Article

Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: A population-based study. Autonomic Neuroscience, 137, 94-101

Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
Autonomic Neuroscience (Impact Factor: 1.37). 12/2007; 137(1-2):94-101. DOI: 10.1016/j.autneu.2007.08.002
Source: PubMed

ABSTRACT Autonomic nervous system (ANS) dysfunction has been suggested in patients with chronic fatigue syndrome (CFS). In this study, we sought to determine whether increased heart rate (HR) and reduced heart rate variability (HRV) parameters observed in CFS patients during wakefulness persist during sleep. To this end, we compared heart rate (HR) and HRV as indicators of ANS function in CFS subjects and non-fatigued (NF) controls in a population-based, case-control study. Thirty subjects with CFS and 38 NF controls, matched for age-, sex- and body mass index, were eligible for analysis. Main outcome measures included mean RR interval (RRI), HR, and HRV parameters derived from overnight ECG. Plasma aldosterone and norepinephrine levels, medicines with cardiovascular effect, and reported physical activity were examined as covariates. General Linear Models were used to assess significance of associations and adjust for potential confounders. Compared to controls, CFS cases had significantly higher mean HR (71.4 vs 64.8 bpm), with a shorter mean RRI [840.4 (85.3) vs 925.4(97.8) ms] (p<0.0004, each), and reduced low frequency (LF), very low frequency (VLF), and total power (TP) of HRV (p<0.02, all). CFS cases had significantly lower plasma aldosterone (p<0.05), and tended to have higher plasma norepinephrine levels. HR correlated weakly with plasma norepinephrine (r=0.23, p=0.05) and moderately with vitality and fatigue scores (r=-0.49 and 0.46, respectively, p<0.0001). Limitation in moderate physical activity was strongly associated with increased HR and decreased HRV. Nevertheless, among 42 subjects with similar physical activity limitations, CFS cases still had higher HR (71.8 bpm) than respective controls (64.9 bpm), p=0.023, suggesting that reduced physical activity could not fully explain CFS-associated differences in HR and HRV. After adjusting for potential confounders case-control differences in HR and TP remained significant (p<0.05). Conclusion: the presence of increased HR and reduced HRV in CFS during sleep coupled with higher norepinephrine levels and lower plasma aldosterone suggest a state of sympathetic ANS predominance and neuroendocrine alterations. Future research on the underlying pathophysiologic mechanisms of the association is needed.

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    • "As fatigue is a prominent feature in autonomic dysregulation, it can be assumed that it is related not only to changes in HPA axis activity, but also to changes in ANS (Nater, Heim, & Raison, 2012). Some studies indeed point to ANS alterations in fatigued individuals: Boneva et al. (2007), for instance, report higher heart rates as well as lower heart rate variability in persons with chronic fatigue syndrome. De Vente, Olff, Van Amsterdam, Kamphuis, and Emmelkamp (2003) found higher resting heart rate in fatigued persons compared to healthy controls. "
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    • "Previous research has shown that there is a relationship between disrupted sleep patterns and chronic fatigue syndrome (CFS; Boneva et al., 2007; Morriss, Wearden, & Battersby, 1997; Togo et al., 2008). Sleep is a consistent complaint of those suffering from CFS; 87– 95% of patients with CFS report feeling unrefreshed on waking, despite adequate sleep duration (Hamaguchi, Kawahito, Takeda, Kato, & Kojima, 2011; Jason et al., 1999; Nisenbaum, Jones, Unger, Reyes, & Reeves, 2003; Nisenbaum, Reyes, Unger, & Reeves, 2004). "
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