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Zerón-Rugerio MF, Zaragozá MC, Domingo JC, Sanmartín-Sentañes R, Alegre-Martin J, Castro-Marrero J, Cambras T. Sleep and circadian rhythm alterations in myalgic encephalomyelitis/chronic fatigue syndrome and post-COVID fatigue syndrome and its association with cardiovascular risk factors: A prospective cohort study. Chronobiol Int 2024:1-12. [PMID: 39037125 DOI: 10.1080/07420528.2024.2380020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
This study aimed to investigate circadian rhythm manifestations in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients (including a subpopulation of long-COVID patients) and matched healthy controls while also exploring their association with cardiovascular health variables. Thirty-one ME/CFS patients (75% females), 23 individuals diagnosed with post-COVID ME/CFS (56% females) and 31 matched healthy controls (68% females) were enrolled in this study. Demographic and clinical characteristics were assessed using validated self-reported outcome measures. Actigraphy data, collected over one week, were used to analyze the 24-h profiles of wrist temperature, motor activity, and sleep circadian variables in the study participants. Associations between lipid profile with endothelial dysfunction biomarkers (such as endothelin-1, ICAM-1 and VCAM-1) and with sleep and circadian variables were also studied. No differences were found in these variables between the two group of patients. Patients showed lower activity and worse sleep quality than matched healthy controls, together with a worse lipid profile than controls, that was associated with disturbances in the circadian temperature rhythm. ICAM-1 levels were associated with plasma lipids in healthy controls, but not in patients, who showed higher levels of endothelin-1 and VCAM-1. These findings suggest that lipid profiles in ME/CFS are linked to disrupted circadian rhythms and sleep patterns, likely due to endothelial dysfunction. Furthermore, they highlight the intricate relationship between sleep, circadian rhythms, and cardiovascular health in this condition.
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Affiliation(s)
- María Fernanda Zerón-Rugerio
- Department of Clinical and Fundamental Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Nutrition and Food Safety Research Institute (INSA-UB), University of Barcelona, Barcelona, Spain
| | | | - Joan Carles Domingo
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Ramon Sanmartín-Sentañes
- Division of Rheumatology, ME/CFS Clinical Unit, Vall d'Hebron University Hospital, Barcelona, Spain
- Division of Rheumatology, Research Unit in ME/CFS and Long COVID, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Alegre-Martin
- Division of Rheumatology, ME/CFS Clinical Unit, Vall d'Hebron University Hospital, Barcelona, Spain
- Division of Rheumatology, Research Unit in ME/CFS and Long COVID, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Castro-Marrero
- Division of Rheumatology, Research Unit in ME/CFS and Long COVID, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Trinitat Cambras
- Nutrition and Food Safety Research Institute (INSA-UB), University of Barcelona, Barcelona, Spain
- Department of Biochemistry and Physiology, School of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
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Lacasa M, Alegre-Martin J, Sentañes RS, Varela-Sende L, Jurek J, Castro-Marrero J. Yeast Beta-Glucan Supplementation with Multivitamins Attenuates Cognitive Impairments in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2023; 15:4504. [PMID: 37960157 PMCID: PMC10647745 DOI: 10.3390/nu15214504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
This research aimed to examine the potential alleviative effects of beta-glucan administration on fatigue, unrefreshing sleep, anxiety/depression symptoms and health-related quality of life in ME/CFS. A 36-week unicenter, randomized, double-blind, placebo-controlled trial was conducted in 65 ME/CFS patients, who were randomly allocated to one of two arms to receive four capsules each one of 250 mg beta-glucan, 3.75 µg vitamin D3, 1.05 mg vitamin B6, and 7.5 mg zinc (n = 35), or matching placebo including only microcrystalline cellulose as an excipient (n = 30) once daily. The findings showed that the beta-glucan supplementation significantly improved cognitive fatigue (assessed with FIS-40 scores) after the 36-week treatment compared to the baseline (p = 0.0338). Taken together, this study presents the novel finding that yeast-derived beta-glucan may alleviate cognitive fatigue symptoms in ME/CFS. Thus, it offers valuable scientific insights into the potential use of yeast beta-glucan as a nutritional supplement and/or functional food to prevent or reduce cognitive dysfunction in patients with ME/CFS. Further interventions are warranted to validate these findings and also to delve deeper into the possible immunometabolic pathomechanisms of beta-glucans in ME/CFS.
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Affiliation(s)
- Marcos Lacasa
- E-Health Center, Universitat Oberta de Catalunya, 08018 Barcelona, Spain;
| | - Jose Alegre-Martin
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research Unit, Division of Rheumatology, Vall d´Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (J.A.-M.); (R.S.S.); (J.J.)
| | - Ramon Sanmartin Sentañes
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research Unit, Division of Rheumatology, Vall d´Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (J.A.-M.); (R.S.S.); (J.J.)
| | - Luisa Varela-Sende
- Clinical Research Department, VITAE Health Innovation, Montmeló, 08160 Barcelona, Spain;
| | - Joanna Jurek
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research Unit, Division of Rheumatology, Vall d´Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (J.A.-M.); (R.S.S.); (J.J.)
| | - Jesus Castro-Marrero
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Research Unit, Division of Rheumatology, Vall d´Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (J.A.-M.); (R.S.S.); (J.J.)
