Post-Exertional Malaise May Be Related to Central Blood Pressure, Sympathetic Activity and Mental Fatigue in Chronic Fatigue Syndrome Patients

Sławomir Kujawski, Joanna Słomko, Lynette Hodges, Derek F. H. Pheby, Modra Murovska, Julia L. Newton, Paweł Zalewski

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Post-exertional malaise (PEM) is regarded as the hallmark symptom in chronic fatigue syndrome (CFS). The aim of the current study is to explore differences in CFS patients with and without PEM in indicators of aortic stiffness, autonomic nervous system function, and severity of fatigue. One-hundred and one patients met the Fukuda criteria. A Chronic Fatigue Questionnaire (CFQ) and Fatigue Impact Scale (FIS) were used to assess the level of mental and physical fatigue.
Aortic systolic blood pressure (sBPaortic) and the autonomic nervous system were measured with the arteriograph and Task Force Monitor, respectively. Eighty-two patients suffered prolonged PEM according to the Fukuda criteria, while 19 did not. Patients with PEM had higher FIS scores (p = 0.02), lower central systolic blood pressure (p = 0.02) and higher mental fatigue (p = 0.03). For a one-point
increase in the mental fatigue component of the CFQ scale, the risk of PEM increases by 34%. For an sBPaortic increase of 1 mmHg, the risk of PEM decreases by 5%. For a one unit increase in sympathovagal balance, the risk of PEM increases by 330%. Higher mental fatigue and sympathetic activity in rest are related to an increased risk of PEM, while higher central systolic blood pressure is related to a reduced risk of PEM. However, none of the between group differences were significant after FDR correction, and therefore conclusions should be treated with caution and replicated in further studies
Original languageEnglish
Title of host publicationChronic Fatigue Syndrome/Myalgic Encephalomyelitis
Subtitle of host publicationDiagnosis and Treatment
EditorsGiovanni Ricevuti, Lorenzo Lorusso
Place of PublicationBasel
PublisherMDPI Multidisciplinary Digital Publishing Institute
ISBN (Electronic)978-3-0365-5970-4
ISBN (Print)978-3-0365-5969-8
Publication statusPublished - Jan 2023


  • PEM
  • myalgic encephalomyelitis
  • brain fog
  • vascular stiffness

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 3.2. Articles or chapters in other proceedings other than those included in 3.1., with an ISBN or ISSN code


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