Professor & patients' paper on the solvable biological challenge of ME/CFS: reader-friendly version
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Study showing LHRV in CFS/ME?

Discussion in 'Latest ME/CFS Research' started by Vic, Jun 17, 2015.

  1. Vic

    Vic

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    I'm looking for a study that shows CFS/ME patients have LHRV compared to controls. I've found some that show LHRV correlation with cognitive performance and sleep quality, but I'm looking for one that plainly shows people with CFS/ME have LHRV. Anyone know of any? Thanks.
     
  2. halcyon

    halcyon Senior Member

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    Auton Neurosci. 2007 Dec 30;137(1-2):94-101. Epub 2007 Sep 12.
    Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study.
    Boneva RS1, Decker MJ, Maloney EM, Lin JM, Jones JF, Helgason HG, Heim CM, Rye DB, Reeves WC.

    Abstract
    Autonomic nervous system (ANS) dysfunction has been suggested in patients with chronic fatigue syndrome (CFS). In this study, we sought to determine whether increased heart rate (HR) and reduced heart rate variability (HRV) parameters observed in CFS patients during wakefulness persist during sleep. To this end, we compared heart rate (HR) and HRV as indicators of ANS function in CFS subjects and non-fatigued (NF) controls in a population-based, case-control study. Thirty subjects with CFS and 38 NF controls, matched for age-, sex- and body mass index, were eligible for analysis. Main outcome measures included mean RR interval (RRI), HR, and HRV parameters derived from overnight ECG. Plasma aldosterone and norepinephrine levels, medicines with cardiovascular effect, and reported physical activity were examined as covariates. General Linear Models were used to assess significance of associations and adjust for potential confounders. Compared to controls, CFS cases had significantly higher mean HR (71.4 vs 64.8 bpm), with a shorter mean RRI [840.4 (85.3) vs 925.4(97.8) ms] (p<0.0004, each), and reduced low frequency (LF), very low frequency (VLF), and total power (TP) of HRV (p<0.02, all). CFS cases had significantly lower plasma aldosterone (p<0.05), and tended to have higher plasma norepinephrine levels. HR correlated weakly with plasma norepinephrine (r=0.23, p=0.05) and moderately with vitality and fatigue scores (r=-0.49 and 0.46, respectively, p<0.0001). Limitation in moderate physical activity was strongly associated with increased HR and decreased HRV. Nevertheless, among 42 subjects with similar physical activity limitations, CFS cases still had higher HR (71.8 bpm) than respective controls (64.9 bpm), p=0.023, suggesting that reduced physical activity could not fully explain CFS-associated differences in HR and HRV. After adjusting for potential confounders case-control differences in HR and TP remained significant (p<0.05).

    CONCLUSION:
    the presence of increased HR and reduced HRV in CFS during sleep coupled with higher norepinephrine levels and lower plasma aldosterone suggest a state of sympathetic ANS predominance and neuroendocrine alterations. Future research on the underlying pathophysiologic mechanisms of the association is needed.
     
  3. halcyon

    halcyon Senior Member

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    Pharmacogenomics
    Vol. 7, No. 3, Pages 407-419 , DOI 10.2217/14622416.7.3.407
    (doi:10.2217/14622416.7.3.407)

    Identifying illness parameters in fatiguing syndromes using classical projection methods
    Gordon Broderick1†, R Cameron Craddock2, Toni Whistler2, Renee Taylor3, Nancy Klimas4 & Elizabeth R Unger2
    † Author for correspondence