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Lacasa M, Prados F, Alegre J, Casas-Roma J. A synthetic data generation system for myalgic encephalomyelitis/chronic fatigue syndrome questionnaires. Sci Rep 2023; 13:14256. [PMID: 37652910 PMCID: PMC10471690 DOI: 10.1038/s41598-023-40364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
Artificial intelligence or machine-learning-based models have proven useful for better understanding various diseases in all areas of health science. Myalgic Encephalomyelitis or chronic fatigue syndrome (ME/CFS) lacks objective diagnostic tests. Some validated questionnaires are used for diagnosis and assessment of disease progression. The availability of a sufficiently large database of these questionnaires facilitates research into new models that can predict profiles that help to understand the etiology of the disease. A synthetic data generator provides the scientific community with databases that preserve the statistical properties of the original, free of legal restrictions, for use in research and education. The initial databases came from the Vall Hebron Hospital Specialized Unit in Barcelona, Spain. 2522 patients diagnosed with ME/CFS were analyzed. Their answers to questionnaires related to the symptoms of this complex disease were used as training datasets. They have been fed for deep learning algorithms that provide models with high accuracy [0.69-0.81]. The final model requires SF-36 responses and returns responses from HAD, SCL-90R, FIS8, FIS40, and PSQI questionnaires. A highly reliable and easy-to-use synthetic data generator is offered for research and educational use in this disease, for which there is currently no approved treatment.
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Affiliation(s)
- Marcos Lacasa
- ADaS Lab - E-Health Center, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018, Barcelona, Spain.
| | - Ferran Prados
- ADaS Lab - E-Health Center, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018, Barcelona, Spain
- Center for Medical Image Computing, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre at UCL and UCLH, London, UK
- Department of Neuroinflammation, Queen Square MS Center, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - José Alegre
- ME/CFS Unit, Division of Rheumatology, Vall d'Hebron Hospital Research Institute Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Casas-Roma
- ADaS Lab - E-Health Center, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018, Barcelona, Spain
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Saidi O, Fantini ML, Gruet M, Duché P. Commentary on Mohamed et al.: Inter- and intra-sleep variability deserve further attention in myalgic encephalomyelitis/chronic fatigue syndrome. Sleep Med Rev 2023; 70:101812. [PMID: 37454521 DOI: 10.1016/j.smrv.2023.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Oussama Saidi
- Laboratory Impact of Physical Activity on Health (IAPS), Toulon University, F-83041, Toulon, France
| | - Maria-Livia Fantini
- NPsy-Sydo, Sleep Disorders, University Hospital of Clermont-Ferrand, CHU Clermont Ferrand, F-63000, Clermont-Ferrand, France
| | - Mathieu Gruet
- Laboratory Impact of Physical Activity on Health (IAPS), Toulon University, F-83041, Toulon, France
| | - Pascale Duché
- Laboratory Impact of Physical Activity on Health (IAPS), Toulon University, F-83041, Toulon, France.
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Zhu X, Zheng T, Ding L, Zhang X. Exploring associations between eHealth literacy, cyberchondria, online health information seeking and sleep quality among university students: A cross-section study. Heliyon 2023; 9:e17521. [PMID: 37408886 PMCID: PMC10319213 DOI: 10.1016/j.heliyon.2023.e17521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Background University students are increasingly inclined to use the Internet for health-related purposes, and their sleep problems are becoming increasingly prominent. Currently, the relationship between sleep quality and online health-related searches is poorly understood. The aim of this study was to exam the associations of sleep quality, Internet use, eHealth literacy, online health information seeking and cyberchondria in the sample of Chinese university students. Methods A total of 2744 students completed self-reported questionnaires online containing the Pittsburgh Sleep Quality Index (PSQI), eHealth Literacy Scale, Online Health Information Seeking, Cyberchondria Severity Scale (CSS) and questions regarding sleep duration, Internet use, health status, and demographic information. Results The prevalence of poor sleep quality (PSQI >7) among the university students was 19.9% and 15.6% students slept less than 7 h per day. As time spent on online daily and playing phone before bed increased, the prevalence of sleep disturbance gained. Sleep disturbance was significantly associated with cyberchondria (OR = 1.545, p = 0.001), health status [good (OR = 0.625, p = 0.039), poor (OR = 3.128, p = 0.010), and fair (OR = 1.932, p = 0.001)]. Sleep quality, online health information seeking and eHealth literacy positively influenced with cyberchondria. Compared to 7-8 h sleep duration, online health information seeking (OR = 0.750, p = 0.012) was significantly associated with ≥8 h sleep duration. Conclusion Our findings highlighted poor health status, too much time spent on online daily and high cyberchondria level might decrease sleep quality in the sample of Chinese university students, further suggesting the need for developing interventions based on online health-related searches for improving sleep quality among university students.
