Fatigue severity remains stable over time and independently associated with orthostatic symptoms in chronic fatigue syndrome: a longitudinal study
Article first published online: 14 NOV 2010
© 2010 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 269, Issue 2, pages 182–188, February 2011
How to Cite
Jones, D. E. J., Gray, J., Frith, J. and Newton, J. L. (2011), Fatigue severity remains stable over time and independently associated with orthostatic symptoms in chronic fatigue syndrome: a longitudinal study. Journal of Internal Medicine, 269: 182–188. doi: 10.1111/j.1365-2796.2010.02306.x
- Issue published online: 11 JAN 2011
- Article first published online: 14 NOV 2010
- Accepted manuscript online: 20 OCT 2010 08:51AM EST
- chronic fatigue syndrome;
- orthostatic symptoms
Abstract. Jones DEJ, Gray J, Frith J, Newton JL (UK NIHR Biomedical Centre in Ageing, Institute of Cellular Medicine, Institute for Ageing and Health, Newcastle University, Newcastle, UK) Fatigue severity remains stable over time and independently associated with orthostatic symptoms in chronic fatigue syndrome: a longitudinal study. J Intern Med 2011; 269: 182–188.
Objectives: To examine fatigue variability over time in chronic fatigue syndrome (CFS) and the effect of other symptoms on its predictability.
Design: Longitudinal cohort study of patients with CFS (Fukuda criteria).
Setting: Specialist CFS clinical service.
Subjects: Phase 1: 100 patients who participated in a study of CFS symptoms in 2005 were revisited in 2009. Phase 2: 25 patients completed fatigue diaries to address intra- and inter-day variability in perceived fatigue.
Main outcome measures: Phase 1: subjects completed fatigue impact scale (FIS), Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS). Changes in variables represented the differences between 2005 and 2009. Phase 2: subjects rated fatigue on a scale of 0 (no fatigue) to 10 (severe fatigue) four times a day for 5 weeks.
Results: Symptom assessment tools were available in both 2005 and 2009 for 74% of patients. FIS and HADS depression (HAD-D) and anxiety (HAD-A) scores significantly improved during follow-up whereas ESS and OGS remained stable. FIS improved in 29/74 (39%) subjects, and by ≥10 points in 19 (26%). FIS worsened by ≥10 points in 33/74 (45%) subjects. On multivariate analysis, independent predictors of current fatigue (FIS in 2009) were FIS in 2005, HAD-D in 2009, OGS in 2009 and change in HAD-A. Reported fatigue was stable from week to week and from day to day. Patients reported higher fatigue in the morning (mean ± SD; 6.4 ± 2), becoming significantly lower at lunchtime (6.2 ± 2; P < 0.05) and increasing again to 7 ± 2 at bedtime.
Conclusions: Current fatigue is independently associated with current autonomic symptom burden, current depression and change in anxiety during follow-up. These findings have implications for targeted symptom management in CFS.