title: Cholinergic autonomic dysfunction in veterans with Gulf War illness: confirmation in a population-based sample.
abstract: BACKGROUND
  The authors of prior small studies raised the hypothesis that symptoms in veterans of the 1991 Gulf War, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction, are due to cholinergic autonomic dysfunction.
  
  
  OBJECTIVE
  To perform a confirmatory test of this prestated hypothesis in a larger, representative sample of Gulf War veterans.
  
  
  METHODS
  Nested case-control study.
  
  
  METHODS
  Clinical and Translational Research Center, University of Texas Southwestern Medical Center, Dallas.
  
  
  METHODS
  Representative samples of Gulf War veterans meeting a validated case definition of Gulf War illness with 3 variants (called syndromes 1-3) and a control group, all selected randomly from the US Military Health Survey.
  
  
  METHODS
  Validated domain scales from the Autonomic Symptom Profile questionnaire, the Composite Autonomic Severity Score, and high-frequency heart rate variability from a 24-hour electrocardiogram.
  
  
  RESULTS
  The Autonomic Symptom Profile scales were significantly elevated in all 3 syndrome groups (P< .001), primarily due to elevation of the orthostatic intolerance, secretomotor, upper gastrointestinal dysmotility, sleep dysfunction, urinary, and autonomic diarrhea symptom domains. The Composite Autonomic Severity Score was also higher in the 3 syndrome groups (P= .045), especially in syndrome 2, primarily due to a significant reduction in sudomotor function as measured by the Quantitative Sudomotor Axon Reflex Test, most significantly in the foot; the score was intermediate in the ankle and upper leg and was nonsignificant in the arm, indicating a peripheral nerve length-related deficit. The normal increase in high-frequency heart rate variability at night was absent or blunted in all 3 syndrome groups (P< .001).
  
  
  CONCLUSIONS
  Autonomic symptoms are associated with objective, predominantly cholinergic autonomic deficits in the population of Gulf War veterans.
authors: Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8874, USA. robert.haley@UTSouthwestern.edu
authors: Robert W
authors: RW
authors: Haley
authors: Elizabeth
authors: E
authors: Charuvastra
authors: William E
authors: WE
authors: Shell
authors: David M
authors: DM
authors: Buhner
authors: W Wesley
authors: WW
authors: Marshall
authors: Melanie M
authors: MM
authors: Biggs
authors: Steve C
authors: SC
authors: Hopkins
authors: Gil I
authors: GI
authors: Wolfe
authors: Steven
authors: S
authors: Vernino
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D059329:Cholinergic Neurons / Q000473:pathology; D005260:Female; D047830:Gulf War; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018923:Persian Gulf Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011159:Population Surveillance / Q000379:methods*; D014728:Veterans / Q000523:psychology