Hypoxaemia in patients with hyperventilation syndrome

Chin, Kazuo; Hirai, Masashi; Kuriyama, T; Kita, Hideo; Nakamura, Toshikatsu; Shimizu, Kazuyoshi; Kuno, Kenshi; Ohi, Motoharu

doi:10.1093/qjmed/90.7.477

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…Given the absence of evidence for organic disease, the disorder seen in this patient was thought to involve a functional abnormality of the breathing pattern under cortical, or perhaps voluntary control. However, such abnormalities in breathing pattern attributed to cortical or psychological causes are typically seen in patients with hyperventilation syndrome [8,9]. This patient, however, showed hypercapnia with apnoea while awake.…”

Section: Discussionmentioning

confidence: 73%

Deep breathing and awake apnoea in a patient who had recurrent hypoxaemia and hypercapnia without sleep apnoea

Chin¹,

Oku²,

Nishimura³

et al. 1998

Eur Respir J

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aaPrimary alveolar hypoventilation is characterized by alveolar hypoventilation in the absence of mechanical hypoventilation [1]. In most patients, hypoventilation is more severe during sleep, and apneic periods are common [2][3][4]. Some patients with primary alveolar hypoventilation have no demonstrable ventilatory response to hypoxia during wakefulness [2,3]. In general, a patient who shows hypoxaemia with hypercapnia during wakefulness is prone to show a further deterioration in blood gases during sleep. We report on a patient who showed central apnoeas with sighs during wakefulness with hypoxaemia and hypercapnia. He had no abnormal breathing during sleep and had normal lung function and normal ventilatory responses to hypoxia and hypercapnia. Administration of a respiratory stimulant (acetazolamide) eliminated apnoeas between sighs, and the patient's hypoxaemia and hypercapnia improved. Case reportA 21 yr old male with dyspnoea was admitted to the Hospital of Chest Disease Research Institute, Kyoto University because of recurrent hypoxaemia with hypercapnia over a 3-month period (arterial oxygen tension (Pa,O 2 ) 9.2 (1.6 SD) kPa, 95% confidence intervals (CI) (7.9-10.5); arterial carbon dioxide tension (Pa,CO 2 ) 6.3 (0.3) kPa (6.0-6.5); pH 7.387 (0.014) (7.376-7.399); n=8) ( fig. 1). The patient was 165 cm tall, and his weight was 60 kg. The patient sighed irregularly at 10-50 s intervals. Medical staff, including physicians, psychoneurologists and nurses, did not find any evidence of a psychiatric problem. The patient had not been exposed to any known toxins, and had not taken any drugs, other than smoking 20 cigarettes·day -1 . The patient's heart size and functional assessment by echocardiography were normal. Despite hypercapnia, he was suspected to have a pulmonary embolism, as evidenced by recurrent hypoxaemia. The patient's pulmonary scintigram, however, was normal, and his pulmonary function was also normal (% vital capacity, 127%; forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, 82%; % diffusing capacity, 112%). He was suspected to have a central nervous system abnormality, possibly multiple sclerosis, because his symptoms and arterial blood gas data fluctuated considerably ( fig. 1) . MagneticDeep breathing and awake apnoea in a patient who had recurrent hypoxaemia and hypercapnia without sleep apnoea. K. Chin, Y. Oku, K. Nishimura, M. Ohi. ©ERS Journals Ltd 1998. ABSTRACT: A 21 yr old with deep breathing and awake apnoea, who had recurrent hypoxaemia and hypercapnia without sleep apnoea, was presented. Although the organic abnormality responsible for the breathing disturbance was not found, administration of acetazolamide facilitated several breaths between sighs, and the patient's hypoxaemia with hypercapnia improved.Some patients who have abnormalities in the cortical control of breathing that cannot be detected by present methods of examination may experience some improvement in breathing with the administration of chemical stimulants such as acetazolamide. E...

