Health-related quality of life and suicide risk in postural tachycardia syndrome



Postural tachycardia syndrome (POTS) is a disorder featured by orthostatic intolerance. The purpose of this study was to investigate the severity of quality of life issues in POTS patients.


Online surveys for health related quality of life, sleep quality, fatigue, pain, and suicidal ideation were completed by 624 POTS patients and 139 controls.


People with POTS have significantly more days of poor physical health (p < 0.001), fewer days with good energy (p < 0.001), and significantly more days with activity limitations (p < 0.001) than controls. Pain severity was significantly higher for those with POTS (p < 0.001) while feelings of control over life was lower than controls (p < 0.001). Sleep quality and daytime fatigue were also significantly worse for those with POTS than controls (p < 0.001). Finally, those with POTS have a significantly higher risk of suicide compared with controls (p < 0.001).


The myriad of symptoms from which many POTS patients suffer is associated with a decreased quality of life. Nearly half of our sample with POTS was at high risk for suicide. More work needs to be done to determine the underlying issues surrounding suicide in POTS so that an appropriate treatment regimen can be developed.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Thieben MJ, Sandroni P, Sletten DM et al (2007) Postural orthostatic tachycardia syndrome: the Mayo Clinic experience. Mayo Clin Proc 82(3):308–313

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Benarroch EE (2012) Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 87(12):1214–1225

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Ojha A, Chelimsky TC, Chelimsky G (2011) Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr 158:119–122

    Article  Google Scholar 

  4. 4.

    Bagai K, Wakwe CI, Malow B et al (2013) Estimation of sleep disturbances using wrist actigraphy in patients with postural tachycardia syndrome. Auton Neurosci Basic Clin 177:260–265

    Article  Google Scholar 

  5. 5.

    Rowe PC, Barron DF, Calkins H, Maumenee IH, Tong PY, Geraghty MT (1999) Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers–Danlos syndrome. J Pediatr 135(4):494–499

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Deb A, Morgenshtern K, Culbertson CJ, Wang LB, Hohler–DePold A (2015) A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome. Baylor Univ Med Cent Proc 28(2):157–159

    Google Scholar 

  7. 7.

    Freitas J, Azevedo E, Santos R, Rocha-Goncalves F (2015) Autonomic activity and biomarker behavior in supine position and after passive postural stress in different orthostatic intolerance syndromes. Portuguese J Cardiol 34(9):543–549

    Article  Google Scholar 

  8. 8.

    Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Haythornthwaite JA, Low PA (2002) Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc 77:531–537

    PubMed  Article  Google Scholar 

  9. 9.

    Conner R, Sheikh M, Grubb B (2012) Postural orthostatic tachycardia syndrome (POTS): evaluation and management. Br J Med Pract 5(4):540

    Google Scholar 

  10. 10.

    Anderson JW, Lambert EA, Sari CI et al (2014) Cognitive function, health-related quality of life, and symptoms of depression and anxiety sensitivity are impaired in patients with the postural orthostatic tachycardia syndrome (POTS). Front Physiol 5:1–9

    CAS  Article  Google Scholar 

  11. 11.

    Bhatia R, Kizibash SJ, Ahrens S et al (2016) Outcomes of adolescent-onset postural orthostatic tachycardia syndrome. J Pediatr 173:149–153

    PubMed  Article  Google Scholar 

  12. 12.

    Benrud-Larson LM, Sandroni P, Haythornthwaite JA, Rummans TA, Low PA (2003) Correlates of functional disability in patients with postural tachycardia syndrome: preliminary cross-sectional findings. Health Psychol 22(6):643–648

    PubMed  Article  Google Scholar 

  13. 13.

    Moon J, Kim DY, Byun JI et al (2016) Orthostatic intolerance symptoms are associated with depression and diminished quality of life in patients with postural tachycardia syndrome. Health Qual Life Outcomes 14(1):144

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Kavi L, Nuttall M, Low DA et al (2016) A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK. Br J Cardiol 23:33

    Google Scholar 

  15. 15.

