What are the causes of hyperventilation syndrome?

From the Guidelines

Hyperventilation syndrome is primarily caused by anxiety, stress, and panic disorders, as evidenced by the most recent study 1, which highlights the importance of psychological factors in the diagnosis and management of this condition. The main causes of hyperventilation syndrome include:

• Anxiety and panic attacks: These can trigger rapid, shallow breathing, as noted in the 2016 study 1, which recommends referring patients for psychological evaluation when symptoms such as hyperventilation and anxiety disorders are present.
• Stress: Chronic stress can lead to altered breathing patterns, as mentioned in the 2003 study 1, which discusses the role of psychogenic disorders, including anxiety and stress, in the development of hyperventilation syndrome.
• Other potential causes, such as pain, medical conditions, hormonal changes, medications, and environmental factors, may also contribute to hyperventilation syndrome, but the evidence suggests that anxiety and stress are the primary triggers. To manage hyperventilation syndrome, practicing slow, deep breathing exercises and seeking treatment for underlying anxiety or stress disorders is crucial, as cognitive-behavioral therapy and relaxation techniques can be effective in reducing symptoms, as suggested by the 2016 study 1. Understanding the physiological basis of hyperventilation syndrome, which reduces blood CO2 levels, leading to respiratory alkalosis, can help explain symptoms such as dizziness, tingling sensations, and other associated symptoms, as discussed in the 2003 study 1.

From the Research

Causes of Hyperventilation Syndrome

The causes of hyperventilation syndrome are complex and multifaceted. Some of the key factors that contribute to the development of this condition include:

• Anxiety and panic disorders, which are closely linked to hyperventilation syndrome 2, 3
• Voluntary hyperventilation, which can provoke panic-like symptoms in some patients with panic disorder 2, 3
• Psychologic factors, such as stress and catastrophic cognitions, which can produce hyperventilation 2, 3
• A biologically and often genetically determined hypersensitivity of a central "alarm" system, which can lead to panic and hyperventilation 3
• Unsteadiness of breathing, which can characterize patients with hyperventilation syndrome and anxiety disorders 4

Physiological Mechanisms

The physiological mechanisms underlying hyperventilation syndrome are not fully understood, but some studies suggest that:

• Hyperventilation can lead to a decrease in end-tidal CO2 fractional concentration (FET,CO2) 5, 4
• Breathing patterns, such as tidal volume and respiratory frequency, can be affected in patients with hyperventilation syndrome 5, 4
• The respiratory control system may be less resistant to challenges, such as mouthpiece breathing or voluntary hyperventilation, in patients with hyperventilation syndrome 4

Relationship to Panic Attacks

The relationship between hyperventilation and panic attacks is still a topic of debate. Some studies suggest that:

• Hyperventilation may not be an important symptom-producing mechanism in panic attacks 6
• Panic attacks may not always be accompanied by hyperventilation, and the degree of hyperventilation may not be impressive even when it does occur 6