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Ratia N, Palu E, Lantto H, Ylikallio E, Luukkonen R, Suomalainen A, Auranen M, Piirilä P. Lowered oxidative capacity in spinal muscular atrophy, Jokela type; comparison with mitochondrial muscle disease. Front Neurol 2023; 14:1277944. [PMID: 38020590 PMCID: PMC10663357 DOI: 10.3389/fneur.2023.1277944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Spinal muscular atrophy, Jokela type (SMAJ) is a rare autosomal dominantly hereditary form of spinal muscular atrophy caused by a point mutation c.197G>T in CHCHD10. CHCHD10 is known to be involved in the regulation of mitochondrial function even though patients with SMAJ do not present with multiorgan symptoms of mitochondrial disease. We aimed to characterize the cardiopulmonary oxidative capacity of subjects with SMAJ compared to healthy controls and patients with mitochondrial myopathy. Methods Eleven patients with genetically verified SMAJ, 26 subjects with mitochondrial myopathy (MM), and 28 healthy volunteers underwent a cardiopulmonary exercise test with lactate and ammonia sampling. The effect of the diagnosis group on the test results was analysed using a linear model. Results Adjusted for sex, age, and BMI, the SMAJ group had lower power output (p < 0.001), maximal oxygen consumption (VO2 max) (p < 0.001), and mechanical efficiency (p < 0.001) compared to the healthy controls but like that in MM. In the SMAJ group and healthy controls, plasma lactate was lower than in MM measured at rest, light exercise, and 30 min after exercise (p ≤ 0.001-0.030) and otherwise lactate in SMAJ was lower than controls and MM, in longitudinal analysis p = 0.018. In MM, the ventilatory equivalent for oxygen was higher (p = 0.040), and the fraction of end-tidal CO2 lower in maximal exercise compared to healthy controls (p = 0.023) and subjects with SMAJ. Conclusion In cardiopulmonary exercise test, subjects with SMAJ showed a similar decrease in power output and oxidative capacity as subjects with mitochondrial myopathy but did not exhibit findings typical of mitochondrial disease.
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Affiliation(s)
- Nadja Ratia
- Unit of Clinical Physiology, HUS Medical Diagnosis Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Edouard Palu
- Unit of Neurophysiology, HUS Medical Diagnosis Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lantto
- Unit of Clinical Physiology, HUS Medical Diagnosis Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emil Ylikallio
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Anu Suomalainen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program of Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Neuroscience Center, HiLife, University of Helsinki, Helsinki, Finland
| | - Mari Auranen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnosis Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Golan H, Courtney R, Wolfberg J. Novel Respiratory Therapy for the Improvement of Post COVID Condition Symptoms: A Case Series. J Voice 2023:S0892-1997(23)00151-0. [PMID: 37316403 DOI: 10.1016/j.jvoice.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Speech-language pathologists are seeing a growing number of patients whose voice and upper airway symptoms are complicated by dyspnea, cognitive difficulties, anxiety, extreme fatigue, and other debilitating post COVID symptoms. These patients are often less responsive to traditional speech-language pathology treatments and there is emerging literature that suggests dysfunctional breathing (DB) might contribute to dyspnea and other symptoms in this patient population. Treatment of DB through breathing retraining has been shown to improve breathing and successfully reduce symptoms similar to those seen in patients with long COVID. There is some preliminary evidence that breathing retraining is helpful for patients with post COVID condition symptoms. However, breathing retraining protocols tend to be heterogeneous and are often not systematic or well described. METHODS This case series reports on an Integrative Breathing Therapy (IBT) protocol used in patients diagnosed with post COVID condition symptoms attending an otolaryngology clinic who presented with signs and symptoms of DB. A systematic evaluation of the biomechanical, biochemical, and psychophysiological dimensions of DB based on principles of IBT was performed on each patient to enable targeted patient-centered care. Patients were then provided with intensive breathing retraining that aimed to comprehensively improve breathing functionality in all these three dimensions of breathing. Treatment involved 6-12 sessions of weekly 1-hour group telehealth sessions combined with 2-4 individual sessions. RESULTS All participants showed improvements in the parameters of DB measured and also reported a reduction in symptoms and improved daily function. CONCLUSIONS These findings suggest that patients with long COVID who present with signs and symptoms of DB might respond positively to comprehensive and intensive breathing retraining that addresses biochemical, biomechanical, and psychophysiological dimensions of breathing. More research is required to further refine this protocol and confirm its effectiveness through a controlled trial.
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Affiliation(s)
- Hadas Golan
- Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts.
| | | | - Jeremy Wolfberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Pauwen NY, Faoro V, Boucharessas F, Colot T, Guillaume A, Sergysels R, Ninane V. Validation Criteria for P ETCO 2 Kinetics during the Hyperventilation Provocation Test in the Diagnosis of Idiopathic Hyperventilation Syndrome. J Clin Med 2022; 11:jcm11216482. [PMID: 36362710 PMCID: PMC9654772 DOI: 10.3390/jcm11216482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The hyperventilation provocation test (HPTest) is a diagnostic tool for idiopathic hyperventilation syndrome (HVS), encountered in some long-COVID patients. However, interpretation of the HPTest remains unclear regarding the relevant PETCO2 values to focus on and whether subjective symptoms should be considered. This study aimed to re-evaluate objective HPTest results for diagnosing HVS by determining accurate PETCO2 kinetics in two groups of patients previously screened via the Nijmegen questionnaire (NQ). Methods: The kinetics of PETCO2 during the HPTest were mathematically modeled and compared between 37 HVS patients (NQ ≥23/64) and 37 healthy controls (NQ <23/64) matched for gender, age, and body dimensions. AUC values with sensitivity and specificity were calculated, and analysis was monitored in a validation cohort of 152 routine HPTests. Results: A threshold value of a less than 12.8 mmHg increment of PETCO2 at the 5th minute of the recovery phase of the HPTest diagnosed HVS patients with excellent sensitivity (0.92) and specificity (0.84). These results were confirmed in the validation cohort, highlighting the presence of 24% false positives/negatives when diagnosing on the basis of complaints in the NQ. Conclusions: For HVS diagnosis, we suggest considering the HPTest, which can more reliably reflect the mechanisms of CO2 homeostasis and the response of the respiratory center to a stimulus, regardless of the subjective onset of symptoms.
