Moon et al: Orthostatic intolerance symptoms are associated w/ depression & diminished QoL [in POTS]

[mango]

Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome

Jangsup Moon, Do-Yong Kim, Jung-Ick Byun, Jun-Sang Sunwoo, Jung-Ah Lim, Tae-Joon Kim, Jung-Won Shin, Woo-Jin Lee, Han Sang Lee, Jin-Sun Jun, Kyung-Il Park, Keun-Hwa Jung, Soon-ae Lee, Ki-Young Jung, Kon Chu, Sang Kun Lee

Health and Quality of Life Outcomes 2016 14:144
DOI:10.1186/s12955-016-0548-x
Received: 7 January 2016. Accepted: 30 September 2016. Published: 12 October 2016.

Abstract
Background
Patients with postural tachycardia syndrome often appear depressive and report diminished quality of life (QOL). In the current study, we first evaluated if the maximal heart rate (HR) increment after standing is associated with the clinical symptoms in patients with excessive orthostatic tachycardia (OT).

Next, we investigated the correlations among the symptoms of orthostatic intolerance (OI), depression, and health-related QOL in these patients. Finally we assessed if patients with minimal OI symptoms suffer from depression or diminished QOL.

Methods
We performed a comprehensive questionnaire-based assessment of symptoms in 107 patients with excessive OT with a ≥ 30 beats/min heart rate increment (or ≥ 40 beats/min in individuals aged between 12 and 19) within 10 min after standing up.

An existing orthostatic intolerance questionnaire (OIQ), the Beck depression inventory-II (BDI-II), and the 36 Item Short-Form Health Survey were completed prior to any treatment.

Correlation analyses among the items of the questionnaires and other parameters were performed. Additionally, patients with minimal OI symptoms were analysed separately.


Results
The maximal orthostatic HR increment was not associated with the clinical symptoms. The OI symptoms were significantly correlated with depression and diminished QOL. The BDI-II score demonstrated a positive linear relationship with total OIQ score (r = 0.516), and both physical and mental component summary scales of SF-36 showed a negative linear relationship with total OIQ score (r = -0.542 and r = -0.440, respectively; all p <0.001).

Some OI symptoms were more strongly associated with depression, and others were more strongly related to QOL. Chest discomfort and concentration difficulties were the most influential OI symptoms for depression, while nausea and concentration difficulties were the most influential symptoms for physical and mental QOL, respectively.

Dizziness and headache were the two most common complaints in patients with mild to moderate OI symptoms. In addition, subjects with minimal OI symptoms also had considerable deterioration in QOL.


Conclusion
The OI symptoms, but not the maximal HR increment, are significantly correlated with depression and diminished QOL in patients with excessive OT. Therefore, pervasive history taking is important when encountering patients with excessive OT.


Keywords
Orthostatic intolerance Depression Quality of life Correlation Postural tachycardia syndrome


https://hqlo.biomedcentral.com/articles/10.1186/s12955-016-0548-x

 

[Forbin]

In summary, when the patients experienced more OI symptoms, they were more depressed and felt greater deterioration in their QOL.

Well, it sounds like they got the direction of causality right (for once).

 

[Hutan]

The maximal orthostatic HR increment was not associated with the clinical symptoms.

This seems odd. I have tracked my maximal orthostatic HR increment (maxOHR) and other symptoms over several months and there was a relationship - during PEM the maxOHR and the incidence and severity of other symptoms both increased.

My daughter, who has mostly recovered from ME, has a sub-clinical, but higher than normal maximal orthostatic HR. My son, who has ME with orthostatic symptoms continues to have a higher than normal maximal orthostatic HR.

A possible reason for the mismatch between my experience of a fairly close relationship between OI and other ME symptoms and what the researchers found is that the researchers only took two maximal orthostatic HR increment (maxOHR) measurements. That would not be enough to deal with the hourly, daily and weekly variation in maxOHR. I expect many of the measures of other clinical symptoms asked for impressions of the average level of symptom over an extended period.

So, if by chance, the maxOHR was higher than normal on the day of measurement but the measure of other symptoms was the patient's perception of the average impact over the last month, the relationship between maxOHR and other symptoms will be blurred.