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Piotrkowska R, Kruk A, Krzemińska A, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K. Factors Determining the Level of Acceptance of Illness and Satisfaction with Life in Patients with Cancer. Healthcare (Basel) 2023; 11:healthcare11081168. [PMID: 37108002 PMCID: PMC10138420 DOI: 10.3390/healthcare11081168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Cancer threatens life and brings about many negative emotions in patients, which influence their satisfaction with life and contribute to a low level of their acceptance of illness. This is why the acceptance of illness is a serious problem among patients with cancer; contributes to the intensification of symptoms; and influences the patient's physical, mental, emotional, social, and spiritual condition. AIM The purpose of this work is to assess the acceptance of illness and satisfaction with life in patients with cancer, as well as to identify social, demographical, and clinical factors that significantly differentiate their acceptance of illness and satisfaction with life. MATERIALS AND METHODS The study involved 120 patients with cancer aged 18 to 88. The study was conducted in the form of a questionnaire based on standard research tools: Acceptance of Illness (AIS), Satisfaction with Life Scale (SWLS), and Numerical Rating Scale (NRS). Social, demographical, and clinical data were collected in the original questionnaire. RESULTS A group of 120 patients was studied, including 55.83% (n = 67) women and 44.16% (n = 53) men. The average age was 56. A general acceptance-of-illness index obtained by the patients was 21.6 ± 7.32 and a general satisfaction-with-life index was 19.14 ± 5.78. The statistical analysis indicated a significant correlation between the acceptance of illness and the intensity of pain (rHO = -0.19; p < 0.05), fatigue ((Z = 1.92; p > 0.05), and diarrhoea (t(118) = 2.54; p < 0.05). The correlation between the intensity of pain and satisfaction with life was negative (rHO = -0.20; p < 0.05). CONCLUSION The greater acceptance of illness, the greater satisfaction with life in patients with cancer. Pain, fatigue, and diarrhoea decrease the acceptance of illness. In addition, pain decreases the level of satisfaction with life. Social and demographical factors do not determine the level of acceptance of illness and satisfaction with life.
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Affiliation(s)
- Renata Piotrkowska
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Agnieszka Kruk
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Aneta Krzemińska
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Katarzyna Kwiecień-Jaguś
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland
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Skin Temperature Circadian Rhythms and Dysautonomia in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Role of Endothelin-1 in the Vascular Tone Dysregulation. Int J Mol Sci 2023; 24:ijms24054835. [PMID: 36902264 PMCID: PMC10003028 DOI: 10.3390/ijms24054835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
There is accumulating evidence of autonomic dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, little is known about its association with circadian rhythms and endothelial dysfunction. This study aimed to explore the autonomic responses through an orthostatic test and analysis of the peripheral skin temperature variations and vascular endothelium state in ME/CFS patients. Sixty-seven adult female ME/CFS patients and 48 healthy controls were enrolled. Demographic and clinical characteristics were assessed using validated self-reported outcome measures. Postural changes in blood pressure, heart rate, and wrist temperature were recorded during the orthostatic test. Actigraphy during one week was used to determine the 24-h profile of peripheral temperature and activity. Circulating endothelial biomarkers were measured as indicators of endothelial functioning. Results showed that ME/CFS patients presented higher blood pressure and heart rate values than healthy controls in the supine and standing position (p < 0.05 for both), and also a higher amplitude of the activity rhythm (p < 0.01). Circulating levels of endothelin-1 (ET-1) and vascular cell adhesion molecule-1 (VCAM-1) were significantly higher in ME/CFS (p < 0.05). In ME/CFS, ET-1 levels were associated with the stability of the temperature rhythm (p < 0.01), and also with the self-reported questionnaires (p < 0.001). This suggests that ME/CFS patients exhibited modifications in circadian rhythm and hemodynamic measures, which are associated with endothelial biomarkers (ET-1 and VCAM-1). Future investigation in this area is needed to assess dysautonomia and vascular tone abnormalities, which may provide potential therapeutic targets for ME/CFS.
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O'Kane TW, Sledjeski EM, Dinzeo TJ. The examination of sleep hygiene, quality of life, and schizotypy in young adults. J Psychiatr Res 2022; 150:1-7. [PMID: 35316717 DOI: 10.1016/j.jpsychires.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
The co-occurrence of sleep disruption and schizophrenia-spectrum symptomology is common, with current research supporting the use of interventions, such as cognitive behavioral therapy for insomnia (CBTi), which include sleep hygiene education. Sleep hygiene refers to patterns of pre-sleep behaviors that can promote or impair sleep. These behaviors are easily identified and modifiable, potentially holding promise as targets of research and clinical practice. However, there is little research examining sleep hygiene in those at-risk for schizophrenia, measured through clusters of sub-clinical symptoms known as schizotypy. Given the likelihood poor sleep exacerbates negative emotions, thus serving as an etiologically relevant stressor, the study of sleep hygiene in at-risk populations appears warranted. Additionally, quality of life (QOL) has previously been shown to be negatively associated with sleep hygiene and schizophrenia-spectrum risk. As such, QOL domains were included to quantify the extent pre-sleep habits and dimensional schizotypy impact individuals' wellbeing. Data was collected from a non-clinical sample of 385 young adults (M = 20.83, SD = 3.61). As anticipated, higher schizotypy was correlated with poorer sleep hygiene and reduced QOL, although only negative schizotypy predicted QOL in the final regression model controlling for sex differences. Sex differences were present for all variables of interest except disorganized schizotypy. Post-hoc item-level analyses suggested that higher levels of schizotypy were correlated with emotional rumination prior to sleep, while increased negative schizotypy was associated with reduced QOL. Future research should further evaluate sleep hygiene as a potentially relevant risk variable in the development of schizophrenia-spectrum symptomology and associated decline in QOL.
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Affiliation(s)
- Thomas W O'Kane
- Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
| | - Eve M Sledjeski
- Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
| | - Thomas J Dinzeo
- Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA.
