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From the Center for Environmental Hazards Research (A.P., J.J.L., S.L.S., A.T., L.T., C.P., L.R.K., J.E.O., B.H.N.), VA Medical Center, East Orange, NJ; Environmental and Occupational Health Sciences Institute (A.P.), Robert Wood Johnson Medical School, Piscataway, NJ; and Department of Psychology (B.H.), University of Miami, Coral Gables, FL.
Address reprint requests to: Arnold Peckerman, PhD, Gulf War Research Center (127B), VA Medical Center, East Orange, NJ 07018-1095. Email: apeckerm{at}nbunj.jvnc.net
OBJECTIVE: The objective of this study was to examine whether inappropriate cardiovascular responses to stressors may underlie symptoms in Gulf War veterans with chronic fatigue.
METHODS: Psychophysiological stress testing was performed on 51 Gulf War veterans with chronic fatigue (using the 1994 case definition of the Centers for Disease Control and Prevention) and 42 healthy veterans. Hemodynamic responses to cold pressor, speech, and arithmetic stressors were evaluated using impedance cardiography.
RESULTS: Veterans with chronic fatigue had diminished blood pressure responses during cognitive (speech and arithmetic) stress tests due to unusually small increases in total peripheral resistance. The cold pressor test, however, evoked similar blood pressure responses in the chronic fatigue and control groups. Low reactivity to cognitive stressors was associated with greater fatigue ratings among ill veterans, whereas an opposite relation was observed among healthy veterans. Self-reported neurocognitive decline was associated with low reactivity to the arithmetic task.
CONCLUSIONS: These results suggest a physiological basis for some Gulf War veterans’ reports of severe chronic fatigue. A greater deficit with responses processed through cerebral centers, as compared with a sensory stimulus (cold pressor), suggests a defect in cortical control of cardiovascular function. More research is needed to determine the specific mechanisms through which the dissociation between behavioral and cardiovascular activities identified in this study may be contributing to symptoms in Gulf War veterans.
Key Words: Gulf War illnesses • chronicfatigue • cardiovascular stress response • impedance cardiography
Abbreviations: AD ACL = Activation-Deactivation Adjective Checklist; BDI= Beck Depression Inventory; CDC = Centers for Disease Control andPrevention; CF = chronic fatigue; CFS = chronic fatiguesyndrome; DBP = diastolic blood pressure; GV = Gulf Warveteran; HR = heart rate; ICF = idiopathic chronic fatigue; MAP = mean arterial pressure; MFI = Multidimensional FatigueInventory; PEP = preejection period; POMS = Profile of MoodStates; 
= cardiac output; SBP = systolic bloodpressure; SV = stroke volume; TPR = total peripheral resistance.
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