{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T03:31:36Z","timestamp":1787628696324,"version":"build-2736575974"},"reference-count":57,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,1,7]],"date-time":"2013-01-07T00:00:00Z","timestamp":1357516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2013,5]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>A significant proportion of patients with chronic fatigue syndrome (CFS<\/jats:styled-content>) also have postural orthostatic tachycardia syndrome (POTS<\/jats:styled-content>). We aimed to characterize these patients and differentiate them from CFS<\/jats:styled-content> patients without POTS<\/jats:styled-content> in terms of clinical and autonomic features.<\/jats:p><\/jats:sec>Methods<\/jats:title>A total of 179 patients with CFS<\/jats:styled-content> (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Health\u2010funded CFS<\/jats:styled-content> clinical services were included in this study. Outcome measures were as follows: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS<\/jats:styled-content>), orthostatic grading scale (OGS<\/jats:styled-content>) and hospital anxiety and depression scale (HADS<\/jats:styled-content>\u2010A and \u2010D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing.<\/jats:p><\/jats:sec>Results<\/jats:title>CFS<\/jats:styled-content> patients with POTS<\/jats:styled-content> (13%, n\u00a0<\/jats:italic>=\u00a0<\/jats:italic>24) were younger (29\u00a0\u00b1\u00a012 vs. 42\u00a0\u00b1\u00a013\u00a0years, P\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.0001), less fatigued (Chalder fatigue scale, 8\u00a0\u00b1\u00a04 vs. 10\u00a0\u00b1\u00a02, P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.002), less depressed (HADS<\/jats:styled-content>\u2010D, 6\u00a0\u00b1\u00a04 vs. 9\u00a0\u00b1\u00a04, P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.01) and had reduced daytime hypersomnolence (ESS<\/jats:styled-content>, 7\u00a0\u00b1\u00a06 vs. 10\u00a0\u00b1\u00a05, P\u00a0<\/jats:italic>=\u00a0<\/jats:italic>0.02), compared with patients without POTS<\/jats:styled-content>. In addition, they exhibited greater orthostatic intolerance (OGS<\/jats:styled-content>, 11\u00a0\u00b1\u00a05; P\u00a0<\/jats:italic><\u00a0<\/jats:italic>0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS<\/jats:styled-content> \u22649 and OGS<\/jats:styled-content> \u22659 identifies accurately CFS<\/jats:styled-content> patients with POTS<\/jats:styled-content> with 100% positive and negative predictive values.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The presence of POTS<\/jats:styled-content> marks a distinct clinical group of CFS<\/jats:styled-content> patents, with phenotypic features differentiating them from those without POTS<\/jats:styled-content>. A combination of validated clinical assessment tools can determine which CFS<\/jats:styled-content> patients have POTS<\/jats:styled-content> with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12022","type":"journal-article","created":{"date-parts":[[2013,4,12]],"date-time":"2013-04-12T14:01:21Z","timestamp":1365775281000},"page":"501-510","source":"Crossref","is-referenced-by-count":62,"title":["Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome"],"prefix":"10.1111","volume":"273","author":[{"given":"I.","family":"Lewis","sequence":"first","affiliation":[{"name":"Institute for Ageing & Health Newcastle University Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Pairman","sequence":"additional","affiliation":[{"name":"Northern CFS Clinical Network Newcastle Hospitals NHS Foundation Trust Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Spickett","sequence":"additional","affiliation":[{"name":"Northern CFS Clinical Network Newcastle Hospitals NHS Foundation Trust Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. L.","family":"Newton","sequence":"additional","affiliation":[{"name":"Institute for Ageing & Health Newcastle University Newcastle UK"},{"name":"Northern CFS Clinical Network Newcastle Hospitals NHS Foundation Trust Newcastle UK"},{"name":"UK NIHR Biomedical Research Centre in Ageing Newcastle University Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,1,7]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Chronic fatigue syndrome \/ Myalgic encephalomyelitis (or encephalopathy); diagnosis and management NICE Clinical Guideline (2007); CG53"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1300\/J092v11n01_02"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-121-12-199412150-00009"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-9877(03)00331-1"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(03)00543-9"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcm057"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00167-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9629(15)40485-9"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-1838(98)00177-5"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)00087-9"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2000.tb06760.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2281.1999.00154.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00168-5"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2004.05.001"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/153537020322800206"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS19980139"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02267785"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-002-0014-1"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200308000-00001"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-200008000-00016"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcn123"},{"key":"e_1_2_7_23_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/S0025-6196(11)61027-6","article-title":"Postural orthostatic tachycardia syndrome: the mayo clinic experience","volume":"82","author":"Thieben MJ","year":"2007","journal-title":"Mayo Clin Proceed"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/18.Supplement_1.S79"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8260.1982.tb01421.x"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_2_7_28_1","first-page":"35","volume-title":"Measures in health psychology: A user's portfolio. Casual and control beliefs","author":"Schwarzer R"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.4065\/80.3.330"},{"key":"e_1_2_7_31_1","first-page":"873","article-title":"Assessment: clinical autonomic testing report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"46","author":"Anonymous","year":"1996","journal-title":"Neurology"},{"key":"e_1_2_7_32_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","volume":"93","author":"Anonymous","year":"1996","journal-title":"Circulation"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/24.8.627"},{"key":"e_1_2_7_34_1","first-page":"747","article-title":"Changes in baroreflex sensitivity in response to home orthostatic training in vasovagal syncope","volume":"52","author":"Tan MP","year":"2008","journal-title":"Hypertension"},{"key":"e_1_2_7_35_1","first-page":"19","article-title":"Subjective sleep quality and daytime sleepiness in a large sample of patients with chronic fatigue syndrome (CFS)","volume":"67","author":"Mariman A","year":"2012","journal-title":"Acta Clin Belg"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2869.1998.00123.x"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2869.2008.00679.x"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2008.05.018"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00162-4"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1521-6942(03)00033-0"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-009-1339-0"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3940(02)01058-3"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3940(96)12559-3"},{"key":"e_1_2_7_44_1","first-page":"767","article-title":"Brainstem perfusion is impaired in chronic fatigue syndrome","volume":"88","author":"Costa D","year":"1995","journal-title":"QJM"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00179-X"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2011.02575.x"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0595"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2010.02228.x"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-000-0070-y"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200308000-00001"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20227"},{"key":"e_1_2_7_52_1","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1042\/CS20090055","article-title":"Chronic: fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function","volume":"118","author":"Hurwitz B","year":"2010","journal-title":"Clin Sci"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2009.02.008"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2011.02429.x"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2010.02310.x"},{"key":"e_1_2_7_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(98)00022-1"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-5-37"},{"key":"e_1_2_7_58_1","first-page":"4","article-title":"Fatigue in Myalgic Encephalomyelitis","volume":"16","author":"Goudsmit EM","year":"2008","journal-title":"Bulletin of thr IACFS\/ME"}],"container-title":["Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjoim.12022","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjoim.12022","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joim.12022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T06:00:56Z","timestamp":1700632856000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/joim.12022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1,7]]},"references-count":57,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2013,5]]}},"alternative-id":["10.1111\/joim.12022"],"URL":"https:\/\/doi.org\/10.1111\/joim.12022","archive":["Portico"],"relation":{},"ISSN":["0954-6820","1365-2796"],"issn-type":[{"value":"0954-6820","type":"print"},{"value":"1365-2796","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,1,7]]}}}