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Ahmed A, Anand AN, Shah I, Yakah W, Freedman SD, Thomas R, Sheth SG. Prospective evaluation of sleep disturbances in chronic pancreatitis and its impact on quality of life: a pilot study. Sleep Breath 2022; 26:1683-1691. [PMID: 34981297 DOI: 10.1007/s11325-021-02541-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/13/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
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Kan J, Cheng J, Hu C, Chen L, Liu S, Venzon D, Murray M, Li S, Du J. A Botanical Product Containing Cistanche and Ginkgo Extracts Potentially Improves Chronic Fatigue Syndrome Symptoms in Adults: A Randomized, Double-Blind, and Placebo-Controlled Study. Front Nutr 2021; 8:658630. [PMID: 34901100 PMCID: PMC8662561 DOI: 10.3389/fnut.2021.658630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Dietary therapy may be beneficial in alleviating symptoms of chronic fatigue syndrome (CFS), a disorder that is characterized by extreme fatigue and other symptoms, but the cause of which remains unclear. The aim of this study was to evaluate the protective effect of a botanical product containing cistanche (Cistanche tubulosa [Schenk] Wight) and ginkgo (Ginkgo biloba L.) extracts on adults with CFS in a randomized, double-blind, placebo-controlled clinical trial. A total of 190 subjects (35-60 years old, non-obese) with CFS were randomized to receive one tablet of a low dose (120-mg ginkgo and 300-mg cistanche), a high dose (180-mg ginkgo and 450-mg cistanche) or a placebo once daily for 60 days. Blood samples and responses on the Chalder fatigue scale (CFQ 11), the World Health Organization's quality of life questionnaire (WHOQOL), and the sexual life quality questionnaire (SLQQ) were collected at baseline and post-intervention. CFS symptoms of impaired memory or concentration, physical fatigue, unrefreshing sleep, and post-exertional malaise were significantly improved (p < 0.001) in both of the treatment groups. The botanical intervention significantly decreased physical and mental fatigue scores of CFQ 11 and improved WHOQOL and SLQQ scores of the subjects (p < 0.01). Levels of blood ammonia and lactic acid in the treatment groups were significantly lower than those of the placebo group (low-dose: p < 0.05; high-dose: p < 0.01). In addition, the change in lactic acid concentration was negatively associated with the severity of CFS symptoms (p = 0.0108) and was correlated with the change in total physical fatigue score of the CFQ (p = 0.0302). Considering the trivial effect size, the results may lack clinical significance. In conclusion, this botanical product showed promising effects in ameliorating the symptoms of CFS. Clinical trials with improved assessment tools, an expanded sample size, and an extended follow-up period are warranted to further validate the findings. Clinical Trial Registration: https://clinicaltrials.gov/, identifier: NCT02807649.
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Affiliation(s)
- Juntao Kan
- Nutrilite Health Institute, Shanghai, China
| | - Junrui Cheng
- Nutrilite Health Institute, Shanghai, China
- Plants for Human Health Institute, North Carolina State University, Kannapolis, NC, United States
| | - Chun Hu
- Nutrilite Health Institute, Buena Park, CA, United States
| | - Liang Chen
- Nutrilite Health Institute, Shanghai, China
| | - Siyu Liu
- Nutrilite Health Institute, Shanghai, China
| | - Dawna Venzon
- Nutrilite Health Institute, Buena Park, CA, United States
| | - Mary Murray
- Nutrilite Health Institute, Buena Park, CA, United States
| | - Shuguang Li
- School of Public Health, Fudan University, Shanghai, China
| | - Jun Du
- Nutrilite Health Institute, Shanghai, China
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Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2021; 13:nu13082658. [PMID: 34444817 PMCID: PMC8399248 DOI: 10.3390/nu13082658] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multisystem, and profoundly debilitating neuroimmune disease, probably of post-viral multifactorial etiology. Unfortunately, no accurate diagnostic or laboratory tests have been established, nor are any universally effective approved drugs currently available for its treatment. This study aimed to examine whether oral coenzyme Q10 and NADH (reduced form of nicotinamide adenine dinucleotide) co-supplementation could improve perceived fatigue, unrefreshing sleep, and health-related quality of life in ME/CFS patients. A 12-week prospective, randomized, double-blind, placebo-controlled trial was conducted in 207 patients with ME/CFS, who were randomly allocated to one of two groups to receive either 200 mg of CoQ10 and 20 mg of NADH (n = 104) or matching placebo (n = 103) once daily. Endpoints were simultaneously evaluated at baseline, and then reassessed at 4- and 8-week treatment visits and four weeks after treatment cessation, using validated patient-reported outcome measures. A significant reduction in cognitive fatigue perception and overall FIS-40 score (p < 0.001 and p = 0.022, respectively) and an improvement in HRQoL (health-related quality of life (SF-36)) (p < 0.05) from baseline were observed within the experimental group over time. Statistically significant differences were also shown for sleep duration at 4 weeks and habitual sleep efficiency at 8 weeks in follow-up visits from baseline within the experimental group (p = 0.018 and p = 0.038, respectively). Overall, these findings support the use of CoQ10 plus NADH supplementation as a potentially safe therapeutic option for reducing perceived cognitive fatigue and improving the health-related quality of life in ME/CFS patients. Future interventions are needed to corroborate these clinical benefits and also explore the underlying pathomechanisms of CoQ10 and NADH administration in ME/CFS.
