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: 1.56). 12/2007; 137(1-2):94-101. DOI: 10.1016/j.autneu.2007.08.002
Source: PubMed


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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    • "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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    ABSTRACT: Sleep disturbances are common in chronic fatigue syndrome (CFS), and one of the key symptom complaints, yet it has been neglected by previous qualitative research. The aim was to explore the specific role of sleep in patients' experience of their illness. A qualitative semi-structured interview format facilitated a detailed and open exploration of sleep, and the extent to which its management and problems were linked to the lived experience of CFS. Eleven semi-structured interviews were conducted with individuals with CFS. Data were transcribed verbatim and analysed thematically, to explore and describe patients' experience of their sleep, and its impact on their condition. Sleep emerged as a key aspect of the illness experience, and its management and effect on daytime functioning was a central pre-occupation for all 11 participants; all of them saw sleep as playing a critical role in their illness through either maintaining or exacerbating existing symptoms. Exploration of individual experiences presented three overarching themes: (1) sleep pattern variability over illness course and from day to day; (2) effect of sleep on daytime functioning; and (3) attempts at coping and sleep management. Each patient with CFS has a unique experience of sleep. Despite the differing narratives regarding the role of sleep in CFS, all participants held the belief that sleep is a vital process for health and well-being which has had a direct bearing on the course and progression of their CFS. Also, every participant regarded their sleep as in some way ‘broken' and in need of management/repair. Patients' insights demonstrate sleep-specific influences on their CFS, and the impact of disturbed sleep should be a consideration for clinical and research work. What is already known on this subject? What this study adds?
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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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    ABSTRACT: We investigated whether stress may influence fatigue, or vice versa, as well as factors mediating this relationship. Fifty healthy participants (31 females, 23.6±3.2 years) completed up to 5 momentary assessments of stress and fatigue during 5 days of preparation for their final examinations (exam condition) and 5 days of a regular semester week (control condition). Sleep quality was measured by self-report at awakening. A sub-group of participants (n=25) also collected saliva samples. Fatigue was associated with concurrent stress, stress reported at the previous measurement point, and previous-day stress. However, momentary stress was also predicted by concurrent fatigue, fatigue at the previous time point, and previous-day fatigue. Sleep quality mediated the association between stress and next-day fatigue. Cortisol and alpha-amylase did not mediate the stress-fatigue relationship. In conclusion, there is a reciprocal stress-fatigue relationship. Both prevention and intervention programs should comprehensively cover how stress and fatigue might influence one another. Copyright © 2015. Published by Elsevier B.V.
    No preview · Article · Jul 2015 · Biological psychology
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    • "Healthy research participants made hypoglycemic with exogenous insulin demonstrate increased SNS tone assessed by heart rate variability [25] and manifestations of somatic arousal [26]. Among individuals diagnosed with chronic fatigue syndrome [27], fibromyalgia [28], IBS [29], Gulf War illness [30], and chronic insomnia [31], disorders associated with chronic stress [11] [12] [13] [14] [15], investigators have analyzed heart rate variability to demonstrate increased SNS tone. Thus, disorders conceptualized as having a common basis of stress are characterized by increased SNS tone and somatic arousal. "
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    ABSTRACT: Objectives We tested the hypothesis that the symptoms of upper airway resistance syndrome (UARS) are manifestations of chronic stress. To accomplish this we utilized the score on a self-report questionnaire for somatic arousal (a component of stress) to compare somatic arousal between UARS patients and healthy controls and, among all participants, to correlate the level of somatic arousal with the severity of UARS symptoms. Methods We administered the Mood and Anxiety Symptom Questionnaire anxious arousal subscale (MASQaas; a 17-item questionnaire with increasing levels of arousal scored 17-85) to 12 UARS patients and 12 healthy controls and compared scores between groups. For all participants, we correlated the MASQaas scores with scores for the Epworth Sleepiness Scale (ESS), Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-fatigue) scale, Pittsburgh Sleep Quality Index (PSQI), SF-36 Health Survey and Perceived Deficits Questionnaire (PDQ; assessing cognitive function). Results Compared to healthy controls, UARS patients demonstrated increased somatic arousal (MASQaas scores of 18 ± 2 and 28 ± 7 respectively; p < 0.0001). For all participants, the MASQaas scores correlated significantly with scores of the ESS (r = 0.64; p = 0.0008), the FACIT-fatigue scale (r = -0.89; p < 0.0001), the PSQI (r = 0.70; p = 0.0002), SF-36 Physical component (r = -0.78; p < 0.0001), SF-36 Mental component (r = -0.74; p < 0.0001) and the PDQ (r = 0.89; p < 0.0001). Conclusions Our findings suggest that UARS patients have increased levels of the stress component, somatic arousal, proportionate to the severity of their symptoms.
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