Frequency Of Postural Orthostatic Tachycardia Syndrome In Young Adults With Chronic Fatigue

https://doi.org/10.5281/zenodo.17920972

Abstract

Background: Chronic fatigue is a frequent presenting complaint in young adults and is often multifactorial. Postural orthostatic tachycardia syndrome (POTS) is an important but under-recognized cause of orthostatic intolerance and fatigue. Local data on the frequency of POTS among young adults with chronic fatigue are limited.

Methodology: This cross-sectional study was conducted at the Punjab Institute of Cardiology, Lahore, from July 10, 2024 to January 10, 2025. A total of 190 consecutive adults aged 20–40 years presenting with chronic fatigue and fulfilling predefined inclusion and exclusion criteria were enrolled. Demographic and clinical data, including age, sex, body mass index (BMI), smoking status, diabetes mellitus, hypertension, and symptom duration, were recorded. All participants underwent tilt table testing, and POTS was diagnosed based on a ≥30 beats/min increase in heart rate or a heart rate ≥120 beats/min within 10 minutes of tilting, in the absence of significant orthostatic hypotension. Continuous variables were summarized as mean ± standard deviation (SD), and categorical variables as frequency and percentage N(%). Associations between POTS and clinical variables were assessed using the chi-square test, with p ≤ 0.05 considered statistically significant.

Results: Among 190 participants, 68(35.8%) were male and 122(64.2%) were female, with a mean age of 32.32 ± 6.16 years. The mean BMI was 25.45 ± 2.16 kg/m²; obesity was present in 32(16.8%) patients. Diabetes mellitus was documented in 30(15.8%), hypertension in 54(28.4%), and current smoking in 33(17.4%) participants. The mean duration of illness was 19.23 ± 11.27 months, and 113(59.5%) had symptoms for >1 year. POTS was diagnosed in 71/190 patients, yielding a frequency of 37.4%. POTS was more frequent in females than males (54/122 [44.2%] vs 17/68 [25.0%]; p = 0.008) and in patients aged ≤30 years compared with >30 years (47/76 [61.8%] vs 24/114 [21.1%]; p = 0.001). Diabetes mellitus was strongly associated with POTS (24/30 [80.0%] vs 47/160 [29.3%] in non-diabetics; p = 0.001). In contrast, POTS was less common among hypertensive patients (6/54 [11.1%]) than among those without hypertension (65/136 [47.7%]; p = 0.002). Obesity and symptom duration showed no statistically significant association with POTS (p = 0.235 and p = 0.543, respectively).

Conclusion: In this single-centre cohort of young adults with chronic fatigue, more than one-third had concomitant POTS on tilt table testing. POTS was particularly frequent among females, younger patients, and those with diabetes, while it was less common in individuals with hypertension. Clinicians evaluating young adults with chronic fatigue should maintain a high index of suspicion for POTS, especially in these higher-risk subgroups, to enable timely diagnosis and appropriate management.