Use of a thermal comfort wearable improves temperature intolerance in patients with postural tachycardia syndrome

Temperature intolerance is a common and often debilitating symptom of postural tachycardia syndrome (POTS), however treatment options are limited. In this open-label pilot study, we examined the use of a novel wearable thermal watch (Embr Wave2™) on thermoregulatory and other autonomic symptoms in POTS. Participants with POTS and temperature intolerance were recruited from the Stanford autonomic disorders clinic. All patients completed an online battery of autonomic and sleep questionnaires including the composite autonomic symptom score-31 (COMPASS-31), the Delphi interoceptive scale, the temperature disturbance index scale (TDIS), and a 10-minute active stand testing at baseline and after 4 weeks of wearable use. Twenty-two POTS participants with severe temperature intolerance were included in the final analysis. At baseline, 55% noted a moderate to severe impact of temperature intolerance on quality of life (QoL). After 4 weeks of wearable use, sustained reductions were seen across multiple TDIS domains, including work, leisure activities, and enjoyment of life (p ≤0.05). No significant changes were seen in COMPASS-31 scores (53.98 [43.36-56.62] vs. 53.04 [44.66-60.30], p = 0.34) or orthostatic tachycardia on stand testing (31.5 [24.8-45.5] bpm vs.31.0 [21.0-40.5] bpm, p = 0.56). Temperature intolerance is common and directly correlated with QoL in patients with POTS. Use of a non-invasive thermal wearable led to improvement in temperature related QoL measures, however global autonomic symptom scores and orthostatic tachycardia remained unchanged. This study highlights the need for other treatment studies with more specific patient reported outcomes measures in POTS patients with temperature intolerance.