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Affiliation(s)
- Nathalie Yaël Pauwen
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), 1070 Anderlecht, Belgium
- Correspondence:
| | - Vitalie Faoro
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), 1070 Anderlecht, Belgium
| | - Françoise Boucharessas
- Department of Pneumology, Centre Hospitalier Universitaire St Pierre & Brugmann, 1000 Bruxelles, Belgium
| | - Thierry Colot
- Department of Pneumology-Physiotherapy, Iris-Sud Hospitals, 1190 Forest, Belgium
| | - Alexis Guillaume
- Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), 1070 Anderlecht, Belgium
| | - Roger Sergysels
- Department of Pneumology, Centre Hospitalier Universitaire St Pierre & Brugmann, 1000 Bruxelles, Belgium
| | - Vincent Ninane
- Department of Pneumology, Centre Hospitalier Universitaire St Pierre & Brugmann, 1000 Bruxelles, Belgium
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Ratia N, Pietiläinen KH, Auranen M, Saksa L, Luukkonen R, Suomalainen A, Piirilä P. Modified Atkins diet modifies cardiopulmonary exercise characteristics and promotes hyperventilation in healthy subjects. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hyperventilation Syndrome: Investigating the Relationship Between Nijmegen Questionnaire, Vestibular Function Tests, and Patient Symptoms. Otol Neurotol 2019; 41:e349-e356. [PMID: 31821257 DOI: 10.1097/mao.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the Nijmegen Questionnaire (NQ) and its relationship to vestibular function tests and symptoms in patients with dizziness; to compare patient characteristics between those with a positive Nijmegen score and patients clinically diagnosed with hyperventilation syndrome (HVS). STUDY DESIGN Retrospective case series. SETTING Tertiary neurotology referral center. PATIENTS Patients seen at vestibular assessment were grouped according to positive (≥24) or negative (<24) Nijmegen scores; secondary analysis was performed on patients grouped by a clinical diagnosis of hyperventilation syndrome. INTERVENTION(S) NQ, vestibular function tests, hospital anxiety and depression scale (HADS), vestibular rehabilitation benefit questionnaire (VRBQ). MAIN OUTCOME MEASURE(S) Medical records of patients presenting for vestibular assessment from January to December 2017 were retrospectively reviewed. Demographic data, self-reported questionnaire results, HVS diagnosis, vestibular test results, and reported symptoms were recorded. RESULTS In total, 359 patients presented for vestibular assessment with completed NQ. One hundred thirty nine patients (39%) had a positive (≥24) Nijmegen score. In 34 patients, a diagnosis of hyperventilation syndrome was recorded; 10 of these patients did not have a positive Nijmegen score.There was no significant difference found in either vestibular lesion type or compensation status between patients with positive and negative Nijmegen scores (p > 0.05). Symptoms commonly described by patients with positive Nijmegen scores include "blurred vision," "tingling," "anxiety," "shortness of breath," "palpitations," "panic," "numbness," "chest pain," and "chest tightness." In contrast, when grouped by HVS diagnosis, patients with HVS were significantly more likely to have No Lesion detected on vestibular function testing (p = 0.0366). "Panic," "anxiety," and "tingling" were the only significant symptoms reported more often in the HVS diagnosis group, while "nausea/vomiting" and "vertigo" were reported significantly less frequently compared with the non-HVS diagnosis group. CONCLUSIONS Hyperventilation is a complex stimulus, with some effects manifesting in neurotology clinics. This study reveals discrepancies in both vestibular assessment findings and symptom profiles between patients with a positive screening score in the NQ and patients clinically diagnosed with hyperventilation syndrome. This data will inform clinicians' interpretation of the NQ in the neurotologic setting.
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Unilateral recurrent laryngeal nerve palsy post-thyroidectomy: Looking for hyperventilation syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:373-377. [DOI: 10.1016/j.anorl.2019.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Courtney R, Biland G, Ryan A, Grace S, Gordge R. Improvements in multi-dimensional measures of dysfunctional breathing in asthma patients after a combined manual therapy and breathing retraining protocol: a case series report. INT J OSTEOPATH MED 2019. [DOI: 10.1016/j.ijosm.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ok JM, Park YB, Park YJ. Association of dysfunctional breathing with health-related quality of life: A cross-sectional study in a young population. PLoS One 2018; 13:e0205634. [PMID: 30308070 PMCID: PMC6181383 DOI: 10.1371/journal.pone.0205634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 09/29/2018] [Indexed: 11/19/2022] Open
Abstract
Symptomatic hyperventilation (SH) is a pathological condition that manifests with breathlessness, dyspnea, light-headedness, anxiety, and paresthesia. However, little is known about the prevalence of SH and its association with health-related quality of life (HRQoL) in a young population. The Nijmegen questionnaire (NQ), which measures severity of SH, had not previously been cross-culturally translated into Korean. In this study, the NQ was cross-culturally translated into Korean (KNQ), using translation and back-translation methods. To examine the reliability and validity levels of the KNQ, as well as its association with HRQoL, 237 college students (21.38 ± 2.45 years) were asked to complete the KNQ, the Korean version of the general health questionnaire (K-GHQ-30) and the short form-36 (K-SF-36). The KNQ showed satisfactory reliability (Cronbach's α = 0.878). In the construct validity test, four factors (neuropsychological, respiratory, neurogastrointestinal, and neuromuscular) were extracted (% of total variance = 59.8). Using a KNQ cut-off score of 23 points, the prevalence of SH was 22.8%. Physical and mental HRQoL levels estimated by the K-GHQ-30 score and the 8 subscale scores of the K-SF-36 were lower in the SH group than in those of the non-SH group. It is concluded that the cross-culturally translated KNQ is reliable and valid, and management of SH may prevent a reduction in physical and mental HRQoL in a young population.
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Affiliation(s)
- Ji-Myung Ok
- Department of Human Informatics of Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Young-Bae Park
- Department of Human Informatics of Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Young-Jae Park
- Department of Human Informatics of Korean Medicine, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
- Department of Biofunctional Medicine and Diagnostics, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
- Department of Diagnosis and Biofunctional Medicine, Kyung Hee University Hospital at Gangdong, Gangdong-Gu, Seoul, Republic of Korea
- * E-mail:
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Cardiopulmonary Exercise Testing in Patients with Heart Failure with Specific Comorbidities. Ann Am Thorac Soc 2018; 14:S110-S115. [PMID: 28380304 DOI: 10.1513/annalsats.201610-803fr] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Exercise capacity is one of the most powerful predicting factors of life expectancy, both in patients with and those without cardiac disease. Cardiopulmonary exercise testing provides a global assessment of the integrative exercise responses involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems, which are not adequately reflected through the measurement of individual organ system function. This relatively noninvasive, dynamic, physiologic overview allows the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision-making. Chronic heart failure is a significant cause of worldwide mortality and morbidity, whose clinical picture is characterized by exercise intolerance and impaired quality of life. The purpose of this review is to provide an update of the role of cardiopulmonary exercise testing in patients with heart failure with specific comorbidities. Patients with heart failure frequently present concomitant clinical conditions, such as obesity, anemia, lung or kidney disease, diabetes mellitus, cancer, depression, and psychogenic disorders, which could affect length and quality of life, including everyday activities and exercise performance. Poor effort and malingering may be suspected when early discontinuation of the exercise test with irregular breathing occurs.
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Bansal T, Haji GS, Rossiter HB, Polkey MI, Hull JH. Exercise ventilatory irregularity can be quantified by approximate entropy to detect breathing pattern disorder. Respir Physiol Neurobiol 2018; 255:1-6. [PMID: 29730423 DOI: 10.1016/j.resp.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/25/2018] [Accepted: 05/02/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breathing pattern disorder (BPD) is a prevalent cause of exertional dyspnea and yet there is currently no reliable objective measure for its diagnosis. We propose that statistical analysis of ventilatory irregularity, quantified by approximate entropy (ApEn), could be used to detect BPD when applied to cardiopulmonary exercise test (CPET) data. We hypothesised that ApEn of ventilatory variables (tidal volume (VT), breathing frequency (Bf), minute ventilation (VE)) would be greater, i.e. more irregular, in patients with BPD than healthy controls. METHODS We evaluated ventilatory ApEn in 20 adults (14 female) with exertional dyspnoea, undergoing CPET and independently diagnosed with BPD by a specialist respiratory physiotherapist. Data were compared with 15 age- gender- and BMI-matched controls. ApEn for VT, Bf and VE were calculated for an incremental cycle exercise test. RESULTS Patients with BPD more frequently rated breathlessness as the reason for exercise limitation and had a lower mean (SD) peak oxygen uptake compared with controls: 80 (18) vs. 124 (27) % predicted (P < 0.001). ApEn was significantly greater for VT (p = .006) and VE (p = .002) in BPD than controls. ApEn VE was inversely related (r2 = 0.24, p = .03) to peak oxygen uptake in BPD but not controls. ROC analysis revealed that ApEn VE > 0.88, conferred a sensitivity and specificity of 70% and 87% respectively, for detection of BPD. CONCLUSIONS Non-linear statistical interrogation of CPET-acquired ventilatory data has utility in the detection of BPD. A simple calculation of approximate entropy of ventilation, during an incremental cardiopulmonary exercise test, provides a quantitative method to detect BPD.
