Autonomic Symptoms in Post-Treatment Lyme Disease: Insights From the COMPASS-31 and the 10-Minute Active Stand Test.
Level 4 - case-series / case-control
Cross-sectional observational study comparing symptom surveys and stand test hemodynamics across patient cohorts
PubMed 41427440 · doi:10.1016/j.mayocpiqo.2025.100674
What was done
Researchers evaluated autonomic symptoms and objective hemodynamic responses in patients with post-treatment Lyme disease (PTLD). The Composite Autonomic Symptom Score-31 (COMPASS-31) survey was administered to 37 patients with PTLD and compared with healthy controls and a cohort of patients with postural orthostatic tachycardia syndrome (POTS) without a Lyme history. In addition, 210 patients with PTLD recruited between July 1, 2016, and October 31, 2024, completed a 10-minute active stand test.
What was found
PTLD patients had higher total COMPASS-31 scores than healthy controls, reporting vasomotor, urinary, and pupillomotor symptom burdens similar to patients with POTS (exact scores not reported in the abstract). On active stand testing, 9 of 210 patients with PTLD (4.29%) met criteria for orthostatic tachycardia, a rate not significantly different from healthy controls. Those with orthostatic tachycardia were earlier in their disease course and had higher rates of subsequent steroid use (P = .009) and antibiotic exposure (P = .007).
Why it matters
The study demonstrates a clear divergence between widespread subjective autonomic complaints and relatively rare objective hemodynamic abnormalities in PTLD. Simple active stand testing can distinguish true orthostatic tachycardia from broader post-treatment symptoms.
Limits
The COMPASS-31 cohort was small (n = 37), and only 9 patients exhibited objective orthostatic tachycardia, limiting subgroup power. Sample sizes and exact scores for healthy controls and POTS comparison groups were omitted from the abstract. The cross-sectional design cannot establish whether antibiotic and steroid exposures contributed to orthostatic tachycardia or were markers of greater disease severity.
Cited by
- contradicts Postural orthostatic tachycardia syndrome (POTS) and dysautonomia occur in 40% to 50% of chronic Lyme and tick-borne disease patients.