Hyperventilation syndrome is a neuropsychiatric pathology that leads to the formation of a pathological respiratory rhythm that increases pulmonary ventilation with the development of alkalosis. It is accompanied by variable vegetative, algic, musculotonic, respiratory, mental disorders. It is diagnosed by testing, hyperventilation test and blood electrolyte analysis. Treatment consists of a combination of non-drug (psychotherapy, relaxation techniques, breathing exercises, BOS therapy) and drug (psychotropic drugs, magnesium, calcium preparations) methods.
F45.3 Somatoform dysfunction of the autonomic nervous system
The term “hyperventilation syndrome” was introduced by the American physician Da Costa in 1871. Subsequently, variable synonymous names of the disease were proposed: “respiratory neurosis”, “neurorespiratory syndrome”, “respiratory dystonia”, but the most widespread remained behind the original term. Hyperventilation syndrome (HVS) is observed in 6-11% of patients seeking medical help. The disease affects people of various age categories, including the elderly and children. The peak incidence occurs at 30-40 years. Women get sick 4-5 times more often than men. HVS has a predominantly chronic course, acute cases account for only 2% of those who are ill.
Etiological triggers that provoke the formation of HVS are polymorphic and are realized against the background of habitually incorrect breathing, which arose due to cultural characteristics, lived life experience, practicing certain sports (running, swimming), playing wind instruments. These factors are divided into:
- Psychogenic. They occur in 60% of cases of HVS. The leading role belongs to mental disorders: anxiety disorder, depression, neurasthenia, phobic disorders, less often – hysterical neurosis. Acute and chronic stressful situations can provoke hyperventilation syndrome. In some cases, the background for the development of the disease is the psychogeny of childhood – childhood situations in which the patient witnessed an episode of asphyxia, an attack of bronchial asthma, suffocation of a drowning person.
- Organic. They include CNS lesions (hydrocephalus, arachnoiditis, dyscirculatory encephalopathy) and diseases of internal organs (hypertension, recurrent bronchitis, diabetes mellitus). The effect of purely organic etiofactors is observed in 5% of patients with HVS.
- Mixed. The effect of a psychogenic trigger is realized against the background of organic pathology. They make up 35% of the total number of cases.
Hyperventilation syndrome can be provoked by drugs of the following groups: beta-adrenomimetics, salicylates, methyl derivatives of xanthine, progesterone preparations.
The functioning of the respiratory system is not as autonomous as the work of other systems and organs. A person is able to regulate the depth of inhalation and exhalation, arbitrarily hold his breath, strengthen it. This feature causes a close connection of the respiratory function with the psychoemotional state. Psychogenic triggers, especially anxiety, provoke biochemical shifts that lead to a violation of the calcium-magnesium balance. There are changes in the work of respiratory enzymes that potentiate the development of hyperventilation. Excessive release of carbon dioxide leads to a drop in its concentration in the blood – hypocapnia, a shift in the pH of the blood to the alkaline side with the development of respiratory alkalosis. These changes cause clinical symptoms: disorders of consciousness, vegetative, sensory, algic disorders, manifestations of tetany. The result is increased anxiety that supports hyperventilation. A vicious circle is formed, which continues to exist even after the termination of the provoking etiofactor.
Hyperventilation syndrome is characterized by the multiplicity and polymorphism of emerging symptoms. Among the variety of symptoms, a typical triad can be traced: respiratory dysfunction, disorders of the emotional sphere, muscle-tonic phenomena. Respiratory disorders are represented by four forms. The first is a subjective feeling of lack of air (“empty breathing”), forcing the patient to take deeper and/or frequent breaths. The second is difficulty breathing, characterized by patients as “tightness when inhaling”, “lump in the throat”, “air entering the lungs, requiring effort”. There is arrhythmic increased breathing with the participation of auxiliary respiratory muscles. The third option is a disorder of respiratory automatism, which is accompanied by a feeling of respiratory arrest, prompting the patient to constantly monitor the respiratory process and consciously “correct” it. The fourth form includes the hyperventilation equivalent, which is yawning, deep sighs, snuffling, coughing.
Psychoemotional disorders are of the nature of anxiety, fear. Typically generalized anxiety disorder. Patients note constant nervous tension, increased anxiety, loss of the ability to relax. The fear of open spaces (agoraphobia) and public places (social phobia) is reinforced by the aggravation of respiratory disorders in them. Musculotonic syndrome is caused by changes in the electrolyte composition of the blood, causing an increase in neuromuscular excitability. It includes paresthesia (sensory disorders felt as “crawling goosebumps”, numbness, burning, tingling in certain parts of the body), tetanic phenomena (tonic convulsions of the distal extremities, muscle spasms). Carpopedal spasm is possible.
