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== Myalgic encephalomyelitis and the ANS == Altered ANS functioning has been seen in many [[myalgic encephalomyelitis]] (ME) patients, as they experience various altered autonomic responses. Symptoms of autonomic dysfunction in ME include: * Blood pressure ** Delayed [[gastric emptying]]<ref>{{Cite journal | last = Burnet | first = Richard B | last2 = Chatterton | first2 = Barry E | date = Dec 2004 | title = Gastric emptying is slow in chronic fatigue syndrome | url =https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-4-32 | journal = BMC Gastroenterology|language=en | volume = 4 | issue = 1|doi=10.1186/1471-230x-4-32|issn=1471-230X}}</ref> ** Elevated baseline heart rate in some studies<ref name="Cauwenbergh2014" /> * Body temperature ** [[thermostatic instability|Rhermostatic instability/impaired thermoregulation]], including significantly increased shivering and [[sweating episode]]s compared to controls<ref name="ICC2011primer">{{citation | last = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | author-link2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | author-link3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | author-link4 = Nancy Klimas | last5 = Broderick | first5 = G | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 =N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | author-link20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | author-link21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | author-link22 = John McLaren-Howard | last23 = Mena | first23 = I | author-link23 = Ismael Mena | last24 = Miwa | first24 = K | author-link24 = Kunihisa Miwa | last25 = Murovska | first25 = M | author-link25= Modra Murovska | last26 = Stevens | first26 = SR | author-link26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="Wyller2077">{{Cite journal | title = Abnormal Thermoregulatory Responses in Adolescents With Chronic Fatigue Syndrome: Relation to Clinical Symptoms | date = 2007-07-01 | url = https://doi.org/10.1542/peds.2006-2759 | journal = Pediatrics | volume = 120 | issue = 1| pages = e129–e137 | last = Wyller | first = Vegard Bruun | author-link = Vegard Bruun Wyller | last2 = Godang | first2 = Kristin | author-link2 = Kristin Godang | last3 = Mørkrid | first3 = Lars | author-link3 = | last4 = Saul | first4 = Jerome Philip | author-link4 = | last5 = Thaulow | first5 = Erik | author-link5 = | last6 = Walløe | first6 = Lars | author-link6 = | first9 = | first11 = |doi=10.1542/peds.2006-2759|pmc=|pmid=|access-date=|issn=0031-4005|quote=|via=}}</ref> ** Reduced capacity to recover from exercise-induced [[muscle acidosis]] (can be attributed to dysfunction of vascular runoff, in part controlled by the ANS)<ref name="Jones2011" /><ref name="ICC2011primer" /> * Digestion ** Increased [[gut-intestinal permeability]] (dysfunction of the PNS via abnormal glandular secretion in digestion)<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivana | last3 = Leunis | first3 = Jean-Claude | date = Apr 2007 | title = Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut-intestinal permeability | url = https://www.ncbi.nlm.nih.gov/pubmed/17007934 | journal = Journal of Affective Disorders | volume = 99 | issue = 1-3 | pages = 237–240|doi=10.1016/j.jad.2006.08.021|issn=0165-0327|pmid=17007934}}</ref> * [[Exercise intolerance]] * Heart rate ** Higher prevalence and severity of [[Postural orthostatic tachycardia syndrome|POTS]]<ref name="Cauwenbergh2014" /> ** Impaired [[blood pressure variability]]<ref>{{Cite journal | last = Frith | first = J. | last2 = Zalewski | first2 = P. | last3 = Klawe | first3 = J.J. | last4 = Pairman | first4 = J. | last5 = Bitner | first5 = A. | last6 = Tafil-Klawe | first6 = M. | last7 = Newton | first7 = J.L. | date = Sep 2012 | title = Impaired blood pressure variability in chronic fatigue syndrome--a potential biomarker |url =https://www.ncbi.nlm.nih.gov/pubmed/22670061 | journal = QJM: monthly journal of the