Postural autonomic profiling in hEDS-POTS with wearable technology

Postural Orthostatic Tachycardia Syndrome (POTS) is a very common form of dysautonomia, characterized by a sustained increase in heart rate of over 30 beats/minute within 10 minutes of rising from a supine to an upright position without a significant decrease in blood pressure. This disruption of the autonomic nervous system (ANS) leads to symptoms such as fainting, dizziness, brain fog, and fatigue. Each patient's POTS symptoms and severity may vary significantly, resulting in difficult and often suboptimal management. This variability in POTS presentation is further complicated by its episodic nature, leading to fluctuation of the day-to-day manifestations of the condition. The variability within and among patients emphasizes the need for personalized diagnostics and treatments that consider the disease heterogeneity. To better understand the individual POTS pathology, metrics such as heart rate variability, sleep times, heart rate, and temperature were collected continuously for 30 days utilizing a Corsano CardioWatch. These wearables were worn by individuals diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS), in whom POTS is highly prevalent. We assumed the exact time of getting out of bed each morning as a routine postural change from supine to standing. The sleep data identified wake up times, and the tri-axial accelerometer data was assessed for 3.5 hours after waking to visually identify the time when each patient rose from the bed. The time found was further validated using activity data that provided step counts and activity type. The sustained heart rate was assessed for ten minutes after arising to quantify and assess the variation in the cardiac autonomic profile each day. Thus far, 2 hEDS-POTS and 2 hEDS-non-POTS (diagnosed) individual’s data have been analyzed and profiled. Interestingly, the two patients with POTS exhibited wide variability of tachycardic heart rate increases of 9.10 to 34.34 bpm and 11.70 to 42.26 bpm, respectively. Furthermore, using our postural change methodology, these two patients met POTS diagnostic criteria on 12.50% and 85.71% of days, respectively. On the contrary, the non-POTS patients exhibited variability of 9.82 to 28.24 bpm and 15.86 to 31.77 bpm with 0% and 6.25% of days meeting POTS criteria, respectively. These initial findings demonstrate there is significant day-to-day variation within each POTS patient, as well as POTS-adjacent activity exhibited in undiagnosed patients with hEDS. This emphasizes the importance of individualized monitoring for personalized treatment strategies and the value of real-world continuous monitoring for diagnosis and treatment in this challenging population. This research was supported by the Ehlers-Danlos Society Research Foundation, and the NIH SPARC Program (OT2 OD028183) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.