Scientific publications on hyperventilation

This article was written by Ph. D. B. Snitslaar, neurologist, in the 80’s associated with the Phobias project of the Department of Personality Studies of the sub faculty of Psychology at the University of Amsterdam. Later he was employed by the Common Medical Service, Research and Development department, Research section. Although many medical terms are used in this article, it can still provide good background information. Even if you are not a medical doctor and are interested in more accurate information about chronic hyperventilation syndrome, the medical articles on this site may be of interest to you.

Scientific publications on chronic hyperventilation have been published since the 1920’s. We refer to the predominantly psycho-social-determined respiratory alkalosis, and not to primarily organically induced hyperventilation.

An impressive amount of knowledge in the scientific publications on hyperventilation

There is an impressive amount of knowledge available about this condition. Yet the diagnosis is lacking in a remarkably large number of patients. For example, at the request of the G.A.K. and the G.M.D., the writer saw 24 persons as part of a psychiatric expertise research in 1980 and the first half of 1981. Based on the anamnestic criteria and findings from research, 18 of them were diagnosed with chronic hyperventilation. It was probable that this condition was by far the most important – or even the only source – of the symptoms which led to absenteeism or incapacity for work. In all 18 cases (75%) the diagnosis had not been made before.

The diagnosis hyperventilation syndrome only at 0.1%

It is possible that the selection criteria used – not yet identified – were the cause. Perhaps only and especially patients with chronic hyperventilation were referred. Nevertheless, it remains remarkable that, for example, in 1980, in the 16,183 cases reported in the diagnosis category V (psychological illnesses), the diagnosis of hyperventilation syndrome was imposed in no more than 179 persons (0.1%).

5 – 11% of patients who consult a house doctor do this because of hyperventilation

Several authors have already made it probable that patients suffering from hyperventilation are not recognized as such among patients who report with symptoms to a doctor. For example, Tavel (1964) found that 5 – 11% of patients who consulted a general practitioner, did so on the basis of symptoms that ultimately turned out to be hyperventilation. Noehren (1966) mentioned 10% for clinical practice in general. And McKell considered that the diagnosis hyperventilation syndrome in 500 patients in a gastroenterology clinic to be 5.8%. In 1969, Silverman wrote that about 30% of non-psychotic psychiatric patients suffered from the syndrome.

25% of patients with hyperventilation received cardiological referrals

Lum examined 700 hyperventilation sufferers in the 1970’s. He reported, among other things, that 25% of these patients had cardiological referrals. Nevertheless, in the end the cause of the symptoms turned out to be the hyperventilation syndrome.

The ‘hyperventilation syndrome’ in the English-language learning and handbooks

However, Lum also pointed to the following. The English-language learning and handbooks mention under the heading ‘hyperventilation syndrome’ only the classical triad. Massive and evident over breathing, paresthesias around mouth and acra and tetanias. Tetanias are rare and are seen in no more than 1% of hyperventilating patients.

Chronic hyperventilation is often not adequately diagnosed

In general, physicians assume that hyperventilation syndrome is exclusively characterized by acute attacks of over breathing. With the symptoms that occur. Nevertheless, it has been shown that chronic hyperventilation is common. This phenomenon is often not adequately diagnosed. We believe this is due to the following reasons.

• The obscurity of doctors with the phenomenon. The condition does not appear as such in the medical handbooks and textbooks. And also gets little attention in the education to the future doctor.
• The patients in question often show a peculiarity characteristic of the the presentation of the symptoms. The doctor consulted experiences a discrepancy between the patient’s degree of anxiety on the one hand and the absence of objective symptoms of a well-defined conventional clinical picture on the other. In addition, there is often a strange kind of vagueness in the symptom presentation. In my opinion that is a translation of the patient’s great uncertainty. And of his need for guidance. This induces uncertainty on the part of the physician. And then it is easier to reassure the patient with the statement ‘that he has nothing’ and that it is based on ‘nerves’.
• Sometimes the physician feels himself fooled by the patient. The doctor dealt with symptoms that seemed to indicate a disorder in the circulatory tract, digestive tract, thyroid function, or the central nervous system. These symptoms seemed to provide a grip in a situation of uncertainty. They were then too eagerly used to refer the patient to a specialist, who then also ‘finds nothing’.

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