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Chronic Fatigue Syndrome - Abnormal Biological Rhythms in School Children

Chronic Fatigue Syndrome and Abnormal Biological Rhythms in School Children

Journal: Journal of Chronic Fatigue Syndrome, Vol. 8 (2) 2001, pp. 29-37

Authors: Akemi Tomoda, MD; Takako Jhodoi, MD; Teruhisa Miike, MD

Affiliation: Depart–ment of Child Development, Kumamoto University Schoolof Medicine, Japan.Address correspondence to: Dr. Akemi Tomoda, Department of ChildDevelop–ment, Kumamoto University School of Medicine, 1 - 1 - 1 Honjo,Kumamoto 860-0811, Japan (E-mail:

Chronic fatigue syndrome occurring in previously healthy children and adolescents is one of the most vexing problems encountered by pediatric practitioners. To investigate the biological rhythms in the pediatric patients with CFS, we examined sleep pattern, circadian rhythm of core body temperature (CBT), and plasma cortisol in 41 patients, aged between 10 and 19 years, who did not have any physical or psychiatric disorders, but had non-specific complaints, and were suspected to have a circadian rhythm disturbance. They were diagnosed as having CFS on the basis of published criteria.

Circadian variation of CBT in the CFS patients did not present a clear rhythm, and appearance time of their lowest CBT was significantlyde–layed compared to healthy subjects. Amplitude of circadian CBT changes, fitted to a cosinor curve by the least square method, was significantly smaller in the patients than in healthy subjects. Moreover, circadian rhythm of plasma cortisol in the patients appeared to be quite different, compared to healthy subjects. These findings suggest that their clinical psychosomatic symptoms (e.g., fatigue and sleep disturbance) might be closely related to the desynchronization of their biorhythms, particularly the circadian rhythm of body temperature and cortisol rhythm.

Chronic fatigue syndrome (CFS) is a condition in which a subjectcomplains of persistent fatigue associated with fever, myalgia,pharyn–gitis, headache, adenopathy, gastrointestinal symptoms, and otherneu–rological problems (1-3). Almost all CFS cases have central nervoussystem symptoms, such as moderate or severe depression, memorydisturbance, confusion and poor concentration, according to thediagnostic criteria for CFS (I ,2,4,5). These symptoms in child andadolescent cases significantly interfere with normal school functioning(3-8). We have encountered many such patients usually with associatedindefinite or definite complaints, their major symptoms being generalfatigue, fever, headache (not migraine), and/or sleep disturbance (4,5).In our clin–ical practices, we recognized that the majority of ourpatients have a circadian rhythm disorder even though they usually do notmention or recognize this problem at the first interview. We hypothesized that there could be certain relationships between biological rhythm disorders in these patients and the definite symptoms. This study examined sleep patterns and circadian rhythms of core body temperature (CBT) and of plasma cortisol level in CFS children and adolescents.

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