Current Projects: Chronic Fatigue Syndrome

chronic fatigue syndrome

Chronic fatigue syndrome (CFS), a common disorder afflicting 900,000 people in the USA, is characterized by unremitting fatigue with significant functional impairment. Symptoms are not improved by bed rest and may be worsened by abruptly increasing physical or mental exertion. Yet, little progress has been made towards enhancing efficacy of clinical interventions for CFS. More information about Chronic Fatigue Syndrome can be found at The CFIDS Association of America.

The absence of conventional diagnostic abnormalities requires that a diagnosis be derived solely based from the presence of unremitting fatigue accompanied by at least four of eight case-defining symptoms:

  1. post-exertion malaise lasting > 24 hours,
  2. unrefreshing sleep, 
  3. impaired short-term memory or concentration,
  4. muscle pain, 
  5. joint pain without swelling or redness, 
  6. headaches of a new type or severity, 
  7. tender lymph nodes in the neck or armpit, 
  8. recurring sore throat.

One over-arching question that we seek to answer is how comorbid conditions such as an undiagnosed/untreated sleep disorder, or latent process evoking enhanced levels of pro-inflammatory cytokines, impact the severity of CFS symptoms as well as outcomes to conventional treatments

Our ongoing lines of scientific inquiry explore the following:

  • Which molecular and biochemical pathways contribute to the symptom of “fatigue” and do they differ from those responsible for the symptom of “sleepiness.”
  • Do disorders characterized by unremitting fatigue and reduced cognitive performance, such as Chronic Fatigue Syndrome, reflect a neuroinflammatory process?
  • Does fatigue severity correspond with electroencephalographic indices of brain activity?
  • How best can we quantitatively and reproducibly differentiate fatigue from sleepiness?
  • When designing and assessing interventions to alleviate fatigue, should sleep promoting interventions be employed simultaneously?

Our program of research has explored the role of disordered sleep as a mechanism contributing to symptom severity. We have also assessed the relationship between symptoms of CFS with autonomic dysfunction and reduced cortical alpha EEG activity. Our current endeavors focus upon mechanisms contributing to the expression of systemic inflammation that exist within a unique subset of CFS patients.

Relevant CFS Publications

  • Decker M.J. Assessing fatigue in Multiple Sclerosis: Shedding light on the elephant in the dark. Invited commentary on Braley and Chervin. SLEEP 2010;33:1005-1006.
  • Decker M.J., Eyal S., Fuxman Y., Shinar X., Cahan C, Reeves WC, Baharav A,Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome. Sleep & Breathing, DOI 10.1007/s11325-009-0305-z, 2009
  • Decker. M.J, Tabassum H., Linn, J.M,., Reeves, WC. Electroencephalographic correlates of chronic fatigue syndrome. Behavior and Brain Function, 5:43, 2009
  • Majer M., Jones J.F., Unger E.R., Youngblood L. S, Decker M.J., Gurbaxani B., Heim C., Reeves W.R., Perception versus polysomnographic assessment of sleep in CFS and non-fatigued controls: results from a population-based study. BMC Neurol. 2007 Dec 5;7(1):40
  • Boneva R.S., Decker M.J., Maloney E.M., Linn J.M., Jones J.F., Helgasson,H., Heim C., Rye D.B., Reeves W.C. Higher Heart rate and reduced heart rate variability persist during sleep in Chronic Fatigue Syndrome in a Population-based Study. Auton Neurosci. 2007 Basic and Clinical 137: 94–101
  • Reeves W.C, Heim C., Maloney E, Youngblood L.S., Unger E.R., Decker M.J., Jones J.F., Rye D.B., Sleep Characteristics of Persons with CFS and Non-Fatigued Controls: Results from a Population-Based Study. BMC Neurology 2006, 6:41
  • Papp K.K., Erokwu B., Decker M.J., Strohl K.P. Medical student competence in eliciting a history for “chronic fatigue.” Sleep and Breathing 5:3;123-129, 2001.

Current Projects


Michael Decker, PhD, RN, RRT, Diplomate
American Board of Sleep Medicine
Associate Professor
School of Nursing