Autonomic Symptoms in Post-Treatment Lyme Disease: Insights From the COMPASS-31 and the 10-Minute Active Stand Test

To determine the prevalence of autonomic symptoms in post-treatment Lyme disease (PTLD) and identify clinical factors that associate with abnormal hemodynamics on the 10-minute active stand test. We administered the Composite Autonomic Symptom Score-31 survey to 37 patients with PTLD and compared them with a cohort of patients with postural orthostatic tachycardia syndrome (POTS) without a known history of Lyme disease. We also report the 10-minute active stand test performed in 210 patients with PTLD recruited from July 1, 2016 through October 31, 2024. Patients with PTLD had higher total Composite Autonomic Symptom Survey 31 scores than healthy controls and reported similar vasomotor, urinary, and pupillomotor symptom burden as patients with POTS. On the 10-minute active stand test, 9 of the 210 (4.29%) patients with PTLD had orthostatic tachycardia. Although the prevalence of orthostatic tachycardia in patients was not significantly different from that of healthy controls, those with orthostatic tachycardia were more likely to be earlier in their disease course and had higher rates of steroid use (=.009) and antibiotic exposure (=.007) after Lyme disease. Autonomic symptoms are common in PTLD. The 10-minute active stand test identified a subgroup of patients with orthostatic tachycardia that associated with distinct clinical features of Lyme disease.