The classic symptoms of the disease are combined with algic symptoms: headaches, cardialgia, abdominal pain. Complaints from the cardiovascular system include discomfort in the heart, palpitations, from the gastrointestinal tract – dyspepsia, unstable stools, flatulence. Disorders of consciousness are typical: obscurity, blurring, syncopal states.
Hyperventilation crisis is an acute condition with a pronounced respiratory rhythm disorder. There is a fear of suffocation. Hyperventilation crisis refers to panic attacks, accompanied by typical symptoms for them: hyperhidrosis, chills, dizziness, nausea, palpitations, fear of death, a feeling of suffocation, hot and / or cold flushes, discomfort in the cardiac region. The condition is associated with psychological discomfort. Occurs in places where, according to the patient’s conviction, he will not be able to provide proper care. A specific feature of the crisis is its relief when breathing in a cellophane (paper) bag. The patient inhales the air that he exhaled into the bag. The air contains an increased concentration of CO2, which allows you to quickly reduce respiratory alkalosis and stop the symptoms caused by it.
Polymorphism of manifestations, dominance of respiratory disorders leads to the initial erroneous assumption about the presence of pathology of the respiratory or cardiovascular system. Patients are examined by a therapist, pulmonologist, cardiologist without revealing serious organic pathology. The reason for the consultation of a neurologist or psychiatrist is the emotional coloring of complaints, expressed anxiety of the patient. To diagnose hyperventilation syndrome allows:
- Psychogenic anamnesis. Indications of a traumatic situation, childhood fears, neurosis, neurasthenia, depressive syndrome are important.
- Neurological examination. Reveals distal hyperhidrosis, positive tests for latent tetany: symptoms of Khvostek, Weiss, Schlesinger, Trusseau test. Additionally, electromyography is performed to confirm neuromuscular hyperexcitability and tetany.
- Psychological examination. It includes the study of personality structure, psychological testing. The Naimigen questionnaire developed in the Netherlands is used, which in 90% of cases allows detecting HVS.
- Hyperventilation test. It is carried out by arbitrary hyperventilation performed by the patient. A positive result (the occurrence of typical vegetative, psychoemotional, tetanic changes) allows us to confirm the diagnosis of HVS.
- Blood electrolytes. There is a drop in the concentration of calcium, magnesium in the blood.
- Examination of internal organs. It is necessary to exclude organic pathology. Tachycardia, lability of pulse and blood pressure are characteristic, extrasystole is possible, fluctuation of the ST segment on the electrocardiogram. Lung X-ray, FVD examination remain normal. Examination of the gastrointestinal tract reveals functional abnormalities in the form of various types of dyskinesia.
Hyperventilation syndrome should be differentiated with respiratory diseases, hypoparathyroidism. The main difference between HVS is labored inhalation, COPD is labored exhalation. Hypoparathyroidism is accompanied by osteosclerosis, calcium deposition in the internal organs, and a decrease in the level of parathyroid hormone.
Therapy is carried out in a complex way by combining pharmacotherapy and non-drug methods. An important role is played by conducting explanatory conversations explaining the nature of disorders, showing the connection of somatic symptoms with an emotional state, convincing in the absence of an organic disease. The treatment includes:
- Psychotherapy. Cognitive-behavioral, psychoanalytic techniques are successfully applied. The presence of childhood psychogeny is an indication for conducting psychoanalysis sessions.
- Formation of proper breathing. It is carried out by regular breathing exercises. An auxiliary technique is the training of relaxation techniques. Hyperventilation crisis is stopped by breathing into a bag.
- BOS therapy. With the help of the equipment, the patient receives objective information about the state of breathing, learns to regulate the respiratory function taking into account the feedback received.
- Medical correction of the mental sphere. The most effective antidepressants with a pronounced anxiolytic effect (fluvoxamine, amitriptyline). It is possible to prescribe sedatives, neuroleptics, tranquilizers. Benzodiazepines (diazepam) are used in the crisis. A pronounced vegetative component is an indication for the use of vegetotropic drugs.
- Elimination of electrolyte disturbances. It is achieved by taking calcium and magnesium preparations. Calcium reduces the tendency to tetany, magnesium has a calming, anticonvulsant effect.
The duration of therapy is usually 4-6 months. To prevent relapses, follow-up of the patient is necessary.
Prognosis and prevention
Hyperventilation syndrome does not pose a danger to life, but significantly reduces its quality. The lack of treatment leads to the further realization of a vicious circle, aggravation of symptoms. Correct complex therapy promotes recovery. In the future, the resumption of trigger factors may cause the development of relapse. Prevention of HVS includes the formation of a benevolent optimistic outlook on life, adequate response to stressful situations, timely correction of emerging psychological problems.