Clinical characteristics and healthcare utilization of orthostatic dysregulation in Japan: a nationwide descriptive study

BACKGROUND: Orthostatic dysregulation (OD) is a physical disorder characterized by circulatory disturbances due to autonomic nervous system imbalance that predominantly affects children. In Japan, OD is common and closely associated with school non-attendance, and its clinical management has developed from a psychosomatic perspective. However, large-scale data on real-world clinical practices are lacking. This study uses nationwide data to describe the comorbidities, prescribed medications, and medical practices for OD. METHODS: This descriptive study utilized the Medical Information Analysis databank, a nationwide administrative database operated by the National Hospital Organization in Japan. We identified 7,213 patients aged 6 to 18 years who were first diagnosed with OD between 2016 and 2023. Descriptive statistics were used to analyze patient demographics, comorbidities, prescribed medications, and medical practices. Subgroup analyses stratified by prescription patterns were conducted. RESULTS: The median age at diagnosis was 13 years, and 55.6% of the patients were female. The most common comorbidity category was mental health/behavioral disorders (23.6%). The most prevalent specific conditions were sleep disorders (10.2%), school non-attendance (9.3%), and autism spectrum disorder/attention-deficit hyperactivity (7.1%). Pharmacotherapy was provided to 44.0% of the patients, with a mean of 1.3 medications per patient. Midodrine was the most prescribed medication (78.3%), followed by amezinium metilsulfate (6.7%), and propranolol (2.8%). Sleep medications were prescribed to 9.4% of treated patients. The most frequent medical practices were blood tests (48.6%), diagnostic imaging (35.9%), and electrocardiograms (24.2%). The subgroup prescribed sleep medications had a higher prevalence of neurodevelopmental disorders, school non-attendance, and depression. CONCLUSIONS: This first nationwide descriptive study of OD in Japan provides real-world evidence on clinical characteristics and healthcare utilization. Heterogeneous comorbidity profiles and prescription patterns reveal the clinical diversity of the patient population. Our findings highlight the need for tailored therapeutic strategies to support more effective care.