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Castro-Marrero J, Zaragozá MC, López-Vílchez I, Galmés JL, Cordobilla B, Maurel S, Domingo JC, Alegre-Martín J. Effect of Melatonin Plus Zinc Supplementation on Fatigue Perception in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Antioxidants (Basel) 2021; 10:antiox10071010. [PMID: 34201806 PMCID: PMC8300692 DOI: 10.3390/antiox10071010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multisystem, and profoundly debilitating condition, probably of multifactorial etiology. No effective approved drugs are currently available for its treatment. Several studies have proposed symptomatic treatment with melatonin and zinc supplementation in chronic illnesses; however, little is known about the synergistic effect of this treatment on fatigue-related symptoms in ME/CFS. The primary endpoint of the study was to assess the effect of oral melatonin plus zinc supplementation on fatigue in ME/CFS. Secondary measures included participants' sleep disturbances, anxiety/depression and health-related quality of life. A proof-of-concept, 16-week, randomized, placebo-controlled, double-blind trial was conducted in 50 ME/CFS patients assigned to receive either oral melatonin (1 mg) plus zinc (10 mg) supplementation (n = 24) or matching placebo (n = 26) once daily. Endpoint outcomes were evaluated at baseline, and then reassessed at 8 and 16 weeks of treatment and 4 weeks after treatment cessation, using self-reported outcome measures. The most relevant results were the significant reduction in the perception of physical fatigue in the Mel-Zinc group at the final treatment follow-up versus placebo (p < 0.05), and the significant improvement in the physical component summary at all follow-up visits in the experimental group. Urinary 6-sulfatoxymelatonin levels were significantly elevated though the treatment in experimental group vs. placebo (p < 0.0001); however, no significantly differences were observed for zinc concentration among participants. Our findings suggest that oral melatonin plus zinc supplementation for 16 weeks is safe and potentially effective in reducing fatigue and improving the quality of life in ME/CFS. This clinical study was registered on ClinicalTrials.gov (NCT03000777).
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Affiliation(s)
- Jesús Castro-Marrero
- Division of Rheumatology, ME/CFS Unit, Vall d’Hebron Hospital Research Institute, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-4893000 (ext. 3753)
| | - Maria-Cleofé Zaragozá
- Clinical Research Department, Laboratorios Viñas, 08012 Barcelona, Spain; (M.-C.Z.); (I.L.-V.); (J.L.G.)
| | - Irene López-Vílchez
- Clinical Research Department, Laboratorios Viñas, 08012 Barcelona, Spain; (M.-C.Z.); (I.L.-V.); (J.L.G.)
| | - José Luis Galmés
- Clinical Research Department, Laboratorios Viñas, 08012 Barcelona, Spain; (M.-C.Z.); (I.L.-V.); (J.L.G.)
| | - Begoña Cordobilla
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (B.C.); (J.C.D.)
| | - Sara Maurel
- Department of Neurosciences, University of the Basque Country, 48940 Leioa, Spain;
| | - Joan Carles Domingo
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (B.C.); (J.C.D.)
| | - José Alegre-Martín
- Division of Rheumatology, ME/CFS Unit, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
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13
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Dantoft TM, Nordin S, Andersson L, Petersen MW, Skovbjerg S, Jørgensen T. Multiple chemical sensitivity described in the Danish general population: Cohort characteristics and the importance of screening for functional somatic syndrome comorbidity-The DanFunD study. PLoS One 2021; 16:e0246461. [PMID: 33626058 PMCID: PMC7904225 DOI: 10.1371/journal.pone.0246461] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity. Methods Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex. Results MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS. Conclusions MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.
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Affiliation(s)
- Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- * E-mail:
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
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14
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Raanes EFW, Stiles TC. Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review. Front Psychiatry 2021; 12:716320. [PMID: 34887782 PMCID: PMC8650213 DOI: 10.3389/fpsyt.2021.716320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Little emphasis has been given to the fact that various psychological processes and behaviors in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have neural correlates that affect-and are affected by-the immune system. The aim of this paper is to provide a systematic review of the literature on cross-sectional and longitudinal associations between psychological and immunological variables/changes in CFS/ME. Methods: The systematic literature search was conducted on Dec 10, 2020 using PubMed. Original research studies investigating associations between a predefined set of psychological and immunological variables in CFS/ME were included. Specifically, the review was focused on studies examining the following psychological variables: executive function, emotion regulation, interpersonal function, sleep, mental health, anxiety, depression, and/or other psychiatric symptoms. In terms of immunological variables, studies investigating interleukin (IL)-1, IL-2, IL-4, IL-6, tumor necrosis factor (TNF), CD4+, and/or CD8+ were included. Besides original research papers, other potentially relevant papers (e.g., literature reviews) were carefully read and reference lists were checked in order to identify any additional relevant studies. Available data was summarized in text and tables. Results: The literature search identified 897 potentially relevant papers. Ultimately, 14 studies (807 participants in total) were included in the review of which only two were longitudinal in nature. The review indicated that executive function is associated with IL-1 and IL-6, and interpersonal function is associated with IL-6 and TNF-α. Further, the available data suggested that emotion regulation is associated with IL-2 and sleep is associated with IL-1, IL-6, TNF-α, and IL-2. Interestingly, poorer emotion regulation, interpersonal function, and sleep have all been found to be associated with higher cytokine levels. Executive function has shown both positive and negative relationships with cytokines and among these psychological constructs, it is also the only one that has been found to be associated with CD4+ and CD8+ counts/percentages. Conclusions: Correlations exist between psychological and immunological variables in CFS/ME. However, there are few consistent findings and there is almost a complete lack of longitudinal studies. This review points to a gap in existing CFS/ME research and hopefully, it will inspire to the generation of innovative, psychoneuroimmunological hypotheses within the CFS/ME research field.