Association of Physicians | volume = 105 | issue = 9 | pages = 831–838|doi=10.1093/qjmed/hcs085|issn=1460-2393|pmid=22670061}}</ref> ** [[Orthostatic intolerance]]<ref name="Cauwenbergh2014">{{Cite journal | last = Van Cauwenbergh | first = Deborah | last2 = Nijs | first2 = Jo | last3 = Kos | first3 = Daphne | last4 = Van Weijnen | first4 = Laura | last5 = Struyf | first5 = Filip | last6 = Meeus | first6 = Mira | date = 2014-04-17 | title = Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review | url =https://onlinelibrary.wiley.com/doi/epdf/10.1111/eci.12256 | journal = European Journal of Clinical Investigation|language=en | volume = 44 | issue = 5 | pages = 516–526|doi=10.1111/eci.12256|issn=0014-2972}}</ref><ref>{{Cite journal | last = Rowe | first = Peter C. | last2 = Lucas | first2 = Katherine E. | date = Mar 2007 | title = Orthostatic Intolerance in Chronic Fatigue Syndrome | url =https://www.amjmed.com/article/S0002-9343(06)00316-0/fulltext | journal = The American Journal of Medicine|language=English | volume = 120 | issue = 3| pages = e13|doi=10.1016/j.amjmed.2006.02.033|issn=0002-9343}}</ref> ** Reduced [[heart rate variability]] at night<ref>{{Cite journal | date = 2013-10-01 | title = Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: A systematic review | url =https://www.sciencedirect.com/science/article/pii/S0049017213000516 | journal = Seminars in Arthritis and Rheumatism|language=en | volume = 43 | issue = 2 | pages = 279–287|doi=10.1016/j.semarthrit.2013.03.004|issn=0049-0172}}</ref> ** Reduced [[Small heart syndrome|left ventricular mass]], end-diastolic volume and cardiac output, and increased residual torsion in diastole<ref name="Jones2011">{{Cite journal | last = Jones | first = David E.J. | last2 = Hollingsworth | first2 = Kieren G. | last3 = Jakovljevic | first3 = Djordje G. | last4 = Fattakhova | first4 = Gulnar | last5 = Pairman | first5 = Jessie | last6 = Blamire | first6 = Andrew M. | last7 = Trenell | first7 = Michael I. | last8 = Newton | first8 = Julia L. | date = 2011-07-12 | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case-control study | url = https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2362.2011.02567.x | journal = European Journal of Clinical Investigation|language=en | volume = 42 | issue = 2 | pages = 186–194|doi=10.1111/j.1365-2362.2011.02567.x|issn=0014-2972}}</ref> * [[Nervous system|Neurological]] correlates with ANS dysfunction ** Altered communication between some parts of the [[brain]] that regulate the ANS<ref>{{Cite journal | date = 2016-01-01 | title = Autonomic correlations with MRI are abnormal in the brainstem vasomotor centre in Chronic Fatigue Syndrome | last = Barnden | first = Leighton R. | first2 = Richard | last2 = Kwiatek | first3 = Benjamin | last3 = Crouch | first4 = Richard | last4 = Burnet | first5 = Peter | last5 = Del Fante | url =https://www.sciencedirect.com/science/article/pii/S2213158216300584 | journal = NeuroImage: Clinical|language=en | volume = 11 | pages = 530–537|doi=10.1016/j.nicl.2016.03.017|issn=2213-1582}}</ref> === The vagus nerve hypothesis === {{Main article | page_name = Vagus nerve infection hypothesis}} The [[Vagus nerve infection hypothesis|vagus nerve hypothesis]] suggests that infection and inflammation of the [[vagus nerve]], a prominent nerve within the ANS, would disrupt normal autonomic function. The vagus nerve communicates information between numerous internal organs and the brain. Infection of the vagus nerve could signal an exaggerated sickness response and perpetuate further dysfunction.<ref>{{Cite journal | last = VanElzakker | first = Michael B. | date = Sep 2013 | title = Chronic fatigue syndrome from vagus nerve infection: a psychoneuroimmunological hypothesis |url =https://www.ncbi.nlm.nih.gov/pubmed/23790471 | journal = Medical Hypotheses | volume = 81 | issue = 3 | pages = 414–423|doi=10.1016/j.mehy.2013.05.034|issn=1532-2777|pmid=23790471}}</ref>
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