Fatigue and altered autonomic nervous system

[pattismith]

Impairments in cognitive performance in chronic fatigue syndrome are common, not related to co-morbid depression but do associate with autonomic dysfunction


Lucy J. Robinson,
Peter Gallagher,
Stuart Watson,
Ruth Pearce,

2019

• Result
• Cognitive performance in unselected CFS patients is in average range on most measures. However, 0–23% of the CFS sample fell below the 5th percentile. Negative correlations occurred between depressive symptoms (HAD-S) with Digit-Symbol-Coding (r = -.507, p = .006) and TMT-A (r = -.382, p = .049). In CFS without depression, impairments of cognitive performance remained with significant differences in indices of psychomotor speed (TMT-A: p = 0.027; digit-symbol substitution: p = 0.004; digit-symbol copy: p = 0.007; scanning: p = .034) Stroop test suggested differences due to processing speed rather than inhibition.
  Both cohorts confirmed relationships between cognitive performance and HRV (digit-symbol copy (r = .330, p = .018), digit-symbol substitution (r = .313, p = .025), colour-naming trials Stroop task (r = .279, p = .050).
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  Conclusion
  
  Cognitive difficulties in CFS may not be as broad as suggested and may be restricted to slowing in basic processing speed. While depressive symptoms can be associated with impairments, co-morbidity with major depression is not itself responsible for reductions in cognitive performance. Impaired autonomic control of heart-rate associates with reductions in basic processing speed.
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• Fatigue in chronic hepatitis B patients is significant and associates with autonomic dysfunction
  • Ying Zhou,
  • Rong Yan,
  • Guo Qing Ru,
  • Li Li Yu &
  • Jiong Yao
• • 2019
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  • Background
    
    Fatigue is an important clinical finding in patients with chronic hepatitis virus infection. However, studies assessing fatigue in patients with chronic hepatitis B (CHB) are very limited. This study aimed to quantify the severity of fatigue in patients with CHB, to determine whether perceived fatigue reflects impairment of functional ability, and to explore potential causes.
    Methods
    
    A total of 133 patients with histologically proven CHB and 59 community controls were assessed using the fatigue impact scale (FIS).
    Results
    
    The degree of fatigue was significantly higher in patients with CHB than in controls (mean (range) FIS 24.9 (0–91) vs. 15.7 (0–31), p < 0.001). Fatigue experienced by patients with CHB was similar to that in primary biliary cirrhosis (PBC) (n = 20) (FIS 22.2 vs. 20.9, p = 0.28). No association was found between FIS and biochemistry and histological parameters of liver disease severity. Significant associations were found between fatigue severity and cognitive impairment (r = 0.39, p < 0.001), daytime somnolence (r = 0.32, p < 0.001), scores of the Chronic Liver Disease Questionnaire (r = − 0.31, p < 0.001), and autonomic symptoms (r = 0.43, p < 0.001). The level of autonomic symptom was the only factor independently associated with the degree of fatigue.
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    Conclusion
    
    Fatigue is a significant problem of functional ability impairment in CHB and similar in degree to that in PBC patients.
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  • Fatigue in patients with CHB appears to be unrelated to the severity of liver disease but is associated with significant autonomic sympto
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    Fatigue in Multiple Sclerosis is related to relapses, autonomic dysfunctions and introversion: A quasi-experimental study
    
    Author links open overlay panelKatrinHankenaCarinaSanderbdHans-PeterSchlakebAndreasKastrupaPaulElingcHelmutHildebrandtad
    
    https://doi.org/10.1016/j.msard.2019
    
    Only patients suffering from a relapse showed a significant increment in fatigue from t1 to t2.
  • Regression analyses revealed that autonomic dysfunctions and introversion best explained the fatigue level.
    Conclusions
    
    This study shows that a relapse is accompanied by an increase in MS-related fatigue
  • . Moreover, autonomic dysfunctions and introversion, more than depression and apathy, play a major role in the explanation of MS-related fatigue.
  • This finding represents additional evidence for the relationship between inflammation, vagal afferent signaling, autonomic dysfunctions, introversion and the feeling of MS-related fatigue.
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[pattismith]

Cerebral blood flow and heart rate variability predict fatigue severity in patients with chronic fatigue syndrome

• Jeff Boissoneault
• Janelle Letzen
• Michael Robinson
• Roland Staud

2018


Abstract

Prolonged, disabling fatigue is the hallmark of chronic fatigue syndrome (CFS). Previous neuroimaging studies have provided evidence for nervous system involvement in CFS etiology, including perturbations in brain structure/function. In this arterial spin labeling (ASL) MRI study, we examined variability in cerebral blood flow (CBFV) and heart rate (HRV) in 28 women: 14 with CFS and 14 healthy controls. We hypothesized that CBFV would be reduced in individuals with CFS compared to healthy controls, and that increased CBFV and HRV would be associated with lower levels of fatigue in affected individuals. Our results provided support for these hypotheses. Although no group differences in CBFV or HRV were detected, greater CBFV and more HRV power were both associated with lower fatigue symptom severity in individuals with CFS. Exploratory statistical analyses suggested that protective effects of high CBFV were greatest in individuals with low HRV. We also found novel evidence of bidirectional association between the very high frequency (VHF) band of HRV and CBFV. Taken together, the results of this study suggest that CBFV and HRV are potentially important measures of adaptive capacity in chronic illnesses like CFS. Future studies should address these measures as potential therapeutic targets to improve outcomes and reduce symptom severity in individuals with CFS.

