Kujawski, Sławomir, Słomko, Joanna, Newton, Julia L et al. · International journal of environmental research and public health · 2021 · DOI
This study looked at how different ME/CFS symptoms appear together in patients. Researchers examined 110 Polish patients and used a network analysis method to see which symptoms tend to occur at the same time and which ones are most closely connected. They found that post-exertional malaise (feeling worse after activity), sleep problems, and memory/concentration difficulties were the most common symptoms, and that certain symptoms were strongly linked to each other.
Understanding how ME/CFS symptoms cluster and influence each other helps clinicians recognize distinct symptom patterns and may guide personalized treatment approaches. This research supports the view that ME/CFS comprises interconnected physiological systems rather than isolated symptoms, potentially informing future diagnostic and therapeutic strategies.
This study cannot establish cause-and-effect relationships between symptoms—network connections show correlation only. It cannot determine whether symptom co-occurrence reflects shared biological mechanisms or separate pathological processes. The findings are limited to a Polish population and may not fully generalize to ME/CFS patients in other geographic or genetic populations.
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
Kujawski, Sławomir, Słomko, Joanna, Newton, Julia L, Eaton-Fitch, Natalie, Staines, Donald R, Marshall-Gradisnik, Sonya, et al. (2021). Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome.. International journal of environmental research and public health. https://doi.org/10.3390/ijerph182010736
BibTeX
@article{mecfsatlas-kujawski-2021-network-analysis,
author = {Kujawski, Sławomir and Słomko, Joanna and Newton, Julia L and Eaton-Fitch, Natalie and Staines, Donald R and Marshall-Gradisnik, Sonya and Zalewski, Paweł},
title = {Network Analysis of Symptoms Co-Occurrence in Chronic Fatigue Syndrome.},
journal = {International journal of environmental research and public health},
year = {2021},
doi = {10.3390/ijerph182010736},
note = {PubMed: 34682478},
url = {https://www.mecfsatlas.com/evidence/kujawski-2021-network-analysis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/kujawski-2021-network-analysis
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