Orthostatic instability in a population-based study of chronic fatigue syndrome

James F. Jones, Ainsley Nicholson, Rosane Nisenbaum, Dimitris A. Papanicolaou, Laura Solomon, Roumiana Boneva, Christine Marcelle Heim, William C. Reeves

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Abstract

PURPOSE: Autonomic nervous system dysfunction has been suggested as involved in the pathophysiology of chronic fatigue syndrome. This population-based case control study addressed the potential association between orthostatic instability (one sign of dysautonomia) and chronic fatigue syndrome. SUBJECTS AND METHODS: Fifty-eight subjects who fulfilled criteria of the 1994 chronic fatigue syndrome research case definition and 55 healthy controls participated in a 2-day inpatient evaluation. Subjects had been identified during a 4-year population-based chronic fatigue syndrome surveillance study in Wichita, Kan. The present study evaluated subjects' current medical and psychiatric status, reviewed past medical/psychiatric history and medication use, used a stand-up test to screen for orthostatic instability, and conducted a head-up tilt table test to diagnose orthostatic instability. RESULTS: No one manifested orthostatic instability in the stand-up test. The head-up tilt test elicited orthostatic instability in 30% of eligible chronic fatigue syndrome subjects (all with postural orthostatic tachycardia) and 48% of controls (50% with neurally mediated hypotension); intolerance was present in only nonfatigued (n = 7) subjects. Neither fatigue nor illness severity were associated with outcome. CONCLUSIONS: Orthostatic instability was similar in persons with chronic fatigue syndrome and nonfatigued controls subjects recruited from the general Wichita population. Delayed responses to head-up tilt tests were common and may reflect hydration status. These findings suggest reappraisal of primary dysautonomia as a factor in the pathogenesis of chronic fatigue syndrome.

Original languageEnglish (US)
Pages (from-to)1415.e19-1415.e28
JournalAmerican Journal of Medicine
Volume118
Issue number12
DOIs
Publication statusPublished - Jan 1 2005

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All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Jones, J. F., Nicholson, A., Nisenbaum, R., Papanicolaou, D. A., Solomon, L., Boneva, R., ... Reeves, W. C. (2005). Orthostatic instability in a population-based study of chronic fatigue syndrome. American Journal of Medicine, 118(12), 1415.e19-1415.e28. https://doi.org/10.1016/j.amjmed.2005.07.059