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Affiliation(s)
- Taranpal Bansal
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Gulam S Haji
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, USA; Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Mike I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK
| | - James H Hull
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust & Imperial College, London UK.
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Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans. J Neurosci 2017; 36:10673-10682. [PMID: 27733617 DOI: 10.1523/jneurosci.2376-16.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Spontaneous ventilation in mammals is driven by automatic brainstem networks that generate the respiratory rhythm and increase ventilation in the presence of increased carbon dioxide production. Hypocapnia decreases the drive to breathe and induces apnea. In humans, this occurs during sleep but not during wakefulness. We hypothesized that hypocapnic breathing would be associated with respiratory-related cortical activity similar to that observed during volitional breathing, inspiratory constraints, or in patients with defective automatic breathing (preinspiratory potentials). Nineteen healthy subjects were studied under passive (mechanical ventilation, n = 10) or active (voluntary hyperventilation, n = 9) profound hypocapnia. Ventilatory and electroencephalographic recordings were performed during voluntary sniff maneuvers, normocapnic breathing, hypocapnia, and after return to normocapnia. EEG recordings were analyzed with respect to the ventilatory flow signal to detect preinspiratory potentials in frontocentral electrodes and to construct time-frequency maps. After passive hyperventilation, hypocapnia was associated with apnea in 3 cases and ventilation persisted in 7 cases (3 and 6 after active hyperventilation, respectively). No respiratory-related EEG activity was observed in subjects with hypocapnia-related apneas. In contrast, preinspiratory potentials were present at vertex recording sites in 12 of the remaining 13 subjects (p < 0.001). This was corroborated by time-frequency maps. This study provides direct evidence of a cortical substrate to hypocapnic breathing in awake humans and fuels the notion of corticosubcortical cooperation to preserve human ventilation in a variety of situations. Of note, maintaining ventilatory activity at low carbon dioxide levels is among the prerequisites to speech production insofar as speech often induces hypocapnia. SIGNIFICANCE STATEMENT Human ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.
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Dysphagia in Parkinson’s Disease. Dysphagia 2017. [DOI: 10.1007/174_2017_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Grammatopoulou EP, Skordilis EK, Georgoudis G, Haniotou A, Evangelodimou A, Fildissis G, Katsoulas T, Kalagiakos P. Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire--NQ. J Asthma 2014; 51:839-46. [PMID: 24823322 DOI: 10.3109/02770903.2014.922190] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. OBJECTIVE To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. METHODS The NQ (n = 162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test-retest reliability. RESULTS Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach's alpha = 0.92) and test-retest reliability (IR = 0.98). Higher NQ scores were found in the following subgroups: women versus men (p < 0.01); participants with moderate versus mild asthma (p < 0.001) or uncontrolled versus controlled asthma (p < 0.001), and participants with breath-hold time (BHT) < 30 versus ≥ 30 s (p < 0.01) or end-tidal CO2 (ETCO2) ≤ 35 versus >35 mmHg (p < 0.001). A cut-off score of >17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO2 (r = -0.68), RR (r = 0.66) and BHT (r = -0.65). The prevalence of HVS was found 34%. CONCLUSION The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.
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Affiliation(s)
- Eirini P Grammatopoulou
- Department of Physical Therapy, Technological and Educational Institution - TEI of Athens , Athens , Greece
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Upton J, Brodie D, Beales D, Richardson J, Jack S, Warburton C, Thomas M, Kendrick A. Correlation between perceived asthma control and thoraco-abdominal asynchrony in primary care patients diagnosed with asthma. J Asthma 2012; 49:822-9. [PMID: 22957811 DOI: 10.3109/02770903.2012.717658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Thoraco-abdominal asynchrony (TAA), the discordant movement of the abdomen and thorax, may impact upon health-related variables. Here, we investigated the extent to which TAA is associated with health-related variables, particularly perceived asthma control and quality of life. METHODS Ambulatory respiratory data from 43 patients diagnosed with asthma and 43 healthy age and sex-matched controls were recorded over 4 hours. Phase relation (Ph Rel Total), the percentage of time that the effects of rib cage (RC) and diaphragmatic movement result in opposite effects on intra-thoracic volume, quantified TAA. Subjects completed the Mini Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire (ACQ), Nijmegen questionnaire (NQ), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI), and General Health Perception (GHP) subscale of the short form 36 questionnaire'. Capnography profiling, breath-hold time (BHT), and standard spirometry were performed. RESULTS The time in asynchrony was significantly greater in the asthma than in the healthy control group (Ph Rel Total = 14% (interquartile range (IQR) 8.5-20.7%) versus 10.4% (IQR 7.1-14.5%), p = .012). In patients with asthma, Ph Rel Total was weakly associated with poorer ACQ scores (r = 0.33, p = .03), and in the healthy control group with GHP (r = 0.319, p = .037). Post-hoc exploratory analysis revealed a moderate relationship in the female asthma subgroup between Ph Rel Total and AQLQ (r = -0.56, p = .003). CONCLUSIONS TAA may be associated with decreased perceived asthma control. In healthy individuals, asynchrony may be associated with low perception of general health. Further studies are required to investigate if the reduction of TAA improves these health-related variables.
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Affiliation(s)
- Jane Upton
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK.
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Courtney R, Greenwood KM, Cohen M. Relationships between measures of dysfunctional breathing in a population with concerns about their breathing. J Bodyw Mov Ther 2010; 15:24-34. [PMID: 21147415 DOI: 10.1016/j.jbmt.2010.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/09/2010] [Accepted: 06/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dysfunctional breathing (DB) is implicated in physical and psychological health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO(2), biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires and tests of breathing function such as breath holding time. AIM This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality. METHOD 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined. RESULTS Significant correlations where found within categories of measures however correlations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels. CONCLUSION DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction should include measures of breathing symptoms, breathing pattern, resting CO(2) and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO(2) monitoring.
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Affiliation(s)
- Rosalba Courtney
- Royal Melbourne Institute of Technology University, School of Health Science, Melbourne, Australia.
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Thijs RD, van den Aardweg JG, Reijntjes RHAM, van Dijk JG, van Lieshout JJ. Contrasting effects of isocapnic and hypocapnic hyperventilation on orthostatic circulatory control. J Appl Physiol (1985) 2008; 105:1069-75. [DOI: 10.1152/japplphysiol.00003.2008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The effects of hyperventilation (HV) on mean arterial pressure (MAP) are variable. To identify factors affecting the MAP response to HV, we dissected the effects of hypocapnic HV (HHV) and isocapnic HV (IHV) and evaluated the effects of acute vs. prolonged HHV. In 11 healthy subjects the cardio- and cerebrovascular effects of HHV and IHV vs. normal ventilation were examined for 15 min in the supine position and also for 15 min during 60° head-up tilt. The end-tidal CO2 of the HHV condition was set at 15–20 mmHg. With HHV in the supine position, mean cerebral blood flow velocity (mCBFV) declined [95% confidence interval (CI) −43 to −34%], heart rate (HR) increased (95% CI 7 to 16 beats/min), but MAP did not change (95% CI −1 to 6 mmHg). However, an augmentation of the supine MAP was observed in the last 10 min of HHV compared with the first 5 min of HHV (95% CI 2 to 12 mmHg). During HHV in the tilted position mCBFV declined (95% CI −28 to −12%) and MAP increased (95% CI 3 to 11 mmHg) without changes in HR. With supine IHV, mCBFV decreased (95% CI −14 to −4%) and MAP increased (95% CI 1 to 13 mmHg) without changes in HR. During IHV in the tilted position MAP was further augmented (95% CI 11 to 20 mmHg) without changes in CBFV or HR. Preventing hypocapnia during HV resulted in a higher MAP, suggesting two contrasting effects of HV on MAP: hypocapnia causing vasodepression and hyperpnea without hypocapnia acting as a vasopressor.
