Clinical Assessment of Autonomic Function in Fibromyalgia by the Refined and Abbreviated Composite Autonomic Symptom Score (COMPASS 31): A Case-Controlled Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887116666210612033002 ◽

2021 ◽

Vol 16 ◽

Author(s):

Basant K. Puri ◽

Gary S. Lee

Keyword(s):

Symptom Score ◽

Autonomic Dysfunction ◽

Autonomic Function ◽

Orthostatic Intolerance ◽

Fibromyalgia Impact Questionnaire ◽

Controlled Study ◽

Group Status ◽

Cross Sectional ◽

Autonomic Symptom ◽

Revised Fibromyalgia Impact Questionnaire

Background: It has been shown that autonomic dysfunction in fibromyalgia can be assessed by the Composite Autonomic Symptom Score (COMPASS) questionnaire. More recently, a refined and much abbreviated 31-item version of the questionnaire has been developed, the COMPASS 31. Objectives: The study has the following objectives: First, to determine whether the COMPASS 31 can assess changes in autonomic function in fibromyalgia. Second, to assess whether the COMPASS 31 values in fibromyalgia patients are positively correlated with scores on the Revised Fibromyalgia Impact Questionnaire (FIQR). Method: A cross-sectional, case-controlled study was carried out with 25 fibromyalgia patients and 26 healthy controls. Results: The two groups were matched for age, sex and ethnicity, but not for body mass index (BMI). The total mean (standard error) COMPASS 31 for the fibromyalgia patients, 37.2 (1.8), differentiated the patients from the controls (9.5 (1.4); p < 0.00000001). The scores were greater in the fibromyalgia patients across all COMPASS 31 autonomic domains, namely orthostatic intolerance (p < 0.00000001), and vasomotor (p < 0.0001), secretomotor (p < 0.000001), gastrointestinal (p < 0.000001), bladder (p < 0.00001), and pupillomotor functions (p < 0.00000001). The total COMPASS 31 values were positively correlated with FIQR scores (rs = 0.45, p < 0.05). General linear modelling of the COMPASS 31 scores showed that only group status (fibromyalgia or control) was significant (p = 3.4 × 10-16), with age, sex and BMI being non-significant. Conclusion: This study confirms that non-pain autonomic dysfunction symptoms occur in fibromyalgia and can be assessed with COMPASS 31.

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Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

10.1101/2021.06.29.21259552 ◽

2021 ◽

Author(s):

Lucia M Li ◽

Ekawat Vichayanrat ◽

Martina del Giovane ◽

Helen HL Lai ◽

Valeria Iodice

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Median Time ◽

Autonomic Dysfunction ◽

Severe Traumatic Brain Injury ◽

Autonomic Function ◽

Autonomic Symptom ◽

Autonomic Symptoms ◽

Clinical Autonomic ◽

Function Testing

Background and Objective: Survivors of moderate-severe traumatic brain injury (msTBI) frequently experience chronic, debilitating somatic symptoms, which are largely unexplained. The phenomenon of paroxysmal sympathetic hyperactivity, reflecting hyperacute autonomic dysfunction, is well-documented after msTBI. Limited animal and human studies, using experimental measures, have found evidence for autonomic dysfunction after msTBI. However, no studies have investigated the range and type of autonomic symptoms and autonomic dysfunction existing in msTBI. We set out to investigate the presence and type of subjective and objective autonomic dysfunction in msTBI. Methods: We conducted two cohort studies. Cohort 1 comprises msTBI patients prospectively recruited from a regional TBI outpatient clinic, in whom we assessed burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) autonomic symptom questionnaire. Cohort 2 comprises msTBI patients who had standard clinical autonomic function testing (supine/tilted catecholamine levels, head-up tilt, Valsalva manoeuvre, respiratory sinus arrhythmia assessment), retrospectively identified from the database of a regional clinical autonomic unit. Results: Cohort 1 comprises 29 msTBI patients (6 females, median age 40 years, range 19-76), with a median time since injury of 19 months (range 4-105). There was multi-domain symptom burden, with all but 3 patients reporting symptoms on the COMPASS31 questionnaire, and 17/29 reporting symptoms in 3+ domains. The most commonly reported symptoms were gastrointestinal (22/29), followed by orthostatic (17/19), pupillomotor (14/29), secretomotor (14/29), bladder (12/29) and, least commonly, vasomotor (6/29). Cohort 2 comprises 19 msTBI patients (7 females, median age 44 years, range 21-64), with a median time between injury and testing of 65 months (range: 2-416). The majority of patients (16/19) had orthostatic symptoms as part of the reason for referral. Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction: 4/19 had evidence of sympathetic dysfunction, 10/19 had evidence of parasympathetic dysfunction, of which 6 had evidence of mixed dysfunction. Discussion: Our results provide evidence for clinically relevant autonomic dysfunction after moderate-severe TBI, even at the chronic stage. Our study advocates for routine enquiry about potential autonomic symptoms in this population, and the utility of formal clinical autonomic testing in providing diagnoses.

