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Symptoms of autonomic dysfunction in chronic fatigue syndrome

Lookup NU author(s): Emerita Professor Julia Newton, Professor David Jones


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Background: Chronic fatigue syndrome (CFS) is common and its cause is unknown. Aim: To study the prevalence of autonomic dysfunction in CFS, and to develop diagnostic criteria. Design: Cross-sectional study with independent derivation and validation phases. Methods: Symptoms of autonomic dysfunction were assessed using the Composite Autonomic Symptom Scale (COMPASS). Fatigue was assessed using the Fatigue Impact Scale (FIS). Subjects were studied in two groups: phase 1 (derivation phase), 40 CFS patients and 40 age- and sex-matched controls; phase 2 (validation phase), 30 CFS patients, 37 normal controls and 60 patients with primary biliary cirrhosis. Results: Symptoms of autonomic dysfunction were strongly and reproducibly associated with the presence of CFS or primary biliary cirrhosis (PBC), and correlated with severity of fatigue. Total COMPASS score >32.5 was identified in phase 1 as a diagnostic criterion for autonomic dysfunction in CFS patients, and was shown in phase 2 to have a positive predictive value of 0.96 (95%5;CI 0.86-0.99) and a negative predictive value of 0.84 (0.70-0.93) for the diagnosis of CFS. Discussion: Autonomic dysfunction is strongly associated with fatigue in some, but not all, CFS and PBC patients. We postulate the existence of a 'cross-cutting' aetiological process of dysautonomia-associated fatigue (DAF). COMPASS >32.5 is a valid diagnostic criterion for autonomic dysfunction in CFS and PBC, and can be used to identify patients for targeted intervention studies. © The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians.

Publication metadata

Author(s): Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DEJ

Publication type: Article

Publication status: Published

Journal: QJM

Year: 2007

Volume: 100

Issue: 8

Pages: 519-526

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

Publisher: Oxford University Press


DOI: 10.1093/qjmed/hcm057

PubMed id: 17617647


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