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Baroreceptor Reflex and Integrative Stress Responses in Chronic Fatigue Syndrome

From the VA Medical Center, East Orange, New Jersey (A.P, B.H.N.); the CFS Cooperative Research Center, Department of Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey (A.P., B.Q., K.A.D., B.H.N.); the Heart Failure Center, Division of Circulatory Physiology, New York Presbyterian Hospital, New York, New York (J.J.L.); the Exercise Physiology Laboratory, State University of Campinas, Sãn Paulo, Brazil (R.G.); and the Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, Tokyo, Japan (Y.Y.).

Address reprint requests to: Arnold Peckerman, PhD, VA Medical Center, War-Related Illness and Injury Study Center (129), 385 Tremont Ave., East Orange, NJ 07018. Email: apeckerm{at}njneuromed.org

OBJECTIVE: Altered cardiovascular responses to mental and postural stressors have been reported in chronic fatigue syndrome (CFS). This study examined whether those findings may involve changes in baroreceptor reflex functioning.

METHODS: Chronotropic baroreceptor reflex (by sequential analysis) and cardiovascular stress responses were recorded during postural (5-minute of active standing) and cognitive (speech task) stress testing in patients with CFS grouped into cases with severe (N = 21) or less severe (N = 22) illness, and in 29 matched control subjects.

RESULTS: Patients with CFS had a greater decline in baroreceptor reflex sensitivity (BRS) during standing, although only those with severe CFS were significantly different from the controls. Systolic blood pressure declined during standing in the control group but was maintained in the CFS patients. In contrast, the patients with less severe CFS had blunted increases in blood pressure during the speech task, which could not, however, be explained by inadequate inhibition of the baroreceptor reflex, with all groups showing an appropriate reduction in BRS during the task.

CONCLUSIONS: These results indicate that in CFS, deficiencies in orthostatic regulation, but not in centrally mediated stress responses, may involve the baroreceptor reflex. This study also suggests that classifying patients with CFS on illness severity may discriminate between patients with abnormalities in peripheral vs. central mechanisms of cardiovascular stress responses.

Key Words: chronic fatigue syndrome, • baroreceptor reflex, • orthostasis, • cardiovascular reactivity.

Abbreviations: AD ACL = Activation-Deactivation Adjective Check List;; BRS = baroreceptor reflex sensitivity;; CFS = chronic fatigue syndrome;; DBP = diastolic blood pressure;; HR = heart rate;; MFI = Multidimensional Fatigue Inventory;; PI = pulse interval;; SBP = systolic blood pressure;; SF-36 = Medical Outcomes Study Short Form-36.

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