mate van "vermoeidheid"

is gerelateerd aan

de ernst van

de orthostatische klachten.








Uit opvolgingsonderzoek van dr. Julia Newton en kollega's blijkt dat:

  • De mate van "vermoeidheid" sterk gerelateerd aan
  • de ernst van autonome symptomen/orthostatische klachten, depressie en angst.

  • De "vermoeidheid" aan het begin van de dag groot is,
  • afneemt in de middag en weer toeneemt in de avond.





Fatigue severity remains stable over time and independently associated with orthostatic symptoms in chronic fatigue syndrome: a longitudinal study.

J Intern Med. 2010 Oct 20. doi: 10.1111/j.1365-2796.2010.02306.x.

Jones DE, Gray J, Frith J, Newton JL.









To examine

fatigue variability over time

in chronic fatigue syndrome (CFS) and

the effect of other symptoms on its predictability.





Longitudinal cohort study of patients with CFS (Fukuda criteria).





Specialist CFS clinical service





Phase 1:

100 patients who participated in a study of CFS symptoms in 2005

were revisited in 2009.


Phase 2:


25 patients completed fatigue diaries

to address intra- and inter-day variability in perceived fatigue.



Main outcome measures:


Phase 1:

subjects completed

fatigue impact scale (FIS),

Epworth sleepiness scale (ESS),

orthostatic grading scale (OGS) and

hospital anxiety and depression scale (HADS).



Changes in variables represented the differences between 2005 and 2009.


Phase 2:


subjects rated fatigue on a scale of 0 (no fatigue) to 10 (severe fatigue)

four times a day for 5 weeks.





Symptom assessment tools were available in both 2005 and 2009 for 74% of patients.


FIS and HADS depression (HAD-D) and anxiety (HAD-A) scores

significantly improved during follow-up

whereas ESS and OGS remained stable.


FIS improved in 29/74 (39%) subjects, and by ≥10 points in 19 (26%).


FIS worsened by ≥10 points in 33/74 (45%) subjects.


On multivariate analysis,

independent predictors of current fatigue (FIS in 2009) were

FIS in 2005, HAD-D in 2009, OGS in 2009 and change in HAD-A.


Reported fatigue was stable from week to week and from day to day.


Patients reported higher fatigue in the morning (mean SD; 6.4 2),

becoming significantly lower at lunchtime (6.2 2; P < 0.05) and

increasing again to 7 2 at bedtime.





Current fatigue

is independently associated with

current autonomic symptom burden, current depression and change in anxiety during follow-up.


These findings have implications for targeted symptom management in CFS.




PMID: 21073560