Cotler, Joseph, Katz, Ben Z, Reurts-Post, Corine et al. · Fatigue : biomedicine, health & behavior · 2020 · DOI
This study looked at whether faster breathing rates could be a sign of post-exertional malaise (PEM)—the worsening of symptoms that many ME/CFS patients experience after activity. Researchers measured breathing rates in 216 ME/CFS patients over two days and compared them to information about PEM and other symptoms. They found that patients with more severe PEM tended to have faster resting breathing rates, while depression, anxiety, and activity level did not explain the faster breathing.
This research provides potential evidence for an objective, measurable sign of PEM—a hallmark symptom of ME/CFS that is difficult to quantify objectively in clinical settings. If respiratory rate proves reliable as a biomarker for PEM, it could help clinicians better diagnose ME/CFS and monitor disease severity, while also validating the physiological basis of PEM rather than attributing it to psychological factors.
This study does not prove that rapid breathing *causes* PEM or prove a direct causal relationship between the two. The cross-sectional design means it captures associations at one point in time and cannot determine whether rapid breathing is a consequence of PEM, a cause of it, or both. Additionally, because psychology/somatic symptoms were not predictive in this particular model, it does not rule out psychological contributions to respiratory symptoms in other contexts.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Cotler, Joseph, Katz, Ben Z, Reurts-Post, Corine, Vermeulen, Ruud, & Jason, Leonard A (2020). A hierarchical logistic regression predicting rapid respiratory rates from post-exertional malaise.. Fatigue : biomedicine, health & behavior. https://doi.org/10.1080/21641846.2020.1845287
BibTeX
@article{mecfsatlas-cotler-2020-hierarchical-logistic,
author = {Cotler, Joseph and Katz, Ben Z and Reurts-Post, Corine and Vermeulen, Ruud and Jason, Leonard A},
title = {A hierarchical logistic regression predicting rapid respiratory rates from post-exertional malaise.},
journal = {Fatigue : biomedicine, health & behavior},
year = {2020},
doi = {10.1080/21641846.2020.1845287},
note = {PubMed: 36313239},
url = {https://www.mecfsatlas.com/evidence/cotler-2020-hierarchical-logistic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/cotler-2020-hierarchical-logistic
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