Prevalence of joint hypermobility, postural orthostatic tachycardia syndrome (POTS), and orthostatic hypotension in school-children

Children with joint hypermobility, postural orthostatic tachycardia syndrome, and orthostatic hypotension report autonomic symptoms such as dizziness, nausea, headaches, and palpitations. It is unclear if there is a pathophysiological link between connective tissue disorders and autonomic symptoms. There is no published data on the prevalence of disorder at the community level. Primary objective: To assess the prevalence of joint hypermobility, orthostatic hypotension, and postural orthostatic tachycardia syndrome in children. Secondary objective: To determine the relationship between joint hypermobility, orthostatic hypotension, and postural orthostatic tachycardia syndrome. Patients and Method: Participants aged 10 to 18 years were selected from public schools in three Colombian cities. The surveys included historical questions on the incidence of dizziness, nausea, headache, tremor, blurred vision, vertigo, anxiety, near syncope and syncope, sweating, palpitations triggered by standing in the two months prior to the investigation. Each of these signs and symptoms was also assessed during the recumbency (10 minutes) and standing (2, 5 and 10 minutes) phases of the investigation. HR and BP measurements were obtained at the same intervals. Joint mobility was measured with a mechanical goniometer and assessed with the Beighton score. Results: Prevalence of joint hyperlaxity: 87 of 306 (28.4%). Prevalence of orthostatic hypotension: 5 of 306 (1.6%). Prevalence of postural orthostatic tachycardia syndrome: 6 of 306 (2.0%). Of 87 children with joint hyperlaxity, only 1 child had joint hyperlaxity at the same time as postural hypotension (1.2%) (p = 0.6735), and 1 child had joint hyperlaxity and postural orthostatic tachycardia syndrome simultaneously (1.2%) (p = 0.5188). Conclusion: Children with joint hyperlaxity did not have a higher prevalence of postural orthostatic tachycardia syndrome and orthostatic hypotension. It seems unlikely that connective tissue disorders are responsible for most cases of postural orthostatic tachycardia syndrome and orthostatic hypotension in the community. Of note, the pathophysiology of postural orthostatic tachycardia syndrome and orthostatic hypotension requires further investigation.