.
Purpose of the Study:
- To investigate the role of the autonomic nervous system (ANS) in the symptomatology of patients with chronic fatigue syndrome (CFS).
- To delineate the pathogenesis of orthostatic intolerance and predisposition to neurally mediated syncope in CFS patients.
Main Methods:
- Twenty-three CFS patients and age-matched controls underwent a comprehensive battery of autonomic function tests.
- CFS patients completed validated questionnaires assessing autonomic symptoms, physical activity levels, and psychiatric comorbidities.
- Multivariate statistical analyses examined relationships between autonomic test results, cardiovascular deconditioning, and psychiatric factors.
Main Results:
- CFS subjects demonstrated significantly increased resting and maximum heart rates upon standing and tilting compared to controls.
- Impaired sympathetic and parasympathetic nervous system function was evident in CFS patients, indicated by reduced blood pressure regulation during orthostatic stress and Valsalva maneuvers.
- Twenty-five percent of CFS subjects exhibited a positive tilt table test, and autonomic symptom onset frequently followed viral infections, suggesting a post-viral neuropathy.
Conclusions:
- Patients with CFS display significant alterations in both sympathetic and parasympathetic nervous system function.
- These autonomic dysfunctions provide a physiological basis for orthostatic intolerance and other related symptoms experienced by CFS patients.
- The observed autonomic changes may be attributed to cardiovascular deconditioning, a post-viral idiopathic autonomic neuropathy, or a combination of both factors.