Journal of Chronic Fatigue Syndrome: Volume 14, Issue 2, 2007

Volume 14, Issue 2, 2007

 * Editorial by Elke Van Hoof, Kenny De Meirleir & Neil McGregor
 * Nine-Year Follow-Up of Danish Chronic Fatigue Syndrome (CFS) Patients: Impact on Health, Social, Vocational, and Personal Lives"'Abstract - Objective: To determine quality of life (QOL) and health in Danish CFS patients 9 years after diagnosis. Methods: Thirty-four adults with CFS responded to questions regarding QOL at diagnosis, and again 5 and 9 years later. At 9-year follow-up patients also responded to questions regarding health, fatigue, use of Health Care system, alcohol and exercise. Results: Two patients (6%) had recovered and 3 patients (10%) had received secondary diagnoses. Overall, there was no improvement, except with depression/anxiety. The order of severity among disabilities remained the same. Work had the highest disability score, followed by post-exertional malaise. Patients slept and rested 13.6 hours a day (mean). Self-reported physical health correlated with hours sleeping and resting. Rheumatic symptoms dominated the health symptoms. Alcohol consumption was low, and the use of the Health Care system was modest. Conclusion: After 9 years QOL was the same as at diagnosis, only mental health had improved.'"
 * The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding CFS/FM"'Abstract - Objective: To assess the effects of an early educational intervention program's ability to alter the perceptions and attitudes of future physicians regarding chronic fatigue syndrome/fibromyalgia (CFS/FM), improve their understanding and acceptance of these diseases, make them feel more comfortable in diagnosing and treating patients. Method: Third-year medical students were surveyed before and after an educational intervention program. The three questions posed to the students in the survey were: (1) How comfortable do you feel you are in diagnosing and treating patients with CFS /FM?, (2) Do you consider CFS/FM legitimate illnesses?, and (3) Do you want to treat patients with CFS/FM? Results: The educational intervention program helped about half of the future physicians feel comfortable in diagnosing and treating patients with CFS/FM and improved by over 25% their willingness to treat patients with CFS. Conclusion: An educational intervention program appeared to improve future physicians' understanding and appreciation of CFS/FM, made them feel more comfortable diagnosing and treating these diseases, and increased their willingness to treat patients with CFS/FM.'"
 * Health-Related Quality of Life in Chronic Fatigue Syndrome versus Rheumatoid Arthritis as Control Group"'Abstract - The objectives of this study were (1) evaluate health-related quality of life (HRQL) in patients with chronic fatigue syndrome (CFS); (2) to compare the HRQL of these patients with that of rheumatoid arthritis (RA) patients and healthy Spanish reference population values (RPV); and (3) to identify the influence of sociodemographic and clinical variables on HRQL in CFS patients. We included 216 outpatients: 94 females/14 males (age 42.9 ± 9.9 years) with CFS and 94 females/14 males with RA (age 42.9 ± 9.9 years). We used a cross-sectional, observational design. Sociodemographic data, comorbidities, pain (VAS) and global functional status were determined. HRQL was measured by the SF-36 and HAQ questionnaires. CFS patients had worse scores than RA patients in all SF36 dimensions except emotional role (p < 0.01). Both CFS and RA patients had worse scores in all SF36 dimensions than RPV. In CFS patients, pain negatively influenced HRQL (p < 0.05) except for physical role, social function and emotional role. Global functional status negatively influenced HRQL (p < 0.05) except for bodily pain, general health and mental health. Comorbidities worsened scores for physical and social functions and mental health. In conclusion, HRQL was worse in patients with CFS than in those with RA. Both CFS and RA patients had worse HRQL compared with RPV. Comorbidities, pain and global functional status influenced HRQL in CFS patients. Standardised HRQL instruments are of value in determining the quality of life in these patients.'"
 * Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients: A Comparison with Sleep Apnea-Hypopnea Patients and Healthy Control Subjects"'Abstract - Objective: The chronic fatigue syndrome (CFS) is a debated clinical entity, not presently associated with specific sleep abnormalities. However, higher levels of deep sleep and/or lower levels of light sleep have been reported in several all-night polysomnography studies in CFS patients. This distribution of Non-Rapid Eye Movement Sleep (NREMS) contrasts with what would be expected if sleep was interrupted by microawakenings, such as in sleep apneas or periodic limb movements, where more light sleep and less deep sleep are commonly observed. This “paradoxical” distribution of NREMS could represent a characteristic feature of chronic fatigue and deserved to be investigated. Methods: A retrospective comparison of the NREMS distribution was performed between 28 “pure” Chronic Fatigue Syndrome patients (without primary sleep or psychiatric disorders), 27 Apneic-Hypopneic patients and 27 Healthy Controls. Results: Data showed CFS patients to have a higher stage 4/stage 2 or stage 4/light sleep ratios than the other two conditions. Conclusion: This sleep pattern is closer to what is observed in cases of infections than to what is seen after sleep fragmentation by primary sleep or in psychiatric disorders. Such a particular sleep pattern could provide insights into the pathophysiology of fatigue.''"
 * Legal and Scientific Considerations of the Exercise Stress Test"'Abstract - This article examines the legal and scientific bases on which an exercise stress test can provide medically acceptable evidence of disability for the Chronic Fatigue Syndrome (CFS) patient. To qualify for disability benefits, a claimant must establish the existence of a serious medically determinable impairment (MDI) that causes the inability to work. The single stress test has been used to objectively establish whether a claimant can engage in “substantial gainful employment” and is an important determinant of the award or denial of benefits. A review of case law indicates problems associated with a single test protocol that may be remedied by a “test-retest” protocol. The results of a preliminary study employing this approach indicate that the test-retest protocol addresses problems inherent in a single test and therefore provides an assessment of CFS related disability consistent with both medical and legal considerations.'"
 * Diminished Cardiopulmonary Capacity During Post-Exertional Malaise"'Abstract - Reduced functional capacity and post-exertional malaise following physical activity are hallmark symptoms of Chronic Fatigue Syndrome (CFS). That these symptoms are often delayed may explain the equivocal results for clinical cardiopulmonary exercise testing with CFS patients. The reproducibility of VO2 max in healthy subjects is well documented. This may not be the case with CFS due to delayed recovery symptoms. Purpose: To compare results from repeated exercise tests as indicators of post-exertional malaise in CFS. Methods: Peak oxygen consumption (VO2 peak), percentage of predicted peak heart rate (HR%), and VO2 at anaerobic threshold (AT), were compared between six CFS patients and six control subjects for two maximal exercise tests separated by 24 hours. Results: Multivariate analysis showed no significant differences between control and CFS, respectively, for test 1: VO2 peak (28.4 ± 7.2 ml/ kg/min; 26.2 ± 4.9 ml/kg/min), AT (17.5 ± 4.8 ml/kg/min; 15.0 ± 4.9 ml/ kg/min) or HR% (87.0 ± 25.4%; 94.8 ± 8.8%). However, for test 2 the CFS patients achieved significantly lower values for both VO2 peak (28.9 ± 8.0 ml/kg/min; 20.5 ± 1.8 ml/kg/min, p = 0.031) and AT (18.0 ± 5.2 ml/kg/min; 11.0 ± 3.4 ml/kg/min, p = 0.021). HR% was not significantly different (97.6 ± 27.2%; 87.8 ± 9.3%, p = 0.07). A follow-up classification analysis differentiated between CFS patients and controls with an overall accuracy of 92%. Conclusion: In the absence of a second exercise test, the lack of any significant differences for the first test would appear to suggest no functional impairment in CFS patients. However, the results from the second test indicate the presence of a CFS related post-exertional malaise. It might be concluded then that a single exercise test is insufficient to demonstrate functional impairment in CFS patients. A second test may be necessary to document the atypical recovery response and protracted malaise unique to CFS.'"