Autonomic Symptom Burden in Idiopathic Hypersomnia (S46.005)

Paul Kim, Joseph Cheung, Logan Schneider, LynnMarie Trotti, Mitchell Miglis
First published April 16, 2019,

Conclusions: Symptoms of ANS impairment, sleepiness, and fatigue are more severe in individuals with IH compared to controls. Moreover, ANS symptom burden correlates moderately with higher levels of sleepiness and fatigue. Future analysis will focus on COMPASS subscores and objective autonomic testing to help identify symptomatic domains, with the goal of more focused therapeutic targets for patients with IH.

 

[pattismith]

Autonomic dysfunction in primary Sjogren’s syndrome: a prospective cohort analysis of 154 Korean patients

Results

The overall autonomic activity in patients with pSS was significantly lower than that in controls. Autonomic dysfunction with the HRV test was observed in 35.7% of the KISS participants and was associated with a higher European League Against Rheumatism Sjogren’s Syndrome Patient Reported Index fatigue score (p = 0.024).
Raynaud’s phenomenon was a more frequent clinical presentation in pSS patients with autonomic dysfunction than in those without autonomic dysfunction (29.4% and 14.4%, respectively; p = 0.048).
Decreased parasympathetic activity was observed in 41.6% of pSS patients. No differences were found in the oral and ocular signs of pSS according to the decreased parasympathetic activity.
Conclusions

In Korean patients with pSS, decreased and imbalanced autonomic activity is prevalent and is associated with fatigue. However, an association between autonomic dysfunction and glandular manifestations was not detected.


Fatigue in Epstein-Barr virus infected adolescents and healthy controls: A prospective multifactorial association

2019
Results

Fatigue was associated with symptoms of sleeping difficulties, negative emotions, and quality of life under all circumstances. Fatigue was independently associated with markers of immune response at EBVsix months and in HC, not at EBVbaseline. An association between fatigue and markers of autonomic cardiovascular control was only present at EBVsix months. Cognitive functioningshifted from a positive association to fatigue at EBVbaseline to a negative trend at EBVsix months. Markers of infection were not associated with fatigue at EBVbaseline, EBVsix months nor in HC.
Conclusion

Irrespective of the cause, fatigue is important for quality of life and is highly associated with negative emotions.
Markers of infection and immune response had respectively none and barely any association to fatigue.
Autonomic alterations and cognitive dysfunction were exclusively associated with fatigue long after infection, corroborating findings from studies of the Chronic Fatigue Syndrome

 

[pattismith]

Multiple Sclerosis Related Fatigue and Autonomic Dysfunction (2120)

Jason T. Poon, Leah Millsap, Preston W. Erickson, John Rose, Melissa M. Cortez
First published April 14, 2020,


Abstract
Objective: To systematically evaluate the relationship between fatigue severity, autonomic symptom burden, and autonomic physiological markers in patients with multiple sclerosis (MS).

Background:

Autonomic dysfunction (AD) is common in patients with MS and is correlated with disability, disease duration, and progression

Previous investigations have shown up to 80% of patients with MS exhibit dysautonomia.

However, few studies have examined the influence of these abnormalities on disabling patient-centered outcomes, such as fatigue.

Design/Methods:

We recruited patients with MS (EDSS<6) from the Salt Lake City region (via University Clinics and National MS Society) and administered the Fatigue Severity Scale (FSS) to identify patients with and without significant fatigue. Participants with FSS score <4 were considered to have mild to no fatigue (n=7), compared to FSS score ≥ 4 (significant fatigue, n=8).
Autonomic assessment, using the Composite Autonomic Symptom Score 31 (COMPASS 31) and standardized cardiovascular autonomic reflex testing was performed on all patients.
Autonomic measures were compared between fatigue and non-fatigue groups, as well as correlation analysis between FSS scores.

Results:

Clinical characteristics of sample: Mean age 47.4 years (range 76–31); 66% female; mean disease duration 12.7 years (range 1.4–30 years); mean EDSS 3.1 (range 1.5–6). There were no statistically significant differences in the above parameters between groups.

COMPASS-31 scores were significantly greater in the significant fatigue group, compared to the low fatigue group (36.5 vs 10.0, p<0.01). High FSS scores significantly correlated with high COMPASS-31 scores (r= 0.74, p<0.05).
Similarly, the significant fatigue group exhibited greater BP variability at rest, as well as greater HR on tilt table testing compared to the low fatigue group.

Conclusions:

While the pathophysiology of MS-related fatigue remains unclear, our data suggests that AD may represent potential physiological mechanisms for at least a portion of patient-reported fatigue and importantly could serve as a potential treatment target.