Health-related quality of life and suicide risk in postural tachycardia syndrome

Pederson, Cathy L.; Brook, Jill B

doi:10.1007/s10286-017-0399-5

Cited by 44 publications

(50 citation statements)

References 32 publications

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“…In clinical practice, there is overlap in the pathophysiology of POTS with patients having more than one etiology. Furthermore, POTS is commonly associated with other co-morbid conditions such as somatic hypervigilance, behavioral amplification, anxiety, depression, and high rates of suicidal ideation [9, 50]. …”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review

2018

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Gastrointestinal symptoms are among the most common complaints in patients with postural tachycardia syndrome (POTS). In some cases, they dominate the clinical presentation and cause substantial disabilities, including significant weight loss and malnutrition, that require the use of invasive treatment to support caloric intake. Multiple cross-sectional studies have reported a high prevalence of gastrointestinal symptoms in POTS patients with connective tissue diseases, such as Ehlers-Danlos, hypermobile type, and in patients with evidence of autonomic neuropathy. Previous studies that evaluated gastric motility in these patients reported a wide range of abnormalities, particularly delayed gastric emptying. The pathophysiology of gastrointestinal symptoms in POTS is likely multifactorial and probably depends on the co-morbid conditions. In patients with POTS and Ehlers-Danlos syndromes, structural and functional abnormalities in the gastrointestinal connective tissue may play a significant role, whereas in neuropathic POTS, the gastrointestinal tract motility and gut hormonal secretion may be directly impaired due to localized autonomic denervation. In patients with normal gastrointestinal motility but persistent gastrointestinal symptoms, gastrointestinal functional disorders should be considered. We performed a systematic review of the literature related to POTS and gastrointestinal symptoms have proposed possible mechanisms and discussed diagnosis and treatment approaches for delayed gastric emptying, the most common gastrointestinal abnormality reported in patients with POTS.

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Section: Introductionmentioning

confidence: 99%

Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review

2018

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“…These mechanisms are not mutually exclusive. Not infrequently, patients with functional disorders affecting the autonomic nervous system have sleep complaints without objective polysomnography abnormalities [13,16]. Also, there are sleep disorders with autonomic dysfunction for which the exact nature of the relationship is yet to be fully understood.…”

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confidence: 99%

Autonomic dysfunction in sleep disorders: introduction to the series

Palma

2018

Clin Auton Res

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Sleep is a fascinating and enigmatic phenomenon occurring, with varying patterns, in virtually all known animal species. This issue of Clinical Autonomic Research features a series of manuscripts authored by renowned experts in the field which focus on the connections between the autonomic nervous system and sleep. Although sleep is not traditionally considered a function regulated by the autonomic nervous system, it is evident that there are overlapping areas in the central nervous system (CNS) that regulate both systems, resulting in interesting and relevant interactions that can potentially impact morbidity and mortality. These interactions are concisely summarized in the review by Fink and colleagues [6], which highlights how specific CNS nuclei play a critical role in regulating cardiovascular autonomic function during both rapid eye movement (REM) and non-REM sleep.The sleep-autonomic interactions can occur, broadly speaking, under three different scenarios, which are not mutually exclusive and can overlap:(1) A common etiology impairs both the autonomic and sleep systems. The α-synucleinopathies, disorders caused by the abnormal accumulation of misfolded α-synuclein, are a very good example of this scenario, as reviewed by Chiaro and colleagues in this issue [5]. Progressive α-synuclein-mediated neurodegeneration of specific brainstem nuclei can result in REM sleep behavior disorder (RBD), a distinctive parasomnia in which patients act out and scream in their dreams. Conversely, α-synuclein-related neurodegeneration of peripheral and central autonomic areas can result in autonomic failure. Consequently, the co-existence of RBD and autonomic failure in patients with pure autonomic failure (PAF) [12], Parkinson disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA) is not infrequent. Interestingly, the presence of RBD and autonomic failure are now well-recognized prodromal markers of PD/DLB and MSA [2, 10]. Moreover, the coexistence of RBD and autonomic failure in patients without overt motor or cognitive deficits carries a very risk of phenoconversion to PD/DLB or MSA [10, 14]. Identifying sleep and autonomic abnormalities in patients is, therefore, highly relevant as the presence of these abnormalities has diagnostic, prognostic and therapeutic implications. (2) Failure of sleep-related cardio-respiratory control mechanisms and impaired arousal response cause or aggravate autonomic dysfunction. In this context, autonomic dysfunction can occur in sleep apnea, as reviewed by Fink and colleagues [6], or in the sudden infant death syndrome, as explained by Horne in her authoritative review [9]. These disorders can potentially result in prolonged hypoxia during sleep, cardiac arrhythmias and death. (3) A disorder in which autonomic dysfunction causes or aggravates a sleep disorder. Examples of this would be congenital central hypoventilation and familial dysautonomia (hereditary sensory and autonomic neuropathy type 3), the latter a rare genetic disease characterized by afferent baroref...

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“…Symptoms associated with POTS include: palpitations, light headedness/syncope, chest discomfort, breathlessness, neuropathic pain, chronic fatigue, poor sleep efficiency, gastrointestinal symptoms, syncope, cognitive slowing and psychological distress (Jones et al, 2016). The symptom burden for patient with POTS can be high and very debilitating; impacting directly on patient's health related quality of life (Pederson and Brook, 2017;McDonald et al, 2014). The functional impairment in patients with POTS has been compared to that of patients with congestive heart failure and chronic obstructive pulmonary disease (COPD) (Benrud-Larson et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

Reilly

Floyd

Lee

et al. 2020

Autonomic Neuroscience

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Postural orthostatic tachycardia syndrome (POTS) is a chronic, multifactorial syndrome with complex symptoms of orthostatic intolerance. Breathlessness is a prevalent symptom, however little is known about the aetiology. Anecdotal evidence suggests that breathless POTS patients commonly demonstrate dysfunctional breathing/hyperventilation syndrome (DB/HVS). There are, however, no published data regarding DB/HVS in POTS, and whether physiotherapy/breathing retraining may improve patients' breathing pattern and symptoms. The aim of this study was to explore the potential impact of a physiotherapy intervention involving education and breathing control on DB/HVS in POTS. A retrospective observational cohort study of all patients with POTS referred to respiratory physiotherapy for treatment of DB/HVS over a 20-month period was undertaken. 100 patients (99 female, mean (standard deviation) age 31 (12) years) with a clinical diagnosis of DB/HV were referred, of which data was available for 66 patients prepost intervention. Significant improvements in Nijmegen score, respiratory rate and breath hold time (seconds) were observed following treatment. These data provide a testable hypothesis that breathing retraining may provide breathless POTS patients with some symptomatic relief, thus improving their healthrelated quality of life. The intervention can be easily protocolised to ensure treatment fidelity. Our preliminary findings provide a platform for a subsequent randomised controlled trial of breathing retraining in POTS.

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Health-related quality of life and suicide risk in postural tachycardia syndrome

Cited by 44 publications

References 32 publications

Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review

Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review

Autonomic dysfunction in sleep disorders: introduction to the series

Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): The impact of a physiotherapy intervention

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