Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia.
Clin Auton Res. 2019 Jun;29(3):321-328. doi: 10.1007/s10286-018-0563-6. Epub 2018 Sep 12.
To investigate a possible association between autonomic dysfunction and fatigue in people with multiple sclerosis.
In 70 people with multiple sclerosis early in the disease course (51 females, mean age 33.8 ± 9.1), quantitative sudomotor axon reflex tests, cardiovascular reflex tests (heart rate and blood pressure responses to the Valsalva maneuver and heart rate response to deep breathing), and the tilt table test were performed. Participants completed the Composite Autonomic Symptom Score 31, the Modified Fatigue Impact Scale, and the Epworth Sleepiness Scale, as well as the Beck Depression Inventory. Cutoff scores of ≥ 38 or ≥ 45 on the Modified Fatigue Impact Scale were used to stratify patients into a fatigued subgroup (N = 17 or N = 9, respectively).
We found clear associations between fatigue and scores in subjective tests of the autonomic nervous system: fatigued patients scored significantly worse on Composite Autonomic Symptom Score 31, and there was a strong correlation between the Modified Fatigue Impact Scale and the Composite Autonomic Symptom Score 31 (r = 0.607, p < 0.001). On the other hand, we found only modest associations between fatigue and scores in objective tests of the autonomic nervous system: there was a clear trend for lower sweating outputs at all measured sites, which reached statistical significance for the distal leg and foot. We found weak correlations between the Modified Fatigue Impact Scale and the Valsalva ratio (r = - 0.306, p = 0.011), as well as between the Modified Fatigue Impact Scale and quantitative sudomotor axon reflex tests of the forearm, proximal, and distal lower leg (r = - 0.379, p = 0.003; r = - 0.356, p = 0.005; and r = - 0.345, p = 0.006, respectively). A multiple regression model showed that the Composite Autonomic Symptom Score 31, Beck Depression Inventory, and Epworth Sleepiness Scale were independent predictors of fatigue (p = 0.005, p = 0.019, and p = 0.010, respectively).
These results suggest that-even early in the course of the disease-people with multiple sclerosis suffer from objective and subjective impairments of the autonomic nervous system. The results also point to an association between autonomic nervous system impairment and multiple sclerosis related fatigue.
研究自主神经功能障碍与多发性硬化症患者疲劳之间的可能关联。
在 70 名多发性硬化症早期患者（51 名女性，平均年龄 33.8±9.1 岁）中，进行定量汗反射测试、心血管反射测试（血压和心率对瓦尔萨尔瓦动作的反应以及心率对深呼吸的反应）和倾斜台测试。参与者完成了综合自主症状评分 31 分、改良疲劳影响量表和爱泼沃斯嗜睡量表，以及贝克抑郁量表。使用改良疲劳影响量表的得分≥38 或≥45 来将患者分为疲劳亚组（分别为 N=17 或 N=9）。
我们发现疲劳与自主神经系统主观测试评分之间存在明显关联：疲劳患者的综合自主症状评分 31 明显更差，改良疲劳影响量表与综合自主症状评分 31 之间存在很强的相关性（r=0.607，p<0.001）。另一方面，我们发现疲劳与自主神经系统客观测试评分之间只有中等程度的关联：所有测量部位的出汗量均明显降低，其中腿部和脚部的差异具有统计学意义。我们发现改良疲劳影响量表与瓦尔萨尔瓦比值（r=-0.306，p=0.011）之间存在弱相关性，以及改良疲劳影响量表与前臂、近端和远端小腿的定量汗反射测试之间存在弱相关性（r=-0.379，p=0.003；r=-0.356，p=0.005；r=-0.345，p=0.006）。多元回归模型显示，综合自主症状评分 31、贝克抑郁量表和爱泼沃斯嗜睡量表是疲劳的独立预测因素（p=0.005、p=0.019 和 p=0.010）。
这些结果表明，即使在疾病早期，多发性硬化症患者也会出现自主神经系统的客观和主观损害。结果还表明，自主神经系统损害与多发性硬化症相关的疲劳之间存在关联。
