Autonomic Nervous System Functioning Related to Nocturnal Sleep in Patients With Chronic Fatigue Syn

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J Clin Sleep Med. 2017 Dec 13. pii: jc-17-00330. [Epub ahead of print]
Autonomic Nervous System Functioning Related to Nocturnal Sleep in Patients With Chronic Fatigue Syndrome Compared to Tired Controls.
Orjatsalo M, Alakuijala A, Partinen M.
Abstract
STUDY OBJECTIVES:
Autonomic nervous system (ANS) dysfunction is common in chronic fatigue syndrome (CFS). One of the main complaints in CFS is unrefreshing sleep. We aimed to study the nocturnal cardiac ANS in different sleep stages in patients filling the 2015 Institute of Medicine CFS diagnostic criteria.

METHODS:
In this case series study, the nocturnal heart rate variability and blood pressure (BP) variables in polysomnography were studied in groups of patients with CFS (n = 8) and tired controls (n = 8) aged 16-49 years. Five of the patients with CFS and controls were female. The heart rate variability and BP parameters and heart rate were studied in all sleep stages and wake.

RESULTS:
The amount of low-frequency oscillations of the electrocardiography R-R-intervals spectra (LF; predominantly reflects sympathetic activity) was higher for patients with CFS in all sleep stages compared to controls (P< .001). During wake, the amount of LF was lower for the patients with CFS (P< .05). The amount of high-frequency oscillations (HF; reflects parasympathetic activity) was lower in stage N3 sleep in the patients with CFS than for the controls (P< .0001), but, in total, HF was higher in patients with CFS (P< .001). Patients with CFS had higher overall nocturnal systolic and mean BP (P< .0001) and lower heart rate (P< .0001) than controls. No significant differences were found in sleep stage distributions.

CONCLUSIONS:
The results suggest a nocturnal dysfunction of the cardiac ANS in CFS, presenting as lower parasympathetic tone in deep sleep and higher sympathetic tone asleep.

KEYWORDS:
autonomic nervous system; blood pressure; chronic fatigue syndrome; dysautonomia; heart rate variability; polysomnography; sleep; systemic exertion intolerance disease

PMID:
29246267
 
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Good research topic to try to answer but Big question marks over effect sizes given how puny the sample size is. 8 patients? kind of a shame.

p values look okay but with only 8 patients and 8 controls ~\_(",)_/~
 

BadBadBear

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I ran my HRV overnight a few times to see what it was doing, but it is rather futile as it is so difficult to find baseline HRV data to compare with.

If anyone on PR has Elite HRV we could certainly attempt our own little study. :)
 

anciendaze

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Good research topic to try to answer but Big question marks over effect sizes given how puny the sample size is. 8 patients? kind of a shame.

p values look okay but with only 8 patients and 8 controls ~\_(",)_/~
Then again, compare this number with the number of patients in PACE who showed a substantial response to GET, let alone the number responding to GET+CBT (zero). There was deliberate misrepresentation of the number of patients subject to that intervention, and the number who responded by objective measurements. The fact that patients who felt worse could simply decline to participate in the walk test was also downplayed, as was the fact that performance of patients in the GET arm of the study remained grouped with patients in other studies having advanced heart failure -- after "successful" treatment.

Yes, this is a small study. One good aspect is that it is much harder to hide things the authors don't want to show.

What a wide range of studies have shown is that some patients given the vague label of "CFS" demonstrate problems standard clinical practice is ignoring. At some point we need to ask those responsible for treatment decisions if they think harming these patients is acceptable because someone else might benefit from an intervention that they do not. What number of excess deaths or incorrect commitals for mental illness would these authorities accept?
 

unto

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there is someone in PR who knows in which situations (such as stress, infections, diseases ...)
do these variations occur? it would be interesting to know
 

pattismith

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this is a japanese study

"..., more than one third of the general adult population complains of chronic fatigue. "

"Frequency analysis of the data obtained from electrocardiography and accelerated plethysmography have revealed that enhanced sympathetic nerve activity based on a decrease in parasympathetic nerve activity is common in acute, sub-acute, and chronic fatigue. Alteration of autonomic function may result in changes and imbalances in neural activities in the central autonomic network of the brain, including the prefrontal and anterior cingulate cortices. Several interventions for the alleviation of fatigue are effective in decreasing sympathetic nerve activity. "

"Nocturnal autonomic nerve activity in CFS
Less nocturnal vagal tone in patients with CFS has been reported frequently [13, 17, 81, 87]. Correlation between fatigue severity and a diurnal sympathetic activity was also found [82]. Diurnal sympathetic hyperactivity may cause an accumulation of the fatigue state and decreased vagal tone during sleep may cause unrefreshing sleep."

this article correlates with the 2017 article posted at the top of the thread;

I wonder is stimulation of the parasympathetic nervous system with pyridostigmine ( Mestinon ) at night could help to regulate our sleep and to improve.
 
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My daughter has been on pyridostigmine three times a day for her POTS for almost two years. She doesn't take it at night, but taking it throughout the day hasn't helped her sleep any better.
 
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AND the age range was 16-49!
Probably trying to avoid the menopause window....(keep it below 49 years).

Yes: why so few. (n=8).

So again a study in which: our measurements differ from normal people. And so again: whats MECFS?

Here we have "tired people" as controls. Thats: interesting. Wonder how they differentiated CFS from tired people.
 

junkcrap50

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I ran my HRV overnight a few times to see what it was doing, but it is rather futile as it is so difficult to find baseline HRV data to compare with.
What do you use to record your HR during sleep? I thought you need a chest strap to for enough data measure HRV.
 

pattismith

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I wonder is stimulation of the parasympathetic nervous system with pyridostigmine ( Mestinon ) at night could help to regulate our sleep and to improve.
Just doing a trial with Ephedrine afternoon (sympathetic nervous system) and Mestinon (parasympathetic nervous system) at night, with concurrent supraphysiologic testosterone. it Seems promising so far.
 

ChookityPop

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Just doing a trial with Ephedrine afternoon (sympathetic nervous system) and Mestinon (parasympathetic nervous system) at night, with concurrent supraphysiologic testosterone. it Seems promising so far.
How did the trial go? What are mestinon doing for you?