Abstract
Introduction: Postural tachycardia syndrome (POTS) is a suspected dysautonomia with symptoms of orthostatic intolerance and abnormally increased heart rate while standing. We aimed to study cardiac autonomic nervous system functioning in head-up tilt (HUT) in adolescents with POTS to find out if parasympathetic tone is attenuated in the upright position.Methods: We compared characteristics of a group of 25 (females 14/25; 56%) adolescents with POTS and 12 (females 4/12; 34%) without POTS aged 9–17 years. We compared heart rate variability with high- and low-frequency oscillations, and their temporal changes in HUT.Results: The high-frequency oscillations, i.e., HF, attenuated in both groups during HUT (p < 0.05), but the attenuation was bigger in POTS (p = 0.04). In the beginning of HUT, low-frequency oscillations, i.e., LF, increased more in POTS (p = 0.01), but in the end of HUT, an attenuation in LF was seen in the POTS group (p < 0.05), but not in the subjects without POTS. There were no associations of previous infections or vaccinations with POTS. Subjects with POTS were sleepier and their overall quality of life was very low.Conclusion: The results imply to an impaired autonomic regulation while standing in POTS, presenting as a lower HF and higher LF in the beginning of HUT and an attenuated LF in the prolonged standing position.
Highlights
Postural tachycardia syndrome (POTS) is a suspected dysautonomia with symptoms of orthostatic intolerance and abnormally increased heart rate while standing
There were no significant differences in age, sex, or body mass index (BMI) between the groups with and without POTS
There were no significant differences in depressive symptoms or attention-deficit hyperactivity disorder (ADHD) symptoms
Summary
Postural tachycardia syndrome (POTS) is a suspected dysautonomia with symptoms of orthostatic intolerance and abnormally increased heart rate while standing. We aimed to study cardiac autonomic nervous system functioning in headup tilt (HUT) in adolescents with POTS to find out if parasympathetic tone is attenuated in the upright position. Postural tachycardia syndrome (POTS) is a type of functional dysautonomia characterized by symptoms of orthostatic intolerance accompanied with abnormally increased heart rate (HR) while standing (Sheldon et al, 2015). Adolescent POTS Patients’ HUT (bpm) for at least 30 s when moving from a recumbent to a standing position but without simultaneous orthostatic hypotension [>20 mmHg drop in systolic blood pressure (SBP)], and other causative conditions or medications must be ruled out (Sheldon et al, 2015). The number of POTS diagnoses is increasing, presumably as a result of better disease recognition (Skufca et al, 2017; Brinth et al, 2018)
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