Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion
Abstract
The objective was to determine the nature of autonomic and vasomotor changes in adolescent patients with orthostatic tachycardia associated with the chronic fatigue syndrome (CFS) and the postural orthostatic tachycardia syndrome (POTS). Continuous electrocardiography and arterial tonometry was used to investigate the heart rate and blood pressure responses before and 3-5 min after head-up tilt in 22 adolescents with POTS and 14 adolescents with CFS, compared with control subjects comprising 10 healthy adolescents and 20 patients with simple faint. Heart rate and blood pressure variability, determined baroreceptor function using transfer function analysis, and measured cardiac vagal and adrenergic autonomic responses were calculated using timed breathing and the quantitative Valsalva maneuver. Two of 10 healthy controls and 14 of 20 simple faint patients experienced vasovagal syncope during head-up tilt. By design, all CFS and POTS patients experienced orthostatic tachycardia, often associated with hypotension. R-R interval and heart rate variability were decreased in CFS and POTS patients compared with control subjects and remained decreased with head-up tilt. Low-frequency (0.05-0.15 Hz) blood pressure variability reflecting vasomotion was increased in CFS and POTS patients compared with control subjects and increased further with head-up tilt. This was associated with depressed baroreflex transfer indicating baroreceptor attenuation through defective vagal efferent response. Only the sympathetic response remained. Heart rate variability declined progressively from normal healthy control subjects through syncope to POTS to CFS patients. Timed breathing and Valsalva maneuver were most often normal in CFS and POTS patients, although abnormalities in select individuals were found. Heart rate and blood pressure regulation in POTS and CFS patients are similar and indicate attenuated efferent vagal baroreflex associated with increased vasomotor tone. Loss of beat-to-beat heart rate control may contribute to a destabilized blood pressure resulting in orthostatic intolerance. The dysautonomia of orthostatic intolerance in POTS and in chronic fatigue are similar.
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There is a striking link between fatigue and the occurrence of dyshomeostasis-inducing autonomic nervous system disorders.
“Second, clinical studies have demonstrated a striking link between fatigue and the occurrence of dyshomeostasis-inducing autonomic nervous system disorders (e.g., Stewart, 2000).”
From Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression (2016) · cites this paper as Stewart, 2000
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- Authors
- Stewart, J. M.
- Affiliations
- New York Medical College (US)
- Corresponding author
- Stewart, Julian M
- ORCID
- Stewart, Julian M
- Venue
- Pediatric Research
- Published
- 2000-08
- Volume
- 48
- Issue
- 2
- Pages
- 218-226
- ISSN
- 0031-3998 (ISSN-L)
- 1530-0447
- OpenAlex
- W2050656100
- Cited by
- 198
- References
- 33
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 6 · 2022: 3 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 6 · 2015: 7 · 2014: 9 · 2013: 15 · 2012: 9
- FWCI
- 7.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r03ai045954-02)
- National Institute of Allergy and Infectious Diseases (1RO3-AI45954-01)
- 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 › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- postural orthostatic tachycardia syndrome, chronic fatigue syndrome, autonomic dysfunction, vagal baroreflex, heart rate variability, blood pressure variability, orthostatic intolerance, adolescents, vasovagal syncope, head-up tilt
- MeSH terms
- Adolescent, Autonomic Nervous System Diseases, Blood Pressure, Heart Rate, Humans, Posture, Reference Values, Sympathetic Nervous System, Syncope, Tachycardia, Vagus Nerve, Valsalva Maneuver, Respiratory Mechanics, Fatigue Syndrome, Chronic, Baroreflex, Tilt-Table Test
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