Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome
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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.
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Mental functioning components had small to medium correlations with symptom burden.
“Mental functioning components (PROMIS mental health T-score and SF-36 mental component) had small”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Moon et al., 2016
The Results section reports that the SF-36 mental component summary score correlated with orthostatic symptom burden (r = −0.436; r = −0.198 after adjustment), consistent with a small-to-medium association. The paper does not report a PROMIS mental health T-score, so it does not support that component of the claim. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBoth physical and mental component summary scales of SF-36 showed a negative linear relationship with total OIQ scores.
“Both physical and mental component summary scales of SF-36 showed a negative linear relationship with total OIQ scores (Moon et al., 2016”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Moon et al., 2016
Two studies found medium correlations between higher symptom burden scores and higher depression scores, and one large study also found this association.
“Two found medium correlations (Benrud-Larson et al., 2003”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Moon et al., 2016
Some OI symptoms were more strongly associated with depression, including chest discomfort and concentration difficulties.
“One medium quality study reported that some OI symptoms were more strongly associated with depression including chest discomfort and concentration difficulties (Moon et al., 2016”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Moon et al., 2016
One medium quality study observed no significant correlation between the degree of orthostatic heart rate increment and symptom burden.
“One medium quality study observed no significant correlation between the degree of orthostatic heart rate increment and symptom burden (Moon et al., 2016”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Moon et al., 2016
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- Authors
- Moon, J., Kim, D.-Y., Byun, J.-I., Sunwoo, J.-S., Lim, J.-A., Kim, T.-J., Shin, J.-W., Lee, W.-J., Lee, H. S., Jun, J.-S., Park, K.-I., Jung, K.-H., Lee, S.-T., Jung, K.-Y., Chu, K., & Lee, S. K.
- Affiliations
- Seoul National University (KR)
- CHA University Bundang Medical Center (KR)
- Seoul National University Hospital (KR)
- Corresponding author
- Lee, Han Sang
- Lee, Soon-Tae
- Chu, Kon
- Lee, Sang Kun
- ORCID
- Venue
- Health and Quality of Life Outcomes
- Published
- 2016-10-12
- Volume
- 14
- Issue
- 1
- Pages
- 144-144
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC5059908
- OpenAlex
- W2530716883
- Cited by
- 66
- References
- 33
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 14 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 3
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Ministry of Health & Welfare, Republic of Korea (Korean Health Technology R&D Project (HI13C1558))
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- postural orthostatic tachycardia syndrome, orthostatic intolerance, depression, quality of life, orthostatic tachycardia, heart rate response to standing, symptom assessment, dizziness, chest discomfort, concentration difficulties, nausea, headache
- MeSH terms
- Adult, Depression, Female, Heart Rate, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome, Republic of Korea
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