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Han J, Zhu Y, Li S, Zhang J, Cheng X, Van den Bergh O, Van de Woestijne KP. The language of medically unexplained dyspnea. Chest 2008; 133:961-8. [PMID: 18263684 DOI: 10.1378/chest.07-2179] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Medically unexplained dyspnea (MUD) refers to a condition characterized by a sensation of dyspnea and is typically applied to patients presenting with anxiety and hyperventilation without cardiopulmonary explanations for their dyspnea. The diagnosis is difficult. We investigated whether descriptors of dyspnea and associated symptoms of MUD are differentially diagnostic. METHODS A respiratory symptom checklist incorporating 61 spontaneously reported descriptors of dyspnea was administered to 96 patients with MUD and 195 patients with cardiopulmonary diseases. Symptom factors measuring different qualitative aspects of dyspnea were derived by a principal component analysis. The separation of two patient groups in terms of symptom factors was achieved by a discriminant analysis. RESULTS Five factors grouped different attributes of dyspnea: urge to breathe, depth and frequency of breathing, difficulty breathing and phase of respiration, wheezing, and affective dyspnea. The other five factors grouped symptoms of anxiety, tingling, cough and sputum, palpitation, and out of control. A discriminant analysis allowed to separate two patient groups (R(2) = 0.45, p < 0.0001). The presence of urge to breathe, affective dyspnea, anxiety, and tingling pointed to the diagnosis of MUD, whereas the reporting of wheezing, cough and sputum, and palpitation indicated cardiopulmonary diseases. The sensitivity was 85%, and specificity was 88%. CONCLUSIONS Descriptors of dyspnea and associated symptoms allows satisfactory separation of patients with MUD from patients with cardiopulmonary diseases. A prospective study will be required to test the validity and predictive values of the descriptor model in another cohort of patients.
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Affiliation(s)
- Jiangna Han
- Department of Pneumology, Peking Union Medical College Hospital, Beijing, China.
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Naschitz JE, Mussafia-Priselac R, Kovalev Y, Zaigraykin N, Slobodin G, Elias N, Rosner I. Patterns of Hypocapnia on Tilt in Patients with Fibromyalgia, Chronic Fatigue Syndrome, Nonspecific Dizziness, and Neurally Mediated Syncope. Am J Med Sci 2006; 331:295-303. [PMID: 16775435 DOI: 10.1097/00000441-200606000-00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether head-up tilt-induced hyperventilation is seen more often in patients with chronic fatigue syndrome (CFS), fibromyalgia, dizziness, or neurally mediated syncope (NMS) as compared to healthy subjects or those with familial Mediterranean fever (FMF). PATIENTS AND METHODS A total of 585 patients were assessed with a 10-minute supine, 30-minute head-up tilt test combined with capnography. Experimental groups included CFS (n = 90), non-CFS fatigue (n = 50), fibromyalgia (n = 70), nonspecific dizziness (n = 75), and NMS (n =160); control groups were FMF (n = 90) and healthy (n = 50). Hypocapnia, the objective measure of hyperventilation, was diagnosed when end-tidal pressure of CO2 (PETCO2) less than 30 mm Hg was recorded consecutively for 10 minutes or longer. When tilting was discontinued because of syncope, one PETCO2 measurement of 25 or less was accepted as hyperventilation. RESULTS Hypocapnia was diagnosed on tilt test in 9% to 27% of patients with fibromyalgia, CFS, dizziness, and NMS versus 0% to 2% of control subjects. Three patterns of hypocapnia were recognized: supine hypocapnia (n = 14), sustained hypocapnia on tilt (n = 76), and mixed hypotensive-hypocapnic events (n = 80). Hypocapnia associated with postural tachycardia syndrome (POTS) occurred in 8 of 41 patients. CONCLUSIONS Hyperventilation appears to be the major abnormal response to postural challenge in sustained hypocapnia but possibly merely an epiphenomenon in hypotensive-hypocapnic events. Our study does not support an essential role for hypocapnia in NMS or in postural symptoms associated with POTS. Because unrecognized hypocapnia is common in CFS, fibromyalgia, and nonspecific dizziness, capnography should be a part of the evaluation of patients with such conditions.
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Affiliation(s)
- Jochanan E Naschitz
- Department of Internal Medicine A, the Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Naschitz JE, Mussafia-Priselac R, Kovalev Y, Zaigraykina N, Slobodin G, Elias N, Storch S, Rosner I. Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt. J Hum Hypertens 2005; 20:157-62. [PMID: 16239900 DOI: 10.1038/sj.jhh.1001947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical syndrome of supine hypertension associated with orthostatic hypotension (OH) in given individuals is recognized by specialists, but is underdiagnosed in the community. The objective of this study was to assess supine hypertension associated with hypotensive reactions on head-up tilt (SH-HRT) among patients evaluated for nonspecific dizziness. Consecutive patients with nonspecific dizziness were studied with a 10-min supine 30-min head-up tilt test. Supine hypertension (SH) was diagnosed when supine systolic blood pressure (SBP) was > or = 140 mmHg and/or supine diastolic blood pressure (DBP) was > or = 90 mmHg. Hypotensive reactions on tilt (HRT) were diagnosed when SBP decreased by > or = 30 mmHg on tilt and/or DBP decreased by > or = 15 mmHg. Of 430 patients tested, 42 (9.8%) had SH-HRT. The median age was 67 years; 37 had a pretest diagnosis of hypertension, with treatment. The median supine BP was 162/90 mmHg; the median nadir BP on tilt was 118/78 mmHg. Four SH-HRT patterns were recognized: (I) SH with typical neurogenic OH (n = 6), (II) SH with vasovagal reaction on tilt (n = 4), (III) SH with sustained HRT (n = 28), and (IV) SH with mixed orthostatic-vasovagal reaction on tilt (n = 4). Dizziness on tilt occurred in 25% of patients category III (SH with sustained HRT), while appearing universally in other SH-HRT patterns. In conclusion, nonspecific dizziness may be the chief complaint in patients with SH-HRT, a disorder often unrecognized by clinicians. Different patterns of SH-HRT on HUTT may reflect different aberrations in cardiovascular homeostasis and may require differentiated management strategies.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, The Bnai-Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Naschitz JE, Mussafia-Priselac R, Peck ER, Peck S, Naftali N, Storch S, Slobodin G, Elias N, Rosner I. Hyperventilation and amplified blood pressure response: is there a link? J Hum Hypertens 2005; 19:381-7. [PMID: 15838538 DOI: 10.1038/sj.jhh.1001830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Based on prior studies, the hypothesis that hyperventilation (HV) may have a pressor effect and play a causal role in hypertension has been suggested. The objective of this study was to correlate HV with blood pressure (BP)-change during a postural challenge. Consecutive subjects referred for evaluation of syncope, dizziness, chronic fatigue syndrome (CFS), fibromyalgia, or non-CFS fatigue were assessed with a 10-min supine 30-min head-up tilt test combined with capnography. We selected for analysis the records of patients aged 17-70 years, not taking vasoactive medications, having sitting systolic BP (SBP) < 140 mmHg, sitting diastolic BP (DBP) < 90 mmHg, and who completed 30 min of tilt. HV was diagnosed when end-tidal pressure of CO2 < 30 mmHg was recorded consecutively for > or = 10 min. Postural hypertension (PHT) was diagnosed when DBP on tilt > or = 90 mmHg was recorded consecutively for > or = 10 min. DBP-change was computed as (median DBP on tilt) -(median DBP supine). PHT and DBP-change were correlated with HV. A total of 320 patient charts were reviewed. PHT was present in 30 cases. The mean DBP-change in patients with PHT was +9.9 mmHg (s.d. 5.8), with three patients manifesting HV. Of the remaining 290 patients, 56 had HV, their mean DBP-change was -0.3 mmHg (s.d. 7.2). The other 234 patients without HV had a mean DBP-change +0.95 mmHg (s.d. 5.7), comparable to the DBP-change in patients with HV. In, conclusion, posturally induced HV was not associated with an increase in BP, nor was PHT associated with HV, except in a small minority of cases.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, Bnai-Zion Medical Center, Haifa, Israel.