    Bagai K, Song Y, Ling JF et al (2011) Sleep disturbance and diminished quality of life in postural tachycardia syndrome. J Clin Sleep Med 7(2):204–210

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Center for Disease Control (2000) Measuring healthy days. Atlanta, CDC

    Google Scholar 

  17. 17.

    Kerns RD, Turk DC, Rudy TE (1985) The west haven-yale multidimensional pain inventory (WHYMPI). Pain 23(4):345–356

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Miglis MG, Muppidi S, Feakins C, Fong L, Prieto T, Jaradeh S (2016) Sleep disorders in patients with postural tachycardia syndrome. Clin Auton Res 26(1):67–73

    PubMed  Article  Google Scholar 

  21. 21.

    Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX (2001) The suicidal behaviors questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 8(4):443–454

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Kowal J, Wilson KG, McWilliams LA, Peloquin K, Duong D (2012) Self-perceived burden in chronic pain: relevance, prevalence, and predictors. Pain 153(8):1735–1741

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Kanzler KE, Bryan CJ, McGeary DD, Morrow CE (2012) Suicidal ideation and perceived burdensomeness in patients with chronic pain. Pain Pract 12(8):602–609

    PubMed  Article  Google Scholar 

  24. 24.

    Xu X, Huang H, Sethi S, Zuzuarregui JRP, Weinberg J, Hohler AD (2016) A survey based study on sleep disturbance in postural tachycardia syndrome. J Neurol Sci 365:199–202

    PubMed  Article  Google Scholar 

  25. 25.

    Mallien J, Isenmann S, Mrazek A, Haensch C-A (2014) Sleep disturbances and autonomic dysfunction in patients with postural orthostatic tachycardia syndrome. Front Neurol 5:118–124

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Cauwenbergh D, Nijs J, Kos D, Weijnen L, Struyf F, Meeus M (2014) Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review. Eur J Clin Invest 44(5):516–526

    PubMed  Article  Google Scholar 

  27. 27.

    Hoad A, Spickett G, Elliott J, Newton J (2008) Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. Int J Med 101(12):961–965

    CAS  Google Scholar 

  28. 28.

    Jarjour IT (2013) Postural tachycardia syndrome in children and adolescents. Semin Pediatr Neurol 20(1):18–26

    PubMed  Article  Google Scholar 

  29. 29.

    Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ, Fischer PR (2010) Postural orthostatic tachycardia syndrome: a clinical review. Pediatr Neurol 42(2):77–85

    PubMed  Article  Google Scholar 

  30. 30.

    Khurana RK (2014) Visceral sensitization in postural tachycardia syndrome. Clin Auton Res 24(2):71–76

    PubMed  Article  Google Scholar 

  31. 31.

    Breivik H, Reme SE, Linton SJ (2014) High risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patients. Scand J Pain 5(1):1–3

    Article  Google Scholar 

  32. 32.

    Calata R, Laglaoui Bakhiyi C, Artero S, Ilgen M, Courtet P (2015) The impact of physical pain on suicidal thoughts and behaviors: meta-analyses. J Psychiatr Res 71:16–32

    Article  Google Scholar 

  33. 33.

    Bernert R, Kim JS, Iwata NG, Perlis ML (2015) Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep 17(3):15–24

    Article  Google Scholar 

  34. 34.

    Ribeiro JD, Pease JL, Gutierrez PM et al (2012) Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord 136(3):743–750

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Cathy L. Pederson.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pederson, C.L., Brook, J.B. Health-related quality of life and suicide risk in postural tachycardia syndrome. Clin Auton Res 27, 75–81 (2017).

Download citation


  • Postural tachycardia syndrome (POTS)
  • Quality of life
  • Pain
  • Sleep
  • Suicide