Naschitz, Jochanan E, Yeshurun, Daniel, Rosner, Itzhak · Medical hypotheses · 2004 · DOI
This study looked at whether people with ME/CFS have problems with their autonomic nervous system—the part that automatically controls heart rate and blood pressure. Researchers found a distinctive pattern of dysautonomia (autonomic dysfunction) in ME/CFS patients that differs from other conditions, and they developed two scoring systems to help identify it. A small pilot study suggested that treating this dysautonomia with a medication called midodrine improved both the autonomic problems and fatigue symptoms.
This research is important because it proposes objective biomarkers (HIS and FRAS scores) that could help diagnose ME/CFS, moving beyond purely subjective clinical criteria. If dysautonomia is indeed central to ME/CFS pathophysiology, it suggests autonomic-targeted treatments like midodrine could offer therapeutic benefits for many patients.
This study does not prove that dysautonomia causes ME/CFS or that treating dysautonomia will cure the illness in all patients. The pilot midodrine data are preliminary and do not establish efficacy across the broader ME/CFS population. Findings are correlational and mechanistic—they suggest a relationship but do not rule out dysautonomia being a consequence rather than a primary cause of ME/CFS.
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
Naschitz, Jochanan E, Yeshurun, Daniel, & Rosner, Itzhak (2004). Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications.. Medical hypotheses. https://doi.org/10.1016/S0306-9877(03)00331-1
BibTeX
@article{mecfsatlas-naschitz-2004-dysautonomia-chronic,
author = {Naschitz, Jochanan E and Yeshurun, Daniel and Rosner, Itzhak},
title = {Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications.},
journal = {Medical hypotheses},
year = {2004},
doi = {10.1016/S0306-9877(03)00331-1},
note = {PubMed: 14962627},
url = {https://www.mecfsatlas.com/evidence/naschitz-2004-dysautonomia-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/naschitz-2004-dysautonomia-chronic
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