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Symptoms of Autonomic Dysfunction in Systemic Sclerosis Assessed by the COMPASS-31 Questionnaire

The Journal of Rheumatology ◽

10.3899/jrheum.170868 ◽

2018 ◽

Vol 45 (8) ◽

pp. 1145-1152 ◽

Cited By ~ 9

Author(s):

Brittany L. Adler ◽

James W. Russell ◽

Laura K. Hummers ◽

Zsuzsanna H. McMahan

Keyword(s):

Systemic Sclerosis ◽

Autonomic Dysfunction ◽

Orthostatic Intolerance ◽

Linear Regression Analysis ◽

Symptom Burden ◽

Pressure Control ◽

Continuous Variables ◽

Autonomic Symptom ◽

Domain Specific ◽

Dichotomous Variables

Objective.Autonomic dysfunction is a known complication of systemic sclerosis (SSc) that can affect vascular tone, gastrointestinal (GI) motility, heart rate, and blood pressure control. We sought to quantify autonomic symptom burden in SSc, and to define the characteristics of patients with SSc and autonomic dysfunction.Methods.Patients with SSc were consecutively recruited during routine clinical visits at the Johns Hopkins Scleroderma Center and asked to complete the Composite Autonomic Symptom Score (COMPASS)-31 questionnaire, a validated tool to assess symptoms of autonomic dysfunction. We determined the relationship between various clinical and serological features of SSc and the total COMPASS-31 scores and domain-specific scores using the Student t test or Wilcoxon rank-sum test for dichotomous variables and linear regression analysis for continuous variables.Results.The study included 104 patients with SSc who completed the COMPASS-31 questionnaire. The mean COMPASS-31 score in this cohort was 24.9 ± 15.5, higher than COMPASS-31 scores from previously published healthy controls (8.9 ± 8.7). Compared to patients with mild or absent GI disease, patients with significant GI disease had higher scores across several subdomains of the COMPASS-31, including orthostatic intolerance (median 10.0 vs 0, p = 0.006) and secretomotor dysfunction (median 6.4 vs 4.3, p = 0.03). There was also a dose-response relationship between GI disease severity and autonomic symptom burden.Conclusion.Symptoms of autonomic dysfunction are common in SSc. Patients with more severe GI disease in SSc report more symptoms of dysautonomia across many facets of the autonomic nervous system.

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Frequency and characteristics of dysautonomic symptoms in multiple sclerosis: a cross-sectional double-center study with the validated Italian version of the Composite Autonomic Symptom Score-31

Neurological Sciences ◽

10.1007/s10072-020-04620-1 ◽

2020 ◽

Author(s):

Matteo Foschi ◽

Giulia Giannini ◽

Elena Merli ◽

Luca Mancinelli ◽

Corrado Zenesini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Symptom Score ◽

Italian Version ◽

Cross Sectional ◽

Autonomic Symptom ◽

Center Study

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Validation of the Composite Autonomic Symptom Score 31 in the German language

Neurological Sciences ◽

10.1007/s10072-021-05764-4 ◽

2021 ◽

Author(s):

Max-Josef Hilz ◽

Ruihao Wang ◽

Wolfgang Singer

Keyword(s):

