Risk Factors for Postural Tachycardia Syndrome in Children and Adolescents

Abstract

BackgroundPostural tachycardia syndrome (POTS) is prevalent in children and adolescents and has a great impact on health. But its risk factors have not been fully understood. This study aimed to explore possible risk factors for children and adolescents with POTS.Methods and Findings600 children and adolescents (test group) aged 7–18 (11.9±3.0) years old, 259 males and 341 females, were recruited for identifying its risk factors. Another 197 subjects aged from 7 to 18 (11.3±2.3) years old were enrolled in the validation group. Heart rate (HR) and blood pressure (BP) were monitored during upright test. Risk factors were analyzed and sensitivity and specificity for predicting POTS were tested via receiver operating characteristic curve. Among 600 subjects, 41 were confirmed with POTS patients (6.8%) based on clinical manifestation and upright test. The results showed a significant difference in daily water intake, the daily sleeping hours, supine HR, HR increment and maximum HR during upright test between POTS and the unaffected children (P<0.05). Likelihood of POTS would increase by 1.583 times if supine HR was increased by 10 beats/min (95%CI 1.184 to 2.116, P<0.01), by 3.877 times if a child's water intake was less than 800 ml/day (95%CI 1.937 to 7.760, P<0.001), or by 5.905 times (95%CI 2.972 to 11.733, P<0.001) if sleeping hours were less than 8 hours/day. Supine HR, daily water intake and sleeping hours showed the capability of predicting POTS in children and adolescents with an AUC of 83.9% (95% CI: 78.6%–89.1%), sensitivity of 80.5% and specificity of 75%. Furthermore, in validation group, predictive sensitivity and specificity were 73.3% and 72.5%.ConclusionFaster supine HR, less water intake and shorter sleeping hours were identified as risk factors for POTS.

Pediatric Disorders of Orthostatic Intolerance

“…106 Sleep disorders, such as problematic sleep onset, maintenance, duration, quality, and daytime sleepiness, are consistently reported. 5,53,57,107,108 However, sleep studies in adults have shown little differences in sleep characteristics among POTS patients and controls. 109 -112 Cognitive symptoms or brain fog, which is described as having difficulty with attention, concentration, and memory, are commonly reported in POTS.…”

Syncope in an Athlete

“…In one study, 28.9% of patients excreted less than 100 mEqIL j1 of sodium in 24 h (3,45) and a large subgroup experienced low plasma, total blood volumes, and red cells (3,33,42,44), illustrating a compensatory physiologic mechanism that differs from chronic dehydration in which the body retains sodium, thus retaining water, to prevent further dehydration. After saline loading, the affected patient's urinary sodium increased and symptoms improved (23). Angiotensinconverting enzyme 2 activity has been shown to be reduced in these patients with inappropriately high plasma angiotensin II levels (3,42).…”

Acute Water Ingestion as a Treatment for Postural Orthostatic Tachycardia Syndrome

“…Potential risk factors for POTS in children and adolescents include a faster supine heart rate, less water intake, and shorter sleeping hours. 7 Currently, there are no clinical trial-or guidelines-established treatments for POTS or class I recommendations for its therapy. Although one study has indicated that one treatment may yield better outcomes over another, 8 another suggested a multidisciplinary approach that includes both conservative and nonpharmacologic measures may be best.…”