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Jack S, Rossiter HB, Pearson MG, Ward SA, Warburton CJ, Whipp BJ. Ventilatory Responses to Inhaled Carbon Dioxide, Hypoxia, and Exercise in Idiopathic Hyperventilation. Am J Respir Crit Care Med 2004; 170:118-25. [PMID: 15059786 DOI: 10.1164/rccm.200207-720oc] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic hyperventilation (IH) is a poorly understood condition of sustained hypocapnia and controversial etiology. Although behavioral/emotional factors may contribute, it is uncertain whether chemosensitivity is altered, hyperventilation is maintained during exercise, and the associated breathlessness reflects the hyperventilation. In 39 patients with IH and 23 control subjects, we described ventilatory responses to isocapnic-hypoxia, hyperoxic-hypercapnia, and exercise; breath-hold tolerance; breathlessness; and psychologic status. Patients demonstrated hyperventilation at rest, with hypocapnia (28 +/- 3.8 mm Hg), a normal (slightly alkaline) arterial pH and [H(+)]a, and a significant base excess (-4.5 +/- 2.7 mEq/L), consistent with compensated respiratory alkalosis. Hyperventilation was sustained during exercise, despite hyperoxic-hypercapnic ventilatory responsiveness being normal and isocapnic-hypoxic ventilatory responsiveness being low relative to control (but exceeding control [2.4 +/- 1.0 vs. 1.6 +/- 0.5 L/min/%, p < 0.05] with acute restoration to normocapnia). Hyperventilation was maintained during exercise, at the resting CO(2) "setpoint." Relative to control, the breath-hold tolerance was attenuated, and dyspnea during exercise was significantly greater and not simply ascribable to the high ventilation. These observations suggest that patients with IH have a sustained hyperventilatory and dyspneic drive that, although not attributable to central chemosensitivity, may possibly have peripheral chemoreflex contributions. The nature and etiology of this chronic hyperventilatory drive remain unclear.
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Affiliation(s)
- Sandy Jack
- Aintree Chest Centre, University Hospital Aintree, Liverpool L9 7AL, UK
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Rietveld S, Rietvelt S, Houtveen JH. Acquired sensitivity to relevant physiological activity in patients with chronic health problems. Behav Res Ther 2004; 42:137-53. [PMID: 14975777 DOI: 10.1016/s0005-7967(03)00104-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Revised: 03/17/2003] [Accepted: 03/25/2003] [Indexed: 11/22/2022]
Abstract
The hypothesis that biased symptom perception toward excessive symptoms is common when relatively normal chronic patients enter symptom-relating situations, irrespective of emotional variables, was tested in 19 women with severe asthma, 18 with somatization-like characteristics, and 18 controls. Each underwent three experimental conditions: mental stress, resting, and physical exercise. Each condition included three breathing conditions: breathing normally, normal compressed air, and 5.5% CO2-enriched compressed air. Results yielded no group differences in physiological measures, e.g. elevated CO2 in exhaled air (end-tidal partial pressure of CO2, PetCO2), or lung function. Asthma patients experienced more breathlessness, and somatization-like participants more breathlessness, miscellaneous symptoms, and subjective stress than controls. Although these differences suggested acquired biased symptom perception, as it turned out, breathlessness in asthmatics was more influenced by PetCO2 and less by subjective stress compared to controls. Likewise, breathlessness in somatization-like participants was similarly influenced by PetCO2 and subjective stress compared to controls, and miscellaneous symptoms were even more influenced by PetCO2 and less by subjective stress compared to controls. It was concluded that acquired sensitivity to physiological activity associated with habitual symptoms may account for excessive symptoms in patients with chronic health problems.
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Affiliation(s)
- Simon Rietveld
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ (CLINICAL RESEARCH ED.) 2001; 322:1098-100. [PMID: 11337441 PMCID: PMC31263 DOI: 10.1136/bmj.322.7294.1098] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2001] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To estimate the prevalence of dysfunctional breathing in adults with asthma treated in the community. DESIGN Postal questionnaire survey using Nijmegen questionnaire. SETTING One general practice with 7033 patients. PARTICIPANTS All adult patients aged 17-65 with diagnosed asthma who were receiving treatment. MAIN OUTCOME MEASURE Score >/=23 on Nijmegen questionnaire. RESULTS 227/307 patients returned completed questionnaires; 219 (71.3%) questionnaires were suitable for analysis. 63 participants scored >/=23. Those scoring >/=23 were more likely to be female than male (46/132 (35%) v 17/87 (20%), P=0.016) and were younger (mean (SD) age 44.8 (14.7) v 49.0 (13.8, (P=0.05). Patients at different treatment steps of the British Thoracic Society asthma guidelines were affected equally. CONCLUSIONS About a third of women and a fifth of men had scores suggestive of dysfunctional breathing. Although further studies are needed to confirm the validity of this screening tool and these findings, these prevalences suggest scope for therapeutic intervention and may explain the anecdotal success of the Buteyko method of treating asthma.
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Affiliation(s)
- M Thomas
- Surgery, Minchinhampton, Stroud, Gloucestershire GL6 9JF.
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Osborne CA, O'Connor BJ, Lewis A, Kanabar V, Gardner WN. Hyperventilation and asymptomatic chronic asthma. Thorax 2000; 55:1016-22. [PMID: 11083886 PMCID: PMC1745650 DOI: 10.1136/thorax.55.12.1016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We have consistently argued that mild asthma is an important underlying aetiological factor in patients with severe symptomatic hyperventilation. While hyperventilation has been demonstrated in acute asthma, there have been few studies in mild chronic asthma, and mechanisms are uncertain. METHODS Twenty three currently asymptomatic chronically asthmatic patients (occasional use of bronchodilators, normal lung function, hyperresponsive to methacholine) were studied and 17 matched normal subjects acted as controls. Ventilation, pattern of breathing, arterial carbon dioxide and oxygen tensions (PaCO(2), PaO(2)), end tidal PCO(2) (PETCO(2)), standard lung function, airway responsiveness to methacholine, airway inflammation assessed by eosinophils in induced sputum, and psychiatric morbidity (Spielberger STAI-Y and Beck Depression Inventory) were measured. RESULTS Despite the absence of current asthmatic symptoms, no clinical evidence of hyperventilation, and normal lung function in the patients with asthma, PaCO(2) and PETCO(2) were significantly (p<0.01) lower in the patients than in the control group (mean (SD) PaCO(2) 4.96 (0.43) kPa for patients versus 5.27 (0.38) kPa for controls (mean difference 0.31 kPa, 95% confidence interval (CI) 0.06 to 0.56, p<0.02)). PETCO(2) was very similar to PaCO(2) in both groups (mean (SD) PETCO(2) 4.89 (0.47) kPa for the patients and 5.28 (0.40) for the controls (mean difference 0.39 kPa, 95% CI 0.12 to 0.66, p<0.01)). There was no significant difference in ventilation or respiratory pattern between the two groups. The reduced PaCO(2) in the asthmatic patients correlated significantly with the concentration of methacholine provoking a fall in FEV(1) of more than 20% (PC(20)) (r = 0.56, p<0.01) but not with any aspect of lung function, eosinophil count, or anxiety/depression. CONCLUSION Mild asymptomatic asthma is not associated with clinically significant hyperventilation but is associated with a significant reduction in both arterial and end tidal PCO(2) which relates to airway hyperresponsiveness rather than to the degree of airway obstruction or mucosal inflammation. Anxiety and depression appear not to be implicated.
