Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome |
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Authors: | An Mariman Liesbeth Delesie Els Tobback Ignace Hanoulle Erica Sermijn Peter Vermeir Dirk Pevernagie Dirk Vogelaers |
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Institution: | 1. Department of General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, University Hospital Ghent, Belgium;2. Center for Neurophysiologic Monitoring, University Hospital Ghent, Belgium;3. Sleep Medicine Center, Kempenhaeghe Foundation, Heeze, The Netherlands;4. Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Ghent, Belgium |
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Abstract: | ObjectiveTo assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).MethodsPatients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography + multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.ResultsOut of 377 patients referred, 279 (74.0%) were included in the study 84.9% female; mean age 38.8 years (SD 10.3)].A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease.In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.ConclusionsA multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care. |
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Keywords: | AASM American Academy of Sleep Medicine AHI apnea-hypopnea index BMI body mass index CDC Centers for Disease Control and Prevention CFS chronic fatigue syndrome DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders 4th edition &mdash text revision ICSD-2 International Classification of Sleep Disorders 2nd edition MSLT multiple sleep latency test MUS medically unexplained symptoms OSA obstructive sleep apnea PLMD periodic limb movement disorder PLM periodic limb movements PSG polysomnography REM rapid eye movements UCF unexplained chronic fatigue SD standard deviation |
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