TVNS & Diaphragmatic Breathing in POTS

Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system characterised primarily by an increase in heart rate when standing up. It is estimated that the condition affects 0.2 to 1 percent of the population, with women being about five times more likely to develop it than men. Symptoms typically include a rapid heartbeat, dizziness, chronic fatigue, difficulty concentrating, and reduced physical capacity. These symptoms substantially impair patients` quality of life, and current treatment options are often inadequate. Since the beginning of the COVD-19 pandemic, the number of diagnosed POTS cases has continued to rise, further highlighting the urgency for new therapeutic approaches. This research project, conducted at the Medical University of Vienna, aims to investigate a non- pharmacological treatment strategy combining two promising methods: transcutaneous auricular vagus nerve stimulation (TVNS) and diaphragmatic breathing. TVNS uses a small device that sends electrical impulses to a specific area of the ear. These impulses activate the vagus nerve, which plays a central role in regulating the autonomic nervous system the system responsible for controlling unconscious bodily functions such as heart rate, blood pressure and inflammatory processes. Studies suggest that TVNS could be an effective treatment for autonomic disorders such as POTS. Diaphragmatic breathing is a technique involving slow, deep breathing that specifically activates the diaphragm, the primary breathing muscle. This technique promotes relaxation and can positively influence the activity of the autonomic nervous system. Previous studies have shown that diaphragmatic breathing reduces stress, lowers heart rate and improves overall well-being. In this study, three groups will be compared. The first group will receive a combination of TVNS and diaphragmatic breathing. The second group will receive TVNS only, without breathing exercises. The third group will receive a placebo TVNS (a sham treatment without therapeutic effect that is outwardly indistinguishable from the real treatment) combined with diaphragmatic breathing. The intervention will be performed daily for twelve weeks, with each session lasting 3045 minutes. Before and after the treatment period, the heart rate, blood pressure and specific blood values (indicating inflammation in the body) of the participants will be measured and compared, as will their sleep quality and overall quality of life. The project aims to determine whether the combination therapy offers greater benefits than each method individually. If successful, this could lead to a safe and practical supplementary treatment for people with POTS, with the goal of alleviating their symptoms and improving their quality of life in the long term.