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Does the Chronic Fatigue Syndrome (CFS) involve the autonomic nervous system?

  [ 26 votes ]   [ Discuss This Article ]
By Freeman R, Komaroff AL • • April 5, 1997

PURPOSE: To investigate the role of the autonomic nervous system in
the symptoms of patients with chronic fatigue syndrome (CFS)
and delineate the pathogenesis of the orthostatic Intolerance
and predisposition to neurally mediated syncope reported in
this patient group.

patients and controls performed a battery of autonomic
function tests. The CFS patients completed questionnaires
pertaining to autonomic and CFS symptoms, their level of
physical activity, and premorbid and coexisting psychiatric
disorders. The relationship between autonomic test results,
cardiovascular deconditioning, and psychiatric disorders was
examined with multivariate statistics and the evidence that
autonomic changes seen in CFS might be secondary to a
postviral, idiopathic autonomic neuropathy was explored.

RESULTS: The CFS subjects had a significant increase in
baseline (P < 0.01) and maximum heart rate (HR) on standing
and tilting (both P < 0.0001). Tests of parasympathetic
nervous system function (the expiratory inspiratory ratio, P <
0.005; maximum minus minimum HR difference, P < 0.05), were
significantly less in the CFS group as were measures of
sympathetic nervous system function (systolic blood pressure
decrease with tilting, P < 0.01; diastolic blood pressure
decrease with tilting, P < 0.05; and the systolic blood
pressure decrease during phase II of a Valsalva maneuver, P <
0.05). Twenty-five percent of CFS subjects had a positive tilt
table test. The physical activity index was a significant
predictor of autonomic test results (resting, sitting,
standing, and tilted HR, P < 0.05 to P < 0.009); and the blood
pressure decrease in phase II of the Valvalsa maneuver, P <
0.05) whereas premorbid and coexistent psychiatric conditions
were not. The onset of autonomic symptoms occurred within 4
weeks of a viral infection in 46% of patients-a temporal
pattern that is consistent with a postviral, idiopathic
autonomic neuropathy.

CONCLUSION: Patients with CFS show
alterations in measures of sympathetic and parasympathetic
nervous system function. These results, which provide the
physiological basis for the orthostatic intolerance and other
symptoms of autonomic function in this patient group, may be
explained by cardiovascular deconditioning, a postviral
idiopathic autonomic neuropathy, or both.

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