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Dysautonomia
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== Myalgic Encephalomyelitis == [[File:Dysautonomia1.png|thumb|Symptoms of autonomic dysfunction are correlated with severity of fatigue in CFS patients.<ref name="Jones2007"/>]] Many people with [[myalgic encephalomyelitis]] (ME) experience [[autonomic dysfunction]]. Symptoms of autonomic dysfunction in ME include altered blood pressure, heart rate, digestion, body temperature, [[exercise]] intolerance, and [[Nervous system|neurological]] correlates with [[autonomic nervous system]] (ANS) dysfunction (for a complete list, see our [[Autonomic nervous system|Autonomic Nervous System page]]). Some researchers suggest that dysautonomia is central to the pathophysiology of ME.<ref name="Naschitz2004">{{Cite journal | date = Feb 2004 | first = Jochanan E | last = Naschitz | first2 = Daniel | last2 = Yeshurun | first3 = Itzhak | last3 = Rosner | title = Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications |url =https://www.sciencedirect.com/science/article/pii/S0306987703003311|journal=Medical Hypotheses|language=en|volume=62|issue=2 | pages = 203–206|doi=10.1016/S0306-9877(03)00331-1|issn=0306-9877}}</ref> Various studies have investigated the efficacy of treating ME patients by targeting autonomic symptoms without significant success.<ref name="Straus2001">{{Cite journal | last = Straus | first = Stephen E. | last2 = Wolff | first2 = Mark | last3 = Lucas | first3 = Katherine E. | last4 = Snader | first4 = Sally | last5 = Hohman | first5 = Patricia | last6 = Soto | first6 = Norberto | last7 = Cuccherini | first7 = Brenda A. | last8 = Sharma | first8 = Geetika | last9 = Anand | first9 = Ravinder | date = 2001-01-03 | title = Fludrocortisone Acetate to Treat Neurally Mediated Hypotension in Chronic Fatigue Syndrome: A Randomized Controlled Trial| url = https://jamanetwork.com/journals/jama/fullarticle/193426|journal=JAMA|language=en|volume=285|issue=1 | pages = 52–59|doi=10.1001/jama.285.1.52|issn=0098-7484}}</ref> === Studies on Dysautonomia and ME === One study (Orjatsalo et al. 2018) has looked at autonomic cardiac function in different sleep stages of people with [[chronic fatigue syndrome]] (CFS). They found that people with CFS had higher [[nocturnal systolic]] and mean BP and lower heart rate than controls, suggesting a [[nocturnal dysfunction]] of the [[cardiac]] ANS in CFS. This means that patients have a lower parasympathetic tone and higher sympathetic tone during sleep.<ref name="Orjatsalo2018">{{Cite journal | last = Orjatsalo | first = Maija | last2 = Alakuijala | first2 = Anniina | last3 = Partinen | first3 = Markku | date = 2018-02-15 | title = Autonomic Nervous System Functioning Related to Nocturnal Sleep in Patients With Chronic Fatigue Syndrome Compared to Tired Controls |url =https://www.ncbi.nlm.nih.gov/pubmed/29246267|journal=Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine|volume=14|issue=2 | pages = 163–171|doi=10.5664/jcsm.6924|issn=1550-9397|pmc=5786834|pmid=29246267}}</ref> [[File:Dysautonomia2.png|thumb|Difference in total autonomic dysfunction (depicted by COMPASS score) between healthy controls (left), CFS patients (middle), and patients with primary biliary cirrhosis (PBC, a condition in which there is strong evidence of a causal link between fatigue and autonomic dysfunction; right). COMPASS scores were significantly higher in the CFS group.<ref name="Jones2007">{{Cite journal | last = Jones | first =D. E.J. | last2 = Shin | first2 = J. | last3 = Seth | first3 = A. | last4 = Sutcliffe | first4 = K. | last5 = Okonkwo | first5 = O. | last6 = Newton | first6 = J.L. | date = 2007-08-01 | title = Symptoms of autonomic dysfunction in chronic fatigue syndrome | url =https://academic.oup.com/qjmed/article/100/8/519/1521818|journal=QJM: An International Journal of Medicine|language=en|volume=100|issue=8 | pages = 519–526|doi=10.1093/qjmed/hcm057|issn=1460-2725}}</ref>]] Another study ([[Kunihisa Miwa|Miwa]] 2016) investigated POTS in patients with both ME and orthostatic intolerance. They hypothesized that the characteristics of sympathetic activation may differ between these patients’ “good days” and “bad days”. Patients were characterized with an active standing test and an [[echocardiography]]. Their results indicated that ME patients may experience exaggerated activation of the sympathetic nervous system. They suggest that sympathetic activation in ME is impaired and is associated with preload failure.<ref name="Miwa2016">{{Cite journal | last = Miwa | first = Kunihisa | authorlink = Kunihisa Miwa | date = Sep 2016 | title = Variability of postural orthostatic tachycardia in patients with myalgic encephalomyelitis and orthostatic intolerance | url =https://www.ncbi.nlm.nih.gov/pubmed/26374335|journal=Heart and Vessels|volume=31|issue=9 | pages = 1522–1528|doi=10.1007/s00380-015-0744-3|issn=1615-2573|pmid=26374335|quote=|via=}}</ref><ref name="Malfait2016"/> [[Julia Newton|Newton]] et al. aimed to determine the prevalence of autonomic dysfunction in CFS using the Composite Autonomic Symptom Scale (COMPASS) and the [[Fatigue Impact Scale]] (FIS). The study included a healthy control group and a control group of patients with primary biliary cirrhosis (PBC; where 60% of patients experience significant fatigue and some experience autonomic dysfunction). Their results indicated that symptoms of autonomic dysfunction were strongly associated with the presence of CFS or PBC (in some but not all patients), and that symptoms correlated with severity of fatigue. COMPASS scores were significantly higher for the CFS group than for the PBC group and healthy control group.<ref name="Jones2007"/>
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