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QJM Advance Access originally published online on July 7, 2007
QJM 2007 100(8):519-526; doi:10.1093/qjmed/hcm057
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Symptoms of autonomic dysfunction in chronic fatigue syndrome

J.L. Newton, O. Okonkwo, K. Sutcliffe, A. Seth, J. Shin and D.E.J. Jones

From the Fatigue Interest group and Liver Research Group, Institute for Cellular Medicine, University of Newcastle, Newcastle, UK

Address correspondence to Dr J.L. Newton, Fatigue Interest Group, Institute for Cellular Medicine, Newcastle University, Newcastle NE2 4HH. e-mail: julia.newton{at}nuth.nhs.uk

Received 5 March 2007 and in revised form 24 April 2007


  Abstract

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%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.


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