Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australi

[osisposis]

J Intern Med. 2014 Apr;275(4):409-17. doi: 10.1111/joim.12161. Epub 2013 Nov 29.
Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australian cohort.
Reynolds GK1, Lewis DP, Richardson AM, Lidbury BA.

Author information

Abstract
OBJECTIVE:
Patients with chronic fatigue syndrome (CFS) are frequently diagnosed with comorbid postural orthostatic tachycardia syndrome (POTS), suggesting a shared pathogenesis. The aim of this study was to examine the relationship between demographic characteristics, autonomic functioning and fatigue levels amongst CFS patients with and without comorbid POTS.
DESIGN AND SETTING:
All patients presenting to the CFS Discovery Clinic between 2009 and 2012 completed a 20-min standing task as part of their initial assessment. Heart rate and pulse pressure were recorded at baseline, at 2-min intervals poststanding, at the end of the task and following a recovery period. Average heart rate and pulse pressure variability were calculated from this data. Age, gender, length of illness and self-reported fatigue scores were also recorded. POTS patients were diagnosed by an orthostatic increase in heart rate >30 beats per min, concomitant symptoms of orthostatic intolerance and no orthostatic hypotension. Differences in autonomic functioning between POTS and CFS patients were compared using independent samples t-tests, whilst logistic and linear regressions were performed to examine the contribution of autonomic functioning to task completion and perceived fatigue, respectively.
RESULTS:
Comorbidity of CFS and POTS (CFS-POTS) was observed in 11% (33/306) of patients. CFS-POTS patients were significantly younger (P < 0.001), had a shorter length of illness (P = 0.034), experienced greater task difficulty (P = 0.002) and were able to stand for significantly shorter periods compared to the CFS-only patients (P < 0.001). CFS-POTS patients experienced significantly lower baseline diastolic blood pressure (P = 0.002), significantly higher heart rate and lower pulse pressures at each standing measurement. Early heart rate changes (P = 0.002) and overall heart rate change (P < 0.001) were significant predictors of completion status, whereas heart rate variability (P < 0.001) and female gender (P < 0.001) were significant predictors of increased perceived task difficulty.
CONCLUSIONS:
Haemodynamic and demographic differences between CFS-POTS and CFS-only patients suggest that the former group reflects a distinct subgroup of the CFS population. The findings highlight the utility of screening younger patients with fatigue for POTS, and identified heart rate variability as an important marker of fatigue for CFS patients in general.
http://www.ncbi.nlm.nih.gov/pubmed/24206536

 

[Never Give Up]

Does anyone know what the number of patients was? An 11% CFS-POTS comorbidity seems awfully low to me. Didn't we already know the rest of this?

 

[taniaaust1]

POTS patients were diagnosed by an orthostatic increase in heart rate >30 beats per min, concomitant symptoms of orthostatic intolerance and no orthostatic hypotension.

I assume that doesnt mean that he excluded the ones who had both POTS and orthostatic hypotension from his study??? or did he??? that would explain much lower numbers of ones with POTS then I would of expected as most with ME/CFS have OH.. if he did that it may really mess up the results of a POTS in ME/CFS study

 

[Kati]

It sounded like they performed a poor man tilt table test which is likely to miss quite a few people. Their numbers would have been higher if they performed a real tilt table test.

 

[SOC]

Does anyone know what the number of patients was? An 11% CFS-POTS comorbidity seems awfully low to me. Didn't we already know the rest of this?

Most of us have some form of OI, but not always POTS. Maybe that's where the difference lies.

 

[Gijs]

POTS patiënts also have the criteria for SEIDS. POTS is a different subgroup, i have also POTS and i see that many CFS patiënts have other symptoms. CFS patiënts without tachycardia are another group.

 

[SOC]

POTS patiënts also have the criteria for SEIDS.

Not if they don't have PEM. POTS presents with exercise intolerance, but that's not PEM.

 

[Gijs]

Not if they don't have PEM. POTS presents with exercise intolerance, but that's not PEM.

O yes, a lot of them do have real PEM. I have PEM objective 2 days exercise test and swollen lymf, soar throat etc.. after exercise also... this is the objective subgroup in CFS.

 

[SOC]

O yes, a lot of them do have real PEM. I have PEM objective 2 days exercise test and swollen lymf, soar throat etc.. after exercise also... this is the objective subgroup in CFS.

Sure, plenty of people with ME/CFS/SEID (whatever we're calling it at the moment) have POTS, but not all POTS patients have PEM. So not all POTS patients meet the criteria for SEID. POTS does not equate to SEID. That doesn't mean there aren't plenty of people with both.

I agree that there are many ways to subgroup SEID patients once you've identified them. The presence of various forms of OI may be one useful way to subgroup... or not. We'll have to see how the research develops.