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Affiliation(s)
- Emilie F W Raanes
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Huang X, Wu D, Wu AS, Wei CW, Gao JD. The Association of Insomnia with Depression and Anxiety Symptoms in Patients Undergoing Noncardiac Surgery. Neuropsychiatr Dis Treat 2021; 17:915-924. [PMID: 33790560 PMCID: PMC8008159 DOI: 10.2147/ndt.s296986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Insomnia is common in patients undergoing surgery. It can increase the rate of postoperative complications, interfere with patient recovery, and decrease hospital satisfaction. However, there are few studies on perioperative insomnia. This study was conducted to investigate the differences in the demographic, health status, and clinical characteristics of patients with and without insomnia postoperatively, and to identify the potential risk factors of insomnia. METHODS There were 299 non-cardiac surgery patients, 165 females, and 134 males, with a mean age of 55 years, enrolled in the study. The Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and Montreal Cognitive Assessment (MoCA) were administered to all the patients preoperatively. The Visual Analogue Scale (VAS) was used preoperatively, and at the end of the surgery, and then one day, two days, and three days after surgery. The PHQ-9, the GAD-7, and the ISI were repeated three days after surgery. Insomnia was diagnosed by the ISI as being a score of 8-28 (mild: 8-14; moderate-severe: 15-21; severe: 22-28). The patients were divided into group A (with insomnia, N=78) and group B (without insomnia, N=221) according to their ISI score three days after surgery. The general clinical data of the two groups were analyzed first, and then binary logistic regression analysis was conducted to assess the risk factors of insomnia. RESULTS A total of 299 non-cardiac surgery patients with a mean age of 55 years were enrolled in the study. Of the included patients, the number of females was 165 and the number of the male was 134. The incidence of insomnia at 3 days postoperatively was 26.1% (78/299). The average points that group A patients scored in the ISI, PHQ-9, and the GAD-7 were significantly higher than those in group B. The VAS score three days after surgery was significantly higher in group A. The PHQ-9 and the GAD-7 three days after surgery showed significantly higher depression and anxiety scores in group A. Logistic regression showed that the ISI (p<0.001, 95% CI=1.218-1.500) and the GAD-7 (p=0.003, 95% CI=1.041-1.218) preoperatively, and the PHQ-9 postoperatively (p<0.001, 95% CI=1.226-1.555), were risk factors of insomnia. CONCLUSION Insomnia is common and can worsen after surgery. The present study suggests that depression and anxiety are risk factors for insomnia after surgery. There is a need for further research and the development of strategies for depression and anxiety management to ensure better sleep quality for patients, which will be of significant benefit to their health. CLINICAL TRIAL REGISTRATION The study was registered at clinical trial (NCT04027751); Trial registration: clinical trial, NCT04027751. Registered 22 July 2019; https://clinicaltrials.gov/ct2/show/NCT04027751?cond=NCT04027751&cntry=CN&draw=2&rank=1.
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Affiliation(s)
- Xiao Huang
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Dan Wu
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - An-Shi Wu
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Chang-Wei Wei
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
| | - Jian-Dong Gao
- Department of Anesthesia, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China
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16
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Salehinejad MA, Majidinezhad M, Ghanavati E, Kouestanian S, Vicario CM, Nitsche MA, Nejati V. Negative impact of COVID-19 pandemic on sleep quantitative parameters, quality, and circadian alignment: Implications for health and psychological well-being. EXCLI JOURNAL 2020; 19:1297-1308. [PMID: 33192213 PMCID: PMC7658458 DOI: 10.17179/excli2020-2831] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has spread worldwide, affecting millions of people and exposing them to home quarantine, isolation, and social distancing. While recent reports showed increased distress and depressive/anxiety state related to COVID-19 crisis, we investigated how home quarantine affected sleep parameters in healthy individuals. 160 healthy individuals who were in home quarantine in April 2020 for at least one month participated in this study. Participants rated and compared their quantitative sleep parameters (time to go to bed, sleep duration, getting-up time) and sleep quality factors, pre-and during home quarantine due to the COVID-19 pandemic. Furthermore, participants' chronotype was determined to see if sleep parameters are differentially affected in different chronotypes. Time to fall asleep and get-up in the morning were significantly delayed in all participants, indicating a significant circadian misalignment. Sleep quality was reported to be significantly poorer in all participants and chronotypes. Poor sleep quality included more daily disturbances (more sleep disturbances, higher daily dysfunctions due to low quality of sleep) and less perceived sleep quality (lower subjective sleep quality, longer time taken to fall asleep at night, more use of sleep medication for improving sleep quality) during home quarantine. Home quarantine due to COVID-19 pandemic has a detrimental impact on sleep quality. Online interventions including self-help sleep programs, stress management, relaxation practices, stimulus control, sleep hygiene, and mindfulness training are available interventions in the current situation.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Institute for Cognitive & Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | | | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Psychology, Ruhr-University Bochum, Bochum, Germany
| | | | - Carmelo M Vicario
