Orthostatic intolerance in chronic fatigue syndrome (Baraniuk 2019)

[Murph]

https://www.ncbi.nlm.nih.gov/pubmed/31159884

2019 Jun 3;17(1):185. doi: 10.1186/s12967-019-1935-y.
Orthostatic intolerance in chronic fatigue syndrome.
Garner R1, Baraniuk JN2.
Author information

Abstract

BACKGROUND:
Orthostatic intolerance (OI) is a significant problem for those with chronic fatigue syndrome (CFS). We aimed to characterize orthostatic intolerance in CFS and to study the effects of exercise on OI.

METHODS:
CFS (n = 39) and control (n = 25) subjects had recumbent and standing symptoms assessed using the 20-point, anchored, ordinal Gracely Box Scale before and after submaximal exercise. The change in heart rate (ΔHR ≥ 30 bpm) identified Postural Orthostatic Tachycardia Syndrome (POTS) before and after exercise, and the transient, exercise-induced postural tachycardia Stress Test Activated Reversible Tachycardia (START) phenotype only after exercise.

RESULTS:
Dizziness and lightheadedness were found in 41% of recumbent CFS subjects and in 72% of standing CFS subjects. Orthostatic tachycardia did not account for OI symptoms in CFS. ROC analysis with a threshold ≥ 2/20 on the Gracely Box Scale stratified CFS subjects into three groups: No OI (symptoms < 2), Postural OI (only standing symptoms ≥ 2), and Persistent OI (recumbent and standing symptoms ≥ 2).

CONCLUSIONS:
Dizziness and Lightheadedness symptoms while recumbent are an underreported finding in CFS and should be measured when doing a clinical evaluation to diagnose orthostatic intolerance. POTS was found in 6 and START was found in 10 CFS subjects. Persistent OI had symptoms while recumbent and standing, highest symptom severity, and lability in symptoms after exercise. Trial registration The trial was registered at the following: https://clinicaltrials.gov/ct2/show/NCT03567811.

KEYWORDS:
Chronic fatigue syndrome; Orthostatic intolerance; POTS; Tachycardia
PMID: 31159884 DOI: 10.1186/s12967-019-1935-y

 

[bombsh3ll]

Interesting research, thanks for sharing! OI is my biggest limitor.
I am a bit confused however by the term orthostatic intolerance being applied to symptoms while recumbent, as by definition it means symptoms occurring whilst sitting or standing that are relieved by recumbence.

Whilst symptoms of dizziness/lightheadedness can & do occur during recumbence, and deserve investigation, these are not by nature orthostatic.

A better term may be "symptoms suggesting cerebral hypoperfusion" either orthostatic or non-orthostatic.

Still, great that this is being looked at.

B xxx

 

[Inara]

I agree with @bombsh3ll. Orthostatic means upright, so it makes no sense to speak of OI when recumbent? I also thought that defining OI by "dizziness and lightheadedness" is a big drawback of the study because OI is not dizziness and lightheadedness alone (some may not even have it, but other symptoms which didn't play any role in the study). I don't fully understand why the authors did that. Or do I misunderstand sth?

 

[starlily88]

Whilst symptoms of dizziness/lightheadedness can & do occur during recumbence, and deserve investigation, these are not by nature orthostatic.

A better term may be "symptoms suggesting cerebral hypoperfusion" either orthostatic or non-orthostatic.

To Bombsh311 - I never was excited to take the "laying on table while they put it in air, lower fast, pass out test"
Instead - awhile ago, when I would use the actual brick bank, to deposit checks - I was in Bank of America near me - always big lines, one teller - I would wait over 20 - 25 minutes (it felt like it was this long) then do my deposit.
Then I would go to front of Bank to outer part - to the ATM's to get cash.
At least 2 times in one year - without any warning physical feelings at all - I would totally pass out, from standing to on Bank floor.
Unfortunately, guys rushed over, tried to "lift" me up - worst thing to do, as the brain was getting no blood, standing in line upright for so long - all blood flowed to my extremeties like hands, feet - away from brain, so naturally my body passed out - to get needed blood back to my brain.

I called my Cardiologist, went in. Why am I passing out in Banks, not Target, not Walmart, not Walgreens, am I allergic to money?
After I told him how long I stood in line - he explained what you call cerebral brain orthostatic thing.

I never stand in any lines now - not for more than few minutes.
Starlily88