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Affiliation(s)
- C A Osborne
- Department of Respiratory Medicine and Allergy, Guy's, King's and St Thomas' School of Medicine, King's Denmark Hill Campus, London SE5 9PJ, UK
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Abstract
OBJECTIVE To determine if hypocapnia occurs in patients with fear of falling and to explore potential causes of hypocapnia. DESIGN Observational study in patients who fall with and without fear of falling. SETTING Rehabilitation wards of an elderly care unit. PATIENTS Consecutive fallers with (n = 20) and without (n = 10) fear of falling. MAIN OUTCOME MEASURES End-tidal CO2 (PETCO2) and respiratory rate (RR) responses were measured during sustained isometric muscle contraction (SIMC) (40% of maximum voluntary contraction of quadriceps for 2 min) and during a 5-meter walk. Falls efficacy scale (FES) and Hospital anxiety and depression scale (HAD). RESULTS Patients with fear of falling had significantly higher FES and HAD scores (p < .01). During SIMC, baseline and nadir PETCO2 levels were significantly lower in patients with a fear of falling (p < .01). During the 5-meter walk, PETCO2 was lower at baseline, at nadir, and at the end of the walk in the fear of falling group than in controls (p < .01). RR was higher at nadir and end of the walk in the fear of falling group than in controls (p < .02). CONCLUSIONS Hypocapnia may occur in patients with a fear of falling during SIMC and walking. Anxiety seems to be the main cause, but muscle weakness may contribute. Breathing or relaxation techniques and reconditioning may have a role in treating fear of falling in the rehabilitation setting.
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Affiliation(s)
- J E Clague
- Geriatric Medicine, Clinical Division 1, University of Manchester, UK
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Malmberg LP, Tamminen K, Sovijärvi AR. Orthostatic increase of respiratory gas exchange in hyperventilation syndrome. Thorax 2000; 55:295-301. [PMID: 10722769 PMCID: PMC1745734 DOI: 10.1136/thorax.55.4.295] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hyperventilation syndrome (HVS) is a common disorder which is difficult to diagnose because of somatic symptoms and its episodic nature. In previous studies respiratory alkalosis in arterial blood was often found during orthostatic tests in patients with HVS. The purpose of this study was to assess these orthostatic changes by non-invasive pulmonary gas exchange measurements and to evaluate whether these responses discriminate patients with HVS from healthy subjects. METHODS Respiratory gases were collected with a face mask and pulmonary gas exchange was measured after 10 minutes at rest and after eight minutes standing upright in 16 patients with HVS and 13 healthy control subjects. In patients with HVS arterial blood samples were also drawn at rest and in the standing position. RESULTS At rest the variables of respiratory gas exchange did not differ significantly between the groups. As a response to standing, minute ventilation increased in both study groups but significantly more in the patients with HVS (mean difference 5.4 l/min (95% CI 1.1 to 9.6)). The changes in end tidal CO(2) fraction (FETCO(2)) and in ventilatory equivalents for oxygen (VE/VO(2)) and for CO(2) (VE/VCO(2)) during the orthostatic test were also significantly larger in patients with HVS than in healthy controls. During standing FETCO(2) was significantly lower (mean difference -1.1 kPa; 95% CI -1.5 to -0.6) and VE/VO(2) (mean difference 18.4; 95% CI 7.7 to 29.0) and VE/VCO(2) (mean difference 11.7; 95% CI 4.8 to 18.6) were significantly higher in HVS patients than in healthy controls. By using the cut off level of 4% for FETCO(2) the sensitivity and specificity of the test to discriminate HVS were 87% and 77%, respectively, and by using the cut off level of 37 for VE/VO(2) they were 93% and 100%, respectively. In the HVS patients arterial PCO(2) and FETCO(2) were closely correlated during the orthostatic test (r = 0.93, p<0.0001). CONCLUSIONS As a response to change in body position from supine to standing, patients with HVS have an accentuated increase in ventilation which distinguishes them from healthy subjects. These findings suggest that non-invasive measurements of pulmonary gas exchange during orthostatic tests are useful in the clinical evaluation of patients with hyperventilation disorders.
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Affiliation(s)
- L P Malmberg
- Laboratory of Clinical Physiology, Department of Allergology, Helsinki University Central Hospital, Helsinki, Finland
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Ringsberg KC, Akerlind I. Presence of hyperventilation in patients with asthma-like symptoms but negative asthma test responses: provocation with voluntary hyperventilation and mental stress. J Allergy Clin Immunol 1999; 103:601-8. [PMID: 10200008 DOI: 10.1016/s0091-6749(99)70231-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A group of patients reporting asthma-like symptoms but with negative asthma tests has been identified. OBJECTIVE The objective of this study was to determine whether hyperventilation might explain these symptoms and whether the tests could be used as diagnostic tools. METHODS A hyperventilation provocation test (HVPT), a mental stress test, and the Word Color Conflict Test (WCCT) were performed on 10 patients with asthma-like symptoms, 10 patients with asthma, and 10 healthy subjects. End-tidal PCO 2 (PETCO2) was recorded 10 minutes after the HVPT and during the WCCT. Blood pressure, heart rate, and respiratory rate were also studied. The Nijmegen symptom questionnaire was used in the assessment of symptoms. RESULTS After the HVPT, the PETCO2 values recovered most slowly in the study group, the difference being significant compared with the healthy group (P <.01). During the WCCT, the study group had the lowest PETCO2 values at the 10- and 15-minute measurements, the difference again being significant compared with the healthy group (P <.05). The study group more often experienced symptoms before the test than the group with asthma (P <.05) and the healthy group (P <.001). The study group recognized significantly more symptoms previously experienced during the HVPT than the group with asthma (P <.05) and the healthy group (P <.01) and during the WCCT than the healthy group (P <.05). The study group showed a negative correlation between the PETCO2 level and the number of symptoms after the HVPT at 8 (r = -0-72; P <.05) and 10 minutes (r = -0.76; P <.05) and after the WCCT (r = -0.59; P <.05). Blood pressure, heart rate, and respiratory rate showed small differences between the groups. CONCLUSION Patients with asthma-like symptoms may experience hyperventilation when provoked. Mental stress might be 1 trigger factor. The HVPT and WCCT can be used as diagnostic instruments.
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Affiliation(s)
- K C Ringsberg
- Department of Health and Environment, Division for Preventive and Social Medicine and Public Health Science, Linköpings Universitet, Linköping, Sweden
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Han JN, Stegen K, Schepers R, Van den Bergh O, Van de Woestijne KP. Subjective symptoms and breathing pattern at rest and following hyperventilation in anxiety and somatoform disorders. J Psychosom Res 1998; 45:519-32. [PMID: 9859854 DOI: 10.1016/s0022-3999(98)00044-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the present study was to investigate the diagnostic specificity of bodily symptoms and respiratory behavior at rest and after a hyperventilation provocation test (HVPT) in patients that were either grouped according to the DSM classification or diagnosed as suffering from hyperventilation syndrome. Nine hundred three anxiety and somatoform patients, showing symptoms supposedly caused by psychogenic hyperventilation, and 170 healthy subjects, were studied. Breathing pattern and end-tidal CO2 concentration were recorded during breathing at rest and following a HVPT. Subjective symptoms in daily life and after HVPT were measured. A principal-components analysis was performed on both the symptoms and breathing variables and their specificity levels were compared in the two classifications of patients. Some symptoms in daily life were grouped together with the same symptoms after the HVPT, other symptoms were not. This suggests that the HVPT elicited partly specific symptoms, and partly reproduced the symptoms experienced in daily life. Similar findings were observed with respect to the breathing variables. Patients with panic differed from other patients with anxiety disorders by an increased level of symptoms and a FETCO2 decline at rest. The HVPT may be informative for diagnosis because it provokes some of the typical somatic and psychological symptoms, and it identifies the breathing instability that is characteristic of both patients with HVS and with anxiety. The same symptoms and breathing variables characterized the patients, whatever their classification. Overall, the specificity of breathing variables is rather low.