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
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17
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Maksoud R, du Preez S, Eaton-Fitch N, Thapaliya K, Barnden L, Cabanas H, Staines D, Marshall-Gradisnik S. A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques. PLoS One 2020; 15:e0232475. [PMID: 32353033 PMCID: PMC7192498 DOI: 10.1371/journal.pone.0232475] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterised by a diverse range of debilitating symptoms including autonomic and cognitive dysfunction. The pathomechanism remains elusive, however, neurological and cognitive aberrations are consistently described. This systematic review is the first to collect and appraise the literature related to the structural and functional neurological changes in ME/CFS patients as measured by neuroimaging techniques and to investigate how these changes may influence onset, symptom presentation and severity of the illness. METHODS A systematic search of databases Pubmed, Embase, MEDLINE (via EBSCOhost) and Web of Science (via Clarivate Analytics) was performed for articles dating between December 1994 and August 2019. Included publications report on neurological differences in ME/CFS patients compared with healthy controls identified using neuroimaging techniques such as magnetic resonance imaging, positron emission tomography and electroencephalography. Article selection was further refined based on specific inclusion and exclusion criteria. A quality assessment of included publications was completed using the Joanna Briggs Institute checklist. RESULTS A total of 55 studies were included in this review. All papers assessed neurological or cognitive differences in adult ME/CFS patients compared with healthy controls using neuroimaging techniques. The outcomes from the articles include changes in gray and white matter volumes, cerebral blood flow, brain structure, sleep, EEG activity, functional connectivity and cognitive function. Secondary measures including symptom severity were also reported in most studies. CONCLUSIONS The results suggest widespread disruption of the autonomic nervous system network including morphological changes, white matter abnormalities and aberrations in functional connectivity. However, these findings are not consistent across studies and the origins of these anomalies remain unknown. Future studies are required confirm the potential neurological contribution to the pathology of ME/CFS.
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Affiliation(s)
- Rebekah Maksoud
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- * E-mail:
| | - Stanley du Preez
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- School of Medical Sciences, Griffith University, Gold Coast, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Natalie Eaton-Fitch
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- School of Medical Sciences, Griffith University, Gold Coast, Australia
| | - Kiran Thapaliya
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Leighton Barnden
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Hélène Cabanas
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Donald Staines
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
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18
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Rekeland IG, Fosså A, Lande A, Ktoridou-Valen I, Sørland K, Holsen M, Tronstad KJ, Risa K, Alme K, Viken MK, Lie BA, Dahl O, Mella O, Fluge Ø. Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study. Front Med (Lausanne) 2020; 7:162. [PMID: 32411717 PMCID: PMC7201056 DOI: 10.3389/fmed.2020.00162] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/09/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease with high symptom burden, of unknown etiology, with no established treatment. We observed patients with long-standing ME/CFS who got cancer, and who reported improvement of ME/CFS symptoms after chemotherapy including cyclophosphamide, forming the basis for this prospective trial. Materials and methods: This open-label phase II trial included 40 patients with ME/CFS diagnosed by Canadian criteria. Treatment consisted of six intravenous infusions of cyclophosphamide, 600-700 mg/m2, given at four-week intervals with follow-up for 18 months, extended to 4 years. Response was defined by self-reported improvements in symptoms by Fatigue score, supported by Short Form 36 (SF-36) scores, physical activity measures and other instruments. Repeated measures of outcome variables were assessed by General linear models. Responses were correlated with specific Human Leukocyte Antigen (HLA) alleles. Results: The overall response rate by Fatigue score was 55.0% (22 of 40 patients). Fatigue score and other outcome variables showed significant improvements compared to baseline. The SF-36 Physical Function score increased from mean 33.0 at baseline to 51.5 at 18 months (all patients), and from mean 35.0 to 69.5 among responders. Mean steps per 24 h increased from mean 3,199 at baseline to 4,347 at 18 months (all patients), and from 3,622 to 5,589 among responders. At extended follow-up to 4 years 68% (15 of 22 responders) were still in remission. Patients positive for HLA-DQB1*03:03 and/or HLA-C*07:04 (n = 12) had significantly higher response rate compared to patients negative for these alleles (n = 28), 83 vs. 43%, respectively. Nausea and constipation were common grade 1-2 adverse events. There were one suspected unexpected serious adverse reaction (aggravated POTS) and 11 serious adverse events in eight patients. Conclusion: Intravenous cyclophosphamide treatment was feasible for ME/CFS patients and associated with an acceptable toxicity profile. More than half of the patients responded and with prolonged follow-up, a considerable proportion of patients reported ongoing remission. Without a placebo group, clinical response data must be interpreted with caution. We nevertheless believe a future randomized trial is warranted. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02444091.
