自主神经症状问卷经常用于评估自主神经障碍。尚不清楚从自主问卷中获得的主观自主神经障碍是否与通过定量自主神经测试测得的客观自主神经障碍相关。我们研究的目的是确定自主神经失调的主观和客观指标之间的相关性。这是2017年至2023年在布莱根妇女和福克纳医院自主实验室进行的一项回顾性横断面研究,评估完成自主测试的患者。分析包括经过验证的自主神经问卷[自主神经症状调查(SAS),综合自主神经症状评分31(指南针-31)]和标准化自主神经测试(Valsalva机动,深呼吸,sudomotor,和倾斜测试)。自主神经测试结果通过心血管反射的定量分级进行分级,sudomotor测试和皮肤活检(QASAT),和综合自主严重程度评分(CASS)。自主测试,QASAT,CASS,在2627例患者中获得SAS,和指南针-31在564名患者中。主观工具之间的相关性很强(SAS与指南针-31,r=0.74,p<0.001)和客观仪器之间(QASAT与CASS,r=0.81,p<0.001)。SAS和QASAT之间以及Compass-31和CASS之间没有相关性。选定诊断的主观和客观工具之间仍然没有相关性(COVID-19急性后遗症,n=61;体位性心动过速综合征,211;周围自主神经病变,463;肌痛性脑脊髓炎/慢性疲劳综合征,95;预加载失败,120;治疗后莱姆病综合征,163;超机动Ehlers-Danlos综合征,213;神经源性直立性低血压,86;II型糖尿病,71,肥大细胞活化综合征,172;遗传性α型胰蛋白酶血症,45).主观和客观工具之间缺乏相关性突出了常用问卷的局限性,一些患者高估了真实的自主神经缺陷,而一些患者低估了真实的自主神经缺陷。独立于诊断的主客观不匹配进一步表明对可靠筛查调查的需求未得到满足。高估症状负担的患者可能代表具有特质自主神经样症状的人群,这需要进一步研究。此时,不建议使用自主问卷代替自主测试.
Autonomic symptom questionnaires are frequently used to assess dysautonomia. It is unknown whether subjective dysautonomia obtained from autonomic questionnaires correlates with objective dysautonomia measured by quantitative autonomic testing. The objective of our study was to determine correlations between subjective and objective measures of dysautonomia. This was a retrospective cross-sectional study conducted at Brigham and Women\'s Faulkner Hospital Autonomic Laboratory between 2017 and 2023 evaluating the patients who completed autonomic testing. Analyses included validated autonomic questionnaires [Survey of Autonomic Symptoms (SAS), Composite Autonomic Symptom Score 31 (Compass-31)] and standardized autonomic tests (Valsalva maneuver, deep breathing, sudomotor, and tilt test). The autonomic testing results were graded by a Quantitative scale for grading of cardiovascular reflexes, sudomotor tests and skin biopsies (QASAT), and Composite Autonomic Severity Score (CASS). Autonomic testing, QASAT, CASS, and SAS were obtained in 2627 patients, and Compass-31 in 564 patients. The correlation was strong between subjective instruments (SAS vs. Compass-31, r = 0.74, p < 0.001) and between objective instruments (QASAT vs. CASS, r = 0.81, p < 0.001). There were no correlations between SAS and QASAT nor between Compass-31 and CASS. There continued to be no correlations between subjective and objective instruments for selected diagnoses (post-acute sequelae of COVID-19, n = 61; postural tachycardia syndrome, 211; peripheral autonomic neuropathy, 463; myalgic encephalomyelitis/chronic fatigue syndrome, 95; preload failure, 120; post-treatment Lyme disease syndrome, 163; hypermobile Ehlers-Danlos syndrome, 213; neurogenic orthostatic hypotension, 86; diabetes type II, 71, mast cell activation syndrome, 172; hereditary alpha tryptasemia, 45). The lack of correlation between subjective and objective instruments highlights the limitations of the commonly used questionnaires with some patients overestimating and some underestimating true autonomic deficit. The diagnosis-independent subjective-objective mismatch further signifies the unmet need for reliable screening surveys. Patients who overestimate the symptom burden may represent a population with idiosyncratic autonomic-like symptomatology, which needs further study. At this time, the use of autonomic questionnaires as a replacement of autonomic testing cannot be recommended.