Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review

Eur J Clin Invest. 2014 May;44(5):516-26. doi: 10.1111/eci.12256.


Introduction: It is hypothesised that the autonomic nervous system responds differently to various stressors in patients with chronic fatigue syndrome (CFS) compared with healthy controls. The goal is to systematically review the scientific literature addressing the functioning of the autonomic nervous system in patients with CFS.

Materials and methods: All studies that were identified through electronic databases (PubMed and Web of Science) were screened for eligibility based on the selection criteria and assessed (two independent raters) for methodological quality using a methodological checklist for case-control studies.

Results: Twenty-seven case-control studies were included. The methodological quality varied between 50% and 71·4%. Some studies showed different responses to head-up tilt and other autonomous testing.

Conclusion: Although comparison between the included case-control studies was difficult, we can conclude that there are differences in autonomous response between patients with CFS and healthy controls. The heart rate dynamic response during the head-up tilt test differs between patients with CFS and healthy controls, supporting the increased prevalence of postural orthostatic tachycardia syndrome. The autonomic response can be useful for the diagnosis of CFS.

Keywords: Autonomic nervous system; dysautonomia; heart rate variability; marker; parasympathetic; stress; sympathetic.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Autonomic Nervous System Diseases / diagnosis
  • Autonomic Nervous System Diseases / physiopathology*
  • Case-Control Studies
  • Diagnosis, Differential
  • Fatigue Syndrome, Chronic / diagnosis
  • Fatigue Syndrome, Chronic / physiopathology*
  • Galvanic Skin Response / physiology
  • Head-Down Tilt / physiology
  • Humans
  • Neuropsychological Tests