Symptom Score ◽

Orthostatic Intolerance ◽

Correlation Coefficients ◽

German Version ◽

Self Assessment ◽

Autonomic Symptom ◽

Autonomic Symptoms ◽

Cronbach Alpha ◽

And Gender ◽

Post Hoc

Abstract Background The Composite Autonomic Symptom Score 31 (COMPASS 31) is a validated, 31-item self-assessment questionnaire assessing autonomic symptoms in six domains, orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor function. So far, there is no validated German COMPASS 31 version. This study aimed at developing and validating a German COMPASS 31. Methods Two autonomic experts with command of German and English independently translated the English COMPASS 31 into German. One agreed-upon German version was translated back into English to assure conformity with the original version. Twenty patients with possible autonomic symptoms and 20 age- and gender-matched healthy persons completed the English and German COMPASS 31 in a randomized order with a 4-week interval. To evaluate reliability of the German COMPASS 31, total scores and sub-scores of the domains assessed with the German version were correlated with corresponding scores of the English version using Pearson’s or Spearman’s test. The Cronbach alpha-coefficient evaluated the internal consistency of the questions. Total- and sub-scores of both COMPASS 31 versions were compared between patients and controls by analysis of variance with post-hoc analysis (significance: p < 0.05). Results Total scores and sub-scores of the German and English COMPASS 31 correlated significantly (p < 0.001) and closely (correlation coefficients: 0.757–0.934). Cronbach alpha-coefficients were above 0.7 in all domains except for the secretomotor domain. In the German and English COMPASS 31, total scores were significantly higher in patients than controls. Conclusions The German COMPASS 31 is reliable, internally consistent, and valid to detect and quantify autonomic symptoms in patients with neurological disorders.

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Fatigue following COVID-19 infection is not associated with autonomic dysfunction

PLoS ONE ◽

10.1371/journal.pone.0247280 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247280

Author(s):

Liam Townsend ◽

David Moloney ◽

Ciaran Finucane ◽

Kevin McCarthy ◽

Colm Bergin ◽

...

Keyword(s):

Blood Pressure ◽

Autonomic Dysfunction ◽

Autonomic Function ◽

Orthostatic Intolerance ◽

Blood Pressure Monitoring ◽

Common Symptom ◽

Test Results ◽

Pressure Monitoring ◽

Autonomic Testing ◽

Function Test

Background The long-term clinical and physiological consequences of COVID-19 infection remain unclear. While fatigue has emerged as a common symptom following infection, little is known about its links with autonomic dysfunction. SARS-CoV-2 is known to infect endothelial cells in acute infection, resulting in autonomic dysfunction. Here we set out to test the hypothesis that this results in persistent autonomic dysfunction and is associated with post-COVID fatigue in convalescent patients. Methods We recruited 20 fatigued and 20 non-fatigued post-COVID patients (median age 44.5 years, 36/40 (90%) female, median time to follow up 166.5 days). Fatigue was assessed using the Chalder Fatigue Scale. These underwent the Ewing’s autonomic function test battery, including deep breathing, active standing, Valsalva manoeuvre and cold-pressor testing, with continuous electrocardiogram and blood pressure monitoring, as well as near-infrared spectroscopy-based cerebral oxygenation. 24-hour ambulatory blood pressure monitoring was also conducted, and patients completed the generalised anxiety disorder-7 questionnaire. We assessed between-group differences in autonomic function test results and used unadjusted and adjusted linear regression to investigate the relationship between fatigue, anxiety, and autonomic test results. Results We found no pathological differences between fatigued and non-fatigued patients on autonomic testing or on 24-hour blood pressure monitoring. Symptoms of orthostatic intolerance were reported by 70% of the fatigued cohort at the time of active standing, with no associated physiological abnormality detected. Fatigue was strongly associated with increased anxiety (p <0.001), with no patients having a pre-existing diagnosis of anxiety. Conclusions These results demonstrate the significant burden of fatigue, symptoms of autonomic dysfunction and anxiety in the aftermath of COVID-19 infection, but reassuringly do not demonstrate pathological findings on autonomic testing.

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