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Affiliation(s)
- Ingrid G Rekeland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Alexander Fosså
- Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Asgeir Lande
- Department of Medical Genetics, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Irini Ktoridou-Valen
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Kari Sørland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Mari Holsen
- Clinical Research Unit, Haukeland University Hospital, Bergen, Norway
| | - Karl J Tronstad
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Kristin Risa
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Kine Alme
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Marte K Viken
- Department of Medical Genetics, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Immunology, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Benedicte A Lie
- Department of Medical Genetics, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Immunology, University of Oslo and Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Olav Dahl
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Olav Mella
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Øystein Fluge
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
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19
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Escorihuela RM, Capdevila L, Castro JR, Zaragozà MC, Maurel S, Alegre J, Castro-Marrero J. Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis. J Transl Med 2020; 18:4. [PMID: 31906988 PMCID: PMC6943898 DOI: 10.1186/s12967-019-02184-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/20/2019] [Indexed: 01/21/2023] Open
Abstract
Background Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME. Methods In this case–control study, 45 female patients who met the 1994 CDC/Fukuda definition for CFS/ME and 25 age- and gender-matched healthy controls underwent HRV recording-resting state tests. The intervals between consecutive heartbeats (RR) were continuously recorded over three 5-min periods. Time- and frequency-domain analyses were applied to estimate HRV variables. Demographic and clinical features, and self-reported symptom measures were also recorded. Results CFS/ME patients showed significantly higher scores in all symptom questionnaires (p < 0.001), decreased RR intervals (p < 0.01), and decreased HRV time- and frequency-domain parameters (p < 0.005), except for the LF/HF ratio than in the healthy controls. Overall, the correlation analysis reached significant associations between the questionnaires scores and HRV time- and frequency-domain measurements (p < 0.05). Furthermore, separate linear regression analyses showed significant relationships between self-reported fatigue symptoms and mean RR (p = 0.005), RMSSD (p = 0.0268) and HFnu indices (p = 0.0067) in CFS/ME patients, but not in healthy controls. Conclusions Our findings suggest that ANS dysfunction presenting as increased sympathetic hyperactivity may contribute to fatigue severity in individuals with ME/CFS. Further studies comparing short- and long-term HRV recording and self-reported outcome measures with previous studies in larger CFS/ME cohorts are urgently warranted.
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Affiliation(s)
- Rosa María Escorihuela
- Departament de Psiquiatria i Medicina Legal, Institut de Neurosciències, Universitat Autònoma de Barcelona, Facultat de Medicina, Avinguda Can Domènech, s/n, 08193, Bellaterra, Barcelona, Spain.
| | - Lluís Capdevila
- Laboratory of Sport Psychology, Department of Basic Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Ramos Castro
- Department of Electronic Engineering, Biomedical and Electronic Instrumentation Group, Universitat Politécnica de Catalunya, Barcelona, Spain
| | | | - Sara Maurel
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Alegre
- CFS/ME Unit, Vall d'Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jesús Castro-Marrero
- CFS/ME Unit, Vall d'Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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20
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Lee JS, Jeon YJ, Park SY, Son CG. An Adrenalectomy Mouse Model Reflecting Clinical Features for Chronic Fatigue Syndrome. Biomolecules 2020; 10:E71. [PMID: 31906307 PMCID: PMC7023174 DOI: 10.3390/biom10010071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/24/2019] [Accepted: 12/29/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is one of the most intractable diseases and is characterized by severe central fatigue that impairs even daily activity. To date, the pathophysiological mechanisms are uncertain and no therapies exist. Therefore, a proper animal model reflecting the clinical features of CFS is urgently required. We compared two CFS animal models most commonly used, by injection with lipopolysaccharide (LPS from Escherichia coli O111:B4) or polyinosinic: polycytidylic acid (poly I:C), along with bilateral adrenalectomy (ADX) as another possible model. Both LPS- and poly I:C-injected mice dominantly showed depressive behaviors, while ADX led to fatigue-like performances with high pain sensitivity. In brain tissues, LPS injection notably activated microglia and the 5-hydroxytryptamine (HT)1A receptor in the prefrontal cortex and hippocampus. Poly I:C-injection also remarkably activated the 5-HT transporter and 5-HT1A receptor with a reduction in serotonin levels in the brain. ADX particularly activated astrocytes and transforming growth factor beta (TGF-β) 1 in all brain regions. Our results revealed that LPS and poly I:C animal models approximate depressive disorder more closely than CFS. We suggest that ADX is a possible method for establishing a mouse model of CFS reflecting clinical features, especially in neuroendocrine system.
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Affiliation(s)
- Jin-Seok Lee
- Institute of Traditional Medicine and Bioscience, Dunsan Hospital of Daejeon University, Daejeon 34323, Korea; (J.-S.L.); (Y.-J.J.)
| | - Yoo-Jin Jeon
- Institute of Traditional Medicine and Bioscience, Dunsan Hospital of Daejeon University, Daejeon 34323, Korea; (J.-S.L.); (Y.-J.J.)
| | - Samuel-Young Park
- Korean Medical College of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34323, Korea;
| | - Chang-Gue Son
- Institute of Traditional Medicine and Bioscience, Dunsan Hospital of Daejeon University, Daejeon 34323, Korea; (J.-S.L.); (Y.-J.J.)
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21
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Nomamiukor FO, Smith LJ, Vujanovic AA. Examining associations between sleep disturbance and distress tolerance in trauma-exposed psychiatric inpatients. Gen Hosp Psychiatry 2018; 55:84-89. [PMID: 30448742 DOI: 10.1016/j.genhosppsych.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Lia J Smith
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, TX, USA.
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