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Affiliation(s)
- J N Han
- Laboratory of Pneumology, U.Z. Gasthuisberg, Leuven, Belgium
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Wientjes CJ, Grossman P, Gaillard AW. Influence of drive and timing mechanisms on breathing pattern and ventilation during mental task performance. Biol Psychol 1998. [DOI: 10.1016/s0301-0511(98)00026-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Naschitz JE, Hardoff D, Bystritzki I, Yeshurun D, Gaitini L, Tamir A, Jaffe M. The role of the capnography head-up tilt test in the diagnosis of syncope in children and adolescents. Pediatrics 1998; 101:E6. [PMID: 9445516 DOI: 10.1542/peds.101.2.e6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the role of the capnography head-up tilt test (CHUTT) in the diagnosis of syncope in pediatric patients. METHODS The CHUTT is a head-up tilt test with concomitant capnometry. Hyperventilation on CHUTT was diagnosed when the patient's end-tidal carbon dioxide pressure (ETPCO2) was </=25 mm Hg. Hyperventilation syncope was diagnosed when three criteria were met: loss of consciousness, ETPCO2 </=25 mm Hg, and no significant drop in blood pressure. The cohort included 65 consecutive children and adolescents (mean age, 14.2 years) who were assessed for syncope by routine investigations and CHUTT. RESULTS The cause of the syncope was established in 67% of cases: cardioinhibitory reaction in 17%, vasodepressor in 20%, psychogenic in 22%, and mixed neurally mediated-psychogenic in 8% of the patients. The history indicated a cause of syncope in 40%, the CHUTT in 49%, and a combination of the history and positive CHUTT in 66% of patients. Neither the patients' clinical data nor values of the blood pressure, heart rate, respiratory rate, and ETPCO2 measured during recumbency predicted which patients would manifest hyperventilation or hyperventilation syncope on tilt. CONCLUSIONS The CHUTT contributes substantially to the diagnosis of syncope in pediatric patients. The CHUTT advances the understanding of the pathophysiological mechanisms of syncope and enables the physician to reassure the patient regarding the essentially benign nature of the condition. Because it is not possible to predict which patients would develop a hyperventilation syncope on the standard tilt test, the modification of this procedure by measuring the ETPCO2 for the assessment of children with syncope should be considered.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, Bnai Zion Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
OBJECTIVES A previous study found that individuals with blood pressure sensitivity to high sodium intake tend to have a high resting partial pressure of end-tidal CO2 (PetCO2). The present study analyzed the test-retest reliability of individual PetCO2 over 6 months, and the association of individual PetCO2 with age, gender, and personality characteristics. METHODS PetCO2 of 104 men and women (mean ages 42.1+/-1.5 years) was monitored via a respiratory gas monitor for 25 minutes during each of three sessions over an 11-day interval, and 59 subjects also participated in a 25-minute follow-up session 261+/-10 days later. Each subject completed the NEO Personality Inventory. RESULTS PetCO2 remained stable within and between monitoring sessions over a 6-month period. PetCO2 was higher in men than in women, and decreased progressively over the life span. PetCO2 was not correlated with the Extraversion, Openness, Agreeableness, or Conscientiousness Scales of the NEO Personality Inventory, but was highly positively associated with the Neuroticism Scale of the NEO Personality Inventory, and with its subscales. CONCLUSIONS High resting end-tidal CO2 tends to be a stable individual characteristic that is accompanied by a tendency to worry and experience negative emotions.
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Affiliation(s)
- A Dhokalia
- Behavioral Hypertension Section, National Institute on Aging, Baltimore, Maryland, USA
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Chin K, Ohi M, Kita H, Otsuka N, Oku Y, Mishima M, Kuno K. Hypoxic ventilatory response and breathlessness following hypocapnic and isocapnic hyperventilation. Chest 1997; 112:154-63. [PMID: 9228371 DOI: 10.1378/chest.112.1.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
STUDY OBJECTIVES To investigate the etiology of posthyperventilation (post-HV) hypoxemia following voluntary hyperventilation (VHV), we examined the effects of hypocapnic (hypo-CO2) and isocapnic (iso-CO2) VHV on the hypoxic ventilatory response (O2-response) and on the sensation of breathlessness during the O2-response. METHODS O2-responses and visual analog scale (VAS) scores for estimating breathlessness in 10 normal subjects during the O2-response under iso-CO2 conditions and under hypo-CO2 conditions immediately following voluntary maximal HV of 3 min duration were examined. RESULTS Although there was no significant difference in the post-HV ventilation levels following hypo-CO2 vs iso-CO2 VHV, the VAS scores at the start of the O2-response following hypo-CO2 VHV (30.2+/-24.2 mm) were significantly higher (p<0.05) than the VAS scores at the start of the O2-response following iso-CO2 VHV (13.7+/-8.4 mm). However, VHV did not have a significant effect on the O2-response at 2 min after the VHV when the arterial O2 saturation (SaO2) was below 90%. The nonsteady-state hypo-CO2 induced by VHV greatly attenuated the O2-response below 90% SaO2 and VAS scores at 70% SaO2. CONCLUSIONS Elevated VAS scores immediately following the hypo-CO2 VHV, which might be independent of actual breathing levels, and the attenuation of the O2-response following the hypo-CO2 VHV were not due to input from lung and chest wall mechanoreceptors induced by the hyperpnea itself, but rather to the hypo-CO2 induced by hyperpnea.
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Affiliation(s)
- K Chin
- Department of Clinical Physiology, Chest Disease Research Institute, Kyoto University, Sakyo-ku, Japan
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Saisch SG, Wessely S, Gardner WN. Patients with acute hyperventilation presenting to an inner-city emergency department. Chest 1996; 110:952-7. [PMID: 8874251 DOI: 10.1378/chest.110.4.952] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We studied 23 consecutive patients with acute hyperventilation presenting to an inner-city emergency department, diagnosed on clinical grounds by the attending physician and confirmed by arterial blood gas values in 5 patients. An organic basis for the presenting complaints was excluded and chest radiograph, serum biochemistry, blood cell count, and thyroid function test results were normal. The male to female ratio was 12:11. Presenting complaints were dyspnea (61%), paresthesia (35%), chest pain or tightness (43%), muscle spasm (9%), dizziness (13%), palpitations (13%), and panic (30%). Similar previous episodes were reported in 74%. Misattribution of the presenting complaints to a cardiac or other life-threatening disorder was reported in 20 patients (87%) and was the main reason for their presentation to the hospital. Although no patients presented with clinical features of asthma, 7 (30%) were known asthmatics receiving treatment and another 10 (44%) had a history and investigation results suggestive of asthma. Only 2 had a history of anxiety or depression, but 17 (78%) patients exceeded the threshold for anxiety or panic on Clinical Interview Schedule (CIS-R) interview (score > or = 12). Marihuana or alcohol abuse were involved in 17% with a history of past abuse in 26%. When assessed 2 months after the attack, 13 (57%) had resting or stressor-induced hyperventilation with a significant (p < 0.05) association with asthma but not with a positive CIS-R score. These results illustrate the multifactorial basis of acute hyperventilation, the importance of misattribution, and the danger of using the term "hyperventilation syndrome" in the emergency department.
