Dysautonomia - the key to understanding chronic fatigue

Professor Manoj Sivan, University of Leeds

Dysautonomia, or autonomic dysfunction, is a well-recognised phenomenon frequently observed in conditions associated with chronic fatigue—particularly in neurological disorders and long-term post-infectious syndromes such as Long COVID, ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), and Fibromyalgia. A defining feature of these conditions is post-exertional malaise, a key symptom of dysautonomia. This dysfunction plays a central role in both the development and persistence of symptoms in these long-term conditions.

Despite robust documentation in the scientific literature, significant stigma and scepticism still surround these syndromes.

In this interactive talk, we will explore diagnostic approaches for dysautonomia, including the NASA Lean Test, drawing on insights from our clinical experience and findings from the NIHR LOCOMOTION study. We will examine the adapted Autonomic Profile (aAP)—a home-based test co-developed with the UCL Autonomic Unit. We will also discuss the role of heart rate variability (HRV) as an indirect marker of autonomic dysfunction, with particular reference to the HEARTLOC study, which investigates HRV biofeedback using diaphragmatic breathing interventions.

Additionally, we will discuss medical and rehabilitation strategies for managing dysautonomia in the context of chronic fatigue and post-exertional malaise.

The goal of this session is to increase awareness of dysautonomia and advocate for compassionate, evidence-based care for those affected.

Bio contd. in ‘more info’ tab.