Assessment of Autonomic Dysfunction with the COMPASS-31 Test and Its Relationship with Disease Activity, Cardiovascular Risk, Anxiety, and Depression in Patients with Sjögren’s Syndrome

BACKGROUND/AIMS Primary Sjögren's syndrome (pSS) is a chronic, auto-immune, multisystemic inflammatory disease and this chronic inflammation may cause risk factors for autonomic dysfunction (AD) and/or cardiovascular risk. This study aimed to determine the frequency of AD in pSS patients using Composite Autonomic Symptom Score-31 (COMPASS-31) and also the relationship between disease activity and cardiovascular risks and AD, as well as to compare the symptoms of AD with healthy study participants.MATERIALS AND METHODS This was a cross-sectional study. The research cohort was comprised of 42 patients diagnosed with pSS and 42 healthy controls. AD was evaluated with the COMPASS-31 questionnaire. Cardiovascular risk was assessed with the 10-year Framingham Risk Score (FRS) algorithm. Body mass index, dyslipidemia, and metabolic syndrome (MetS) were recorded. In the pSS group, disease activity was evaluated with European League against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) and European League against Rheumatism Sjögren's Syndrome Patient Reported Index (ESSPRI). Additionally, the Numerical Rating Scale and Hospital Anxiety and Depression Scale (HADS) were recorded.RESULTS Patients with pSS had a significantly higher mean total COMPASS-31 score than the controls (58.5 vs. 50.0; p=0.040). In sub-domain analysis, pSS patients exhibited significantly higher mean scores in the pupillomotor domain than controls (13.5 vs. 9.0; p=0.002). MetS (10 vs. 2; p=0.023), the mean 10-year FRS (6.0 vs. 2.0; p=0.012), HADS depression score (9.5 vs. 5.0; p=0.001) and HADS anxiety score were higher in those patients with pSS (11.3 vs. 6.7; p<0.001). COMPASS-31 was not correlated with ESSDAI or ESSPRI (p=0.128, p=0.0.66 respectively). The FRS and HADS depression score were evaluated as being effective on the COMPASS-31 score (p=0.535, p=0.465 respectively).CONCLUSION An increased prevalence of AD, cardiovascular risk, MetS, depression, and anxiety levels in patients with pSS was found in this study. The total COMPASS score did not correlate with disease activity. The COMPASS-31 questionnaire showed a relationship between cardiovascular risk and HAD depression symptom levels.