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Affiliation(s)
- S G Saisch
- Department of Respiratory Medicine, King's College School of Medicine and Dentistry, London, UK
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Hornsveld HK, Garssen B, Dop MJ, van Spiegel PI, de Haes JC. Double-blind placebo-controlled study of the hyperventilation provocation test and the validity of the hyperventilation syndrome. Lancet 1996; 348:154-8. [PMID: 8684155 DOI: 10.1016/s0140-6736(96)02024-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hyperventilation syndrome (HVS) describes a set of somatic and psychological symptoms thought to result from episodic or chronic hyperventilation. Recognition of symptoms during the hyperventilation provocation test (HVPT) is the most widely used criterion for diagnosis of HVS. We have investigated the validity of the HVPT and of the concept of HVS. METHODS In a randomised, double-blind, crossover design, the ability of 115 patients with suspected HVS to recognise symptoms during the HVPT was compared with the ability to recognise symptoms during a placebo test (isocapnic overbreathing, with carbon dioxide levels maintained by manual titration). 30 patients who had positive results on the HVPT underwent ambulatory transcutaneous monitoring of pCO2 to ascertain whether they hyperventilated during spontaneous symptom attacks. FINDINGS Of the 115 patients who underwent the HVPT and the placebo test, 85 (74%) reported symptom recognition during the HVPT (positive diagnosis HVS). Of that subset, 56 were also positive on the placebo test (false-positive), and 29 were negative on the placebo test (true-positive). False-positive and true-positive patients did not differ in symptom profile or in physiological variables. During ambulatory monitoring (15 true-positive, 15 false-positive) 22 attacks were registered. Transcutaneous end-tidal, pCO2 decreased during only seven. The decreases were slight and apparently followed the onset of the attack, which suggests that hyperventilation is a consequence rather than a cause of the attack. There were no apparent differences between false-positive and true-positive patients. INTERPRETATION The HVPT is invalid as a diagnostic test for HVS. Hyperventilation seems a negligible factor in the experience of spontaneous symptoms. The term HVS should be avoided.
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Affiliation(s)
- H K Hornsveld
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, Netherlands
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Lavietes MH, Natelson BH, Cordero DL, Ellis SP, Tapp WN. Does the stressed patient with chronic fatigue syndrome hyperventilate? Int J Behav Med 1996; 3:70-83. [PMID: 16250768 DOI: 10.1207/s15327558ijbm0301_6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- M H Lavietes
- Department of Medicine, Chronic Fatigue Syndrome Center, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, USA
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Affiliation(s)
- W N Gardner
- Department of Thoracic Medicine, Kings College School of Medicine and Dentistry, London, United Kingdom
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Gordon GH, Bernstein MJ. PSYCHIATRIC MIMICS OF ALLERGIC AIRWAYS DISEASE. Immunol Allergy Clin North Am 1996. [DOI: 10.1016/s0889-8561(05)70243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hornsveld H, Garssen B, van Spiegel P. Voluntary hyperventilation: the influence of duration and depth on the development of symptoms. Biol Psychol 1995; 40:299-312. [PMID: 7669838 DOI: 10.1016/0301-0511(95)05120-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hyperventilation is considered an important factor in the development of somatic symptoms or even panic attacks, though its role has recently been disputed. Arguments are often based on findings from the so-called Hyperventilation Provocation Test (HVPT), which is a procedure consisting of voluntarily overbreathing. The HVPT has been widely used for diagnosing Hyperventilation Syndrome and for experimentally eliciting panic attacks. Almost no attention, however, has been paid to standardizing the test and determining critical values with respect to depth and duration of hyperventilation. In the present study, symptom development was examined in 16 healthy subjects who underwent four HVPTs that differed in depth of hyperventilation (end-tidal PCO2 < 2.4 kPa or < 1.9 kPa), as well as duration of hyperventilation (2 or 5 min). Both depth and duration appeared to have an independent effect on the development of symptoms. In the 5-min condition, symptoms appeared mainly within the first 3 min. To be sure that the HVPT is long enough and deep enough to elicit symptoms in most people, a minimum duration of 3 min is advised, with end-tidal PCO2 decreasing to at least 1.9 kPa or dropping well over 50% of baseline.
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Affiliation(s)
- H Hornsveld
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
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Boiten FA, Frijda NH, Wientjes CJ. Emotions and respiratory patterns: review and critical analysis. Int J Psychophysiol 1994; 17:103-28. [PMID: 7995774 DOI: 10.1016/0167-8760(94)90027-2] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The literature on emotions and respiration is reviewed. After the early years of experimental psychology, attention to their relationship has been sparse, presumably due to difficulties in adequate measurement of respiration. The available data suggest nevertheless that respiration patterns reflect the general dimensions of emotional response that are linked to response requirements of the emotional situations. It is suggested that the major dimensions are those of calm-excitement, relaxation-tenseness, and active versus passive coping. Research on the emotion-respiration relationships has been largely restricted to the correlates of respiration rate, amplitude, and volume. Finer distinctions than those indicated may well be possible if a wider range of parameters, such as the form of the respiratory cycle, is included in the investigation.
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Affiliation(s)
- F A Boiten
- Department of Experimental Psychology, University of Amsterdam, The Netherlands
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Abstract
1. In nine normal subjects, analysis was performed of the number, length and location of apnoeic pauses during 20 min of recovery following voluntary overbreathing (VHV). Four different rates of recovery of end-tidal PCO2 (PET,CO2), studied in randomized order, were induced by overbreathing to 15 or 25 mmHg, each for 3 or 6 min. Subjects breathed mildly hyperoxic gas mixtures (inspired PO2 approximately 250 mmHg) to and fro into an open circuit via a mouthpiece and pneumotachograph. 2. Apnoeic pauses rarely occurred immediately after the end of VHV but gradually increased in number and length. When averaged across all subjects and protocols, the largest pauses occurred 2.0 +/- 0.3 min (S.D.; range 1.6-2.4 min) after the end of VHV. Based on a definition of apnoea as expiratory time greater than 6 s, apnoeas occurred between mean times of 0.8 and 5.6 min after the end of VHV, the end of this period being associated with a mean PET,CO2 value of 36.4 mmHg, which was below the initial mean resting value of 39.8 mmHg. 3. Within this apnoeic period, 80% of experiments produced apnoeas of less than 10 s duration, 61% of between 10 and 20 s duration and 42% of between 20 and 30 s duration. Only one out of nine subjects consistently failed to show apnoeas. 4. The range of lengths of individual apnoeas and the number per minute were independent of the length and level of VHV and were not significantly different between the four protocols. 5. The number and length of apnoeas did not change in repeated runs in each subject. We were not able to confirm previous reports that apnoeas occurred more frequently in subjects familiar with the experiment. 6. These results reconciled previous studies showing either apnoea or hyperpnoea following voluntary overbreathing in conscious humans. They showed an initial period of heightened breathing lasting about a minute with few apnoeas, consistent with 'after-discharge'. Beyond that, apnoeas occurred as an 'all-or-nothing' phenomenon as long as PET,CO2 was on average less than 3.4 mmHg below resting PET,CO2. The occurrence and length of apnoeas was consistent in individual subjects with no evidence of a learning effect.
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Affiliation(s)
- M S Meah
- Department of Thoracic Medicine, King's College School of Medicine and Dentistry, London
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Abstract
The aim of this article is to present an overview of the practical aspects of capnography and to define its uses and limitations. Modern rapid-response infrared CO2 analyzers are able to follow changes in CO2 concentrations within a single breath and have, therefore, gained wide clinical acceptance for respiratory monitoring and for studying aspects of respiratory control. Their use for the estimation of mean arterial CO2 tensions is limited, however, to individuals with normal lungs during resting metabolic states. They also require careful calibration taking barometric and water vapor pressure into account. Commonly encountered technical problems in capnography are condensation of water vapor and mucus plugging in the sampling tubes as well as poor recordings as a result of faulty connections and electrical interference. These can be minimized through selection and careful setting up of the most appropriate equipment for prevailing conditions. Despite some marked limitations, capnography can be a valuable tool in the assessment of ventilatory state and some aspects of respiratory control.
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Affiliation(s)
- S G Saisch
- Department of Thoracic Medicine, King's College School of Medicine and Dentistry, London, U.K
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Affiliation(s)
- D Sharpstone
- Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire
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