Autonomic Phenotypes in Chronic Fatigue Syndrome (CFS) Are Associated with Illness Severity: A Cluster Analysis.

Joanna Słomko,Monika Zawadka-Kunikowska,Paweł Zalewski,Jacek J Klawe,Sławomir Kujawski,Małgorzata Tafil-Klawe,Julia L Newton,Justyna Szrajda,Modra Murovska,Fernando Estévez-López,Karl J Morten

doi:10.3390/jcm9082531

Abstract

In this study we set out to define the characteristics of autonomic subgroups of patients with Chronic Fatigue Syndrome (CFS). The study included 131 patients with CFS (Fukuda criteria). Participants completed the following screening symptom assessment tools: Chalder Fatigue Scale, Fatigue Impact Scale, Fatigue Severity Scale, Epworth Sleepiness Scales, the self-reported Composite Autonomic Symptom Scale. Autonomic parameters were measured at rest with a Task Force Monitor (CNS Systems) and arterial stiffness using an Arteriograph (TensioMed Kft.). Principal axis factor analysis yielded four factors: fatigue, subjective and objective autonomic dysfunction and arterial stiffness. Using cluster analyses, these factors were grouped in four autonomic profiles: 34% of patients had sympathetic symptoms with dysautonomia, 5% sympathetic alone, 21% parasympathetic and 40% had issues with sympathovagal balance. Those with a sympathetic-dysautonomia phenotype were associated with more severe disease, reported greater subjective autonomic symptoms with sympathetic over-modulation and had the lowest quality of life. The highest quality of life was observed in the balance subtype where subjects were the youngest, had lower levels of fatigue and the lowest values for arterial stiffness. Future studies will aim to design autonomic profile-specific treatment interventions to determine links between autonomic phenotypes CFS and a specific treatment.

Highlights

Chronic Fatigue Syndrome (CFS) is a multi-system complex disorder, characterized by extreme mental and physical fatigue with an array of physical symptoms not relieved by rest
It has been suggested that deregulation of stress-responsive systems: hypothalamic-pituitary-adrenal axis, autonomic nervous system and immune system contributes to the core symptoms of CFS [2]
The present study provided an understanding of CFS heterogeneity by including fatigue severity, autonomic symptoms and arterial stiffness measured by objective or/and subjective assessments, in a cohort of CFS patients that fulfil the Fukuda criteria

Summary

Introduction

Chronic Fatigue Syndrome (CFS) is a multi-system complex disorder, characterized by extreme mental and physical fatigue with an array of physical symptoms not relieved by rest. Additional core symptoms include post-exertional malaise, sleep disturbance, cognitive abnormalities including memory loss, poor concentration and a general reduction in cognitive ability. Over the last 20 years a variety of hypotheses have been proposed, to explain the complex etiology, including disruptions in mitochondrial, metabolic, immunological, virological, neuroendocrinological and psychological function [1]. It remains to be proven that these are not just a consequence of inactivity and we need to start to link the biological differences to the clinical phenotype if we are to make real progress in understanding the causes of the condition. Autonomic imbalance has been frequently reported in patients with CFS, with symptoms including dysautonomia with orthostatic hypotonia, postural orthostatic tachycardia syndrome and gastro-intestinal disturbances being important components [3]. CSF can include sympathetic hyperactivation or parasympathetic dysfunction—fatigue, unrefreshing sleep, cognitive disturbance, post-exertional malaise could all link to this autonomic dysfunction [4]

Methods

Results

Conclusion