    Objectives: To examine the potential of multivariate projection methods in identifying common patterns of change in clinical and gene expression data that capture the illness state of subjects with unexplained fatigue and nonfatigued control participants. Methods: Data for 111 female subjects was examined. A total of 59 indicators, including multidimensional fatigue inventory (MFI), medical outcome Short Form 36 (SF-36), Centers for Disease Control and Prevention (CDC) symptom inventory and cognitive response described illness. Partial least squares (PLS) was used to construct two feature spaces: one describing the symptom space from gene expression in peripheral blood mononuclear cells (PBMC) and one based on 117 clinical variables. Multiplicative scatter correction followed by quantile normalization was applied for trend removal and range adjustment of microarray data. Microarray quality was assessed using mean Pearson correlation between samples. Benjamini-Hochberg multiple testing criteria served to identify significantly expressed probes. Results: A single common trend in 59 symptom constructs isolates of nonfatigued subjects from the overall group. This segregation is supported by two co-regulation patterns representing 10% of the overall microarray variation. Of the 39 principal contributors, the 17 probes annotated related to basic cellular processes involved in cell signaling, ion transport and immune system function. The single most influential gene was sestrin 1 (SESN1), supporting recent evidence of oxidative stress involvement in chronic fatigue syndrome (CFS). Dominant variables in the clinical feature space described heart rate variability (HRV) during sleep. Potassium and free thyroxine (T4) also figure prominently. Conclusion: Combining multiple symptom, gene or clinical variables into composite features provides better discrimination of the illness state than even the most influential variable used alone. Although the exact mechanism is unclear, results suggest a common link between oxidative stress, immune system dysfunction and potassium imbalance in CFS patients leading to impaired sympatho-vagal balance strongly reflected in abnormal HRV.
     
  4. voner

    voner Senior Member

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    Symptoms of autonomic dysfunction in chronic fatigue syndrome

    J.L. Newton , O. Okonkwo , K. Sutcliffe , A. Seth , J. Shin , D.E.J. Jones
    DOI: http://dx.doi.org/10.1093/qjmed/hcm057 519-526 First published online: 7 July 2007

    http://qjmed.oxfordjournals.org/content/100/8/519?ref=vidupdatez.com/image


    Reduced Cardiac Vagal Modulation Impacts on Cognitive Performance in Chronic Fatigue Syndrome
    • Alison Beaumont,
    • Alexander R. Burton,
    • Jim Lemon,
    • Barbara K. Bennett,
    • Andrew Lloyd,
    • Uté Vollmer-Conna

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049518
     
  5. Kati

    Kati Patient in training

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    Yould you mind please explaining the acronyms?
     
    Bob likes this.
  6. voner

    voner Senior Member

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    Katie,

    Low heart rate variability = LHRV.

    acronyms seem to be a unavoidable scourge. .....
     
  7. Ema

    Ema Senior Member

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    This is all super interesting to me. I've been measuring HRV with my iPhone and a wireless monitor for a few weeks now and it is consistently low indicating poor vagal tone and sympathetic (fight or flight dominance).

    Now to figure out how to fix it!

    Here's a nice primer on HRV from Ben Greenfield Fitness:

    http://hwcdn.libsyn.com/p/e/2/8/e28...42870690&hwt=e8c0cbcf9459b9910b9a5ab17fdedeb6

    Plus a link to the app and monitor I have:

    http://sweetwaterhrv.com/index.shtml

    I'm curious to know if anyone else is tracking HRV? And what people have done to improve it?
     
  8. voner

    voner Senior Member

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    Ema likes this.
  9. Avengers26

    Avengers26 Senior Member

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    @Ema I do see the app on the website you linked but i couldn't find the monitor. What is the cost? Thanks.
     
  10. Ema

    Ema Senior Member

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    Avengers26 likes this.
  11. Research 1st

    Research 1st Severe ME, POTS & MCAS.

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    Doctors have run this test for years in cardiac patients and it's useful in ME to look at changes in eyes closed in a 'resting
    state' laying flat alone in the room (relaxed as possible with as calm pulse as possible) and then eyes open standing upright alert.

