Hyperventilation disorders

Hyperventilation syndrome falls into the shadowy hinterland between physiology, psychiatry, psychology and medicine. In this respect it joins a long list of syndromes from the past of which effort syndrome is just one example. Myalgic encephalomyelitis (ME) and postviral fatigue syndrome are recent attempts to impose a unitary definition on what is probably a complex interaction between many different organic and psychological factors. The recent introduction of terms such as somatization disorder recognize this aetiological heterogeneity (1).

The symptoms of hypocapnia induced by voluntary overbreathing were first described by Haldane in 1908, the first case of spontaneous hyperventilation by Goldman in 1922 (2), and the term Hyperventilation Syndrome was first used by Dalton, Kerr and Gliebe in 1937 to describe patients with symptoms both of hypocapnia and anxiety (3). Since then, many different interpretations of this term have appeared in the literature encompassing patients with widely different aetiologies. Much research in this area is bedevilled by failure to define clearly the detailed characteristics of the patients studied; by the assumption of definitions for which there is no universal agreement; and by the presentation of scientifically unsound data lacking in rigorous quantitative proof and with perpetuation of circular arguments. The papers in this issue of the journal make a commendable attempt to reintroduce the reader to the historical perspectives of this subject and to clarify some of the issues, but unfortunately also have some of the shortcomings common to so many of the studies in this very difficult field.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292944/pdf/jrsocmed00129-0005.pdf

 

Source: Gardner W. Hyperventilation disorders. J R Soc Med. 1990 Dec;83(12):755-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1292944/

 

Aerobic work capacity in chronic fatigue syndrome

Comment on Aerobic work capacity in patients with chronic fatigue syndrome. [BMJ. 1990]

SIR,

The data of Dr Marshall S Riley and colleagues (1) are consistent with our findings (2) that most patients referred with the chronic fatigue syndrome have the effort syndrome-that is, chronic hyperventilation as a consequence of excessive effort and distress.(3)

May we draw attention to three points. Dr Riley and colleagues concluded that the patients could not be hyperventilating because their values of end-tidal partial pressure of carbon dioxide at rest and at peak exercise did not differ significantly from those of the controls.

In our opinion the values published for the controls (35 8 mmHg at rest and 36-3 mmHg at peak exercise) are too low to be accepted as normal. The finding that the patients reached their anaerobic threshold far quicker than did the controls is consistent with the early acidosis on exertion known to occur in chronic hyperventilation. This is a consequence of the depletion of the body’s buffer base reserves,(4) brought about by renal compensation for chronic respiratory alkalosis.(5)

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664329/pdf/bmj00207-0055b.pdf

 

Source: Rosen SD, King JC, Wilkinson JB, Nixon PG. Aerobic work capacity in chronic fatigue syndrome. BMJ. 1990 Nov 24;301(6762):1217. [Comment] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664329/