Rosen, S D, King, J C, Wilkinson, J B et al. · Journal of the Royal Society of Medicine · 1990 · DOI
This 1990 study examined whether chronic fatigue syndrome (CFS) might actually be caused by a breathing pattern problem called chronic hyperventilation. The researchers found that 93 out of 100 patients diagnosed with CFS showed signs of this breathing issue instead. They suggest doctors should check patients for hyperventilation problems before diagnosing them with ME or CFS.
This study raises important questions about diagnostic accuracy in ME/CFS by proposing that some patients labeled with CFS may actually have a treatable breathing disorder. If valid, this could redirect some patients to more effective, conventional treatments. However, its conclusions have been substantially challenged by subsequent ME/CFS research and are not widely accepted in current clinical practice.
This study does not prove that CFS and ME are synonymous with hyperventilation syndrome, nor that hyperventilation is the primary cause of most ME/CFS cases. The study's cross-sectional design cannot establish causation. Furthermore, subsequent research and clinical experience have not supported the authors' conclusion that hyperventilation accounts for the majority of ME/CFS presentations, and many ME/CFS patients do not have respiratory abnormalities.
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
Rosen, S D, King, J C, Wilkinson, J B, & Nixon, P G (1990). Is chronic fatigue syndrome synonymous with effort syndrome?. Journal of the Royal Society of Medicine. https://doi.org/10.1177/014107689008301204
BibTeX
@article{mecfsatlas-rosen-1990-chronic-fatigue,
author = {Rosen, S D and King, J C and Wilkinson, J B and Nixon, P G},
title = {Is chronic fatigue syndrome synonymous with effort syndrome?},
journal = {Journal of the Royal Society of Medicine},
year = {1990},
doi = {10.1177/014107689008301204},
note = {PubMed: 2125315},
url = {https://www.mecfsatlas.com/evidence/rosen-1990-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/rosen-1990-chronic-fatigue
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