    In ME the sympathetic nervous system is aroused at rest more than usual and sharply increases standing up. Conversely, the parasympathetic is largely depressed or absent (as in Autism). I had my HRV test done a long time ago in a private hospital by an 'unconventional' doctor who even today would be scoffed at for 'believing' in the ME patient (sad reflection of the times). The good news is we can get these HRV tests as patients now, it's just a matter of finding a private doctor who has the equipment: ECG, Laptop, Software and press 'print' is all it needs.

    The benefit for us , is it's a painless and totally safe (non invasive) method to provide evidence of abnormal central nervous system arousal or suppression. This demonstrates we have evidence of a neurological problem. Ideally you also want a 'TILT' test. I'll get onto that next.

    Another test, usually run in a large hospital (or by a specialist in autonomic/cardiology) is a Baroreflex test. This is similar in terms of what it shows. In ME during a TILT test procedure (an autonomic test it will show when you're upright your nerve impulses going crazy, and thus this is evidence your brain and heart are interacting, simply by being upright. This equipment is specialist and costly, it won't be in 'most' hospitals so you'd have to track it down.
    What you need to show your CNS getting excited when upright in a hospital setting regarding TILT test is:

    TILT table
    ECG
    Beat to beat blood pressure monitoring (BP taken every second on finger)
    Ear clip and PC for Baroreflex response then shown on the PC attached to all the wires.

    The benefit of this complex specialist test, is it not only shows you have a physical problem beyond your control, it helps get you 'under' a neurologist or a cardiologist at the hospital (hopefully), who otherwise may have dismissed you for having 'CFS'.

    For people worried who are more active, but are still plague by Orthostatic Intolerance (O.I) I'd also add that in myself it made no difference to the test results when I was mobile, or bedridden. Always the same result. The benefit to that finding (at least in myself) is it disproves deconditioning theory of ME CFS, and also disproves de conditioning POTS (autonomic dysfunction) in ME CFS also, because the 'problem' you demonstrate is always there, regardless of your physical fitness level. Thus you must have a chronic neurological disorder. Thus CBT GET won't work, and thus you need better care. If you're lucky enough to have private health insurance, then better avenues of health management open up to you.

    So I'd say the first cheap and easy test to try out (if you can't get Hospital based Baroreflex assessment) is the HRV test., which to recap is a painless ECG, a laptop and a print out they hand you to take home and keep showing sympathetic 'tone' vs parasympathetic tone. I'd say, with this, you are then more likely to get a TILT test too, if you're being denied one,or cannot get a doctors referral, for Orthostatic Intolerance or other CNS symptoms that worsen when upright or 'awake' and conversely, also fire off in your sleep.

    If you have autonomic problems (common in ME), you'll get lots of weird and wonderful things happening to you in your sleep too including episodes of:

    Waking up with vertigo/dizzyness/fainting when laying flat
    Cardiac arrhythmias and shortness of breath with or without each other
    Breathing rhythm changes
    Cold/hot sweats
    Confusion
    Hot flashes
    Itching
    Nocturnal supine polyuria (peeing too much, laying flat, at night) - ruins sleep if you pee multiple times at night.

    Hence in total, finding out if you have an autonomic dysfunction via an HRV and then TILT + more (don't forget the valsalva manoeuvre test) also is helpful in getting you a neurological diagnosis, a diagnosis far removed from the 'fatigue' of Fukuda Criteria CFS. This then bypasses disbelief ME is neurological, as you don't need to go with an ME diagnosis at all to have autonomic problems diagnosed and managed, (you can go with a dysautonomia diagnosis) of which POTS is just one form.


     
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  12. Sidereal

    Sidereal Senior Member

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    Not really. Reduced heart rate variability is also found in many psychiatric disorders.
     
  13. Ema

    Ema Senior Member

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    Maybe those are really neurological disorders as well...
     
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  14. Sidereal

    Sidereal Senior Member

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    I agree but the rest of the world doesn't (yet). Medicine still divides brain problems into neurological vs psychiatric so to say that abnormal HRV proves that ME is a neurological disorder (as currently understood) is not correct, I'm afraid.
     

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