Ying-Chih, Cheng, Yu-Chen, Huang, Wei-Lieh, Huang · Neuroscience and biobehavioral reviews · 2020 · DOI
This large review combined results from 85 studies comparing heart rhythm patterns between people with conditions like fibromyalgia and ME/CFS (functional somatic syndromes) and healthy people. Researchers found that patients with these conditions have lower heart rate variability—meaning their heart's rhythm is less flexible and adaptive—which suggests their nervous system may not be responding normally to stress and daily activities.
This meta-analysis provides robust evidence that ME/CFS and related conditions involve measurable objective changes in autonomic nervous system function, supporting the biological basis of these diseases rather than a purely psychological etiology. Understanding HRV abnormalities may help explain symptoms like exercise intolerance, orthostatic problems, and post-exertional malaise in ME/CFS patients.
This study does not establish whether HRV abnormalities cause the symptoms of ME/CFS or are a consequence of the disease—only that they are associated. The review cannot determine whether HRV patterns could serve as diagnostic biomarkers or predict patient outcomes. It also does not explain the mechanisms underlying these autonomic changes or identify optimal interventions.
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
Ying-Chih, Cheng, Yu-Chen, Huang, & Wei-Lieh, Huang (2020). Heart rate variability in patients with somatic symptom disorders and functional somatic syndromes: A systematic review and meta-analysis.. Neuroscience and biobehavioral reviews. https://doi.org/10.1016/j.neubiorev.2020.02.007
BibTeX
@article{mecfsatlas-ying-chih-2020-heart-rate,
author = {Ying-Chih, Cheng and Yu-Chen, Huang and Wei-Lieh, Huang},
title = {Heart rate variability in patients with somatic symptom disorders and functional somatic syndromes: A systematic review and meta-analysis.},
journal = {Neuroscience and biobehavioral reviews},
year = {2020},
doi = {10.1016/j.neubiorev.2020.02.007},
note = {PubMed: 32068033},
url = {https://www.mecfsatlas.com/evidence/ying-chih-2020-heart-rate},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/ying-chih-2020-heart-rate
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