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Section: Discussionmentioning

confidence: 73%

Deep breathing and awake apnoea in a patient who had recurrent hypoxaemia and hypercapnia without sleep apnoea

Chin¹,

Oku²,

Nishimura³

et al. 1998

Eur Respir J

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“…MacDonald’s case was reported as an example of a near-fatal instance of PHA. Chin reported hypoxemia and PHA in patients with HVS [13]. Three patients presented PHA, and their SaO 2 levels were 48%, 63%, and 68%.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was successfully treated with intubation and ventilation. Chin et al reported cases with HVS that presented long PHA and severe hypoxemia [13]. The treatments administered to the patients were not mentioned.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have reported PHA related to HVS. To our knowledge, only Inagaki [11], MacDonald [12], and Chin [13] reported PHA with hypoxemia related to HVS. However, aside from MacDonald’s case, there are few previous case reports of HVS patients who were rescued from PHA after having long term PHA accompanied by cyanosis, hypoxemia, and loss of consciousness.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged post-hyperventilation apnea in two young adults with hyperventilation syndrome

Munemoto

Masuda²,

Nagai³

et al. 2013

BioPsychoSocial Med

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BackgroundThe prognosis of hyperventilation syndrome (HVS) is generally good. However, it is important to proceed with care when treating HVS because cases of death following hyperventilation have been reported. This paper was done to demonstrate the clinical risk of post-hyperventilation apnea (PHA) in patients with HVS.Case presentationWe treated two patients with HVS who suffered from PHA. The first, a 21-year-old woman, had a maximum duration of PHA of about 3.5 minutes and an oxygen saturation (SpO2) level of 60%. The second patient, a 22-year-old woman, had a maximum duration of PHA of about 3 minutes and an SpO2 level of 66%. Both patients had loss of consciousness and cyanosis. Because there is no widely accepted regimen for treating patients with prolonged PHA related to HVS, we administered artificial ventilation to both patients using a bag mask and both recovered without any after effects.ConclusionThese cases show that some patients with HVS develop prolonged PHA or severe hypoxia, which has been shown to lead to death in some cases. Proper treatment must be given to patients with HVS who develop PHA to protect against this possibility. If prolonged PHA or severe hypoxemia arises, respiratory assistance using a bag mask must be done immediately.

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“…There are reports that hypoxemia and hypercapnemia may occur in patients with apnea or hypopnea that is consistent with the apnea and hypopnea criteria established by the American Academy of Sleep Medicine (AASM), 16 and that in such cases the patient may hyperventilate to remedy the situation. 17 Based on these reports, we judged apnea and hypopnea to occur when there was a clear decrease in respiratory amplitude for more than 10 s, or when there was a decrease in amplitude of more than 30% compared with the normal respiratory waveform for more than 10 s and a forced respiratory waveform with an acute rhombus (or triangle) shape accompanying hyperventilation. There is a possibility of mistakes due to body movement if there is not a forced respiratory waveform when apnea and hypopnea are analyzed in the SD-101.…”

Section: Sd-101mentioning

confidence: 99%

A sheet-type device for home-monitoring sleep apneas in children

Arimoto

Shiomi

Sasanabe

et al. 2011

Sleep and Biological Rhythms

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There are some simplified devices for screening SAS. However, they have some problems as to a way to operate and disconnection of oro-nasal sensors in children. The simplified device that had used the multipoint pressure sensor seat (SD-101) recently was developed in Japan. For adults, the utility of SD-101 is reported. This study was performed to clarify the usefulness of SD-101 in detecting SAS in children. The infant (0-12 years old) from whom they consulted Sleep Disorders Center or otorhinolaryngology at Aichi Medical University hospital and SAS had been doubted was targeted between October 2005 and November 2009. The inspection was executed using PSG together with SD-101 under hospitalization and using another simplified device (LS-300) with SD-101 at house. The analysis of SD-101 was done by using software for adults and added to the manual correction. SD-101 judged apnea-hypopnea when the respiratory pressure changes decrease. The correlation was admitted in AHI of 31 examples that used PSG together with SD-101 (R 2 = 0.87). The cases who had used LS-300 together with SD-101 were 75 examples. AHI could not be obtained in the remaining 21 children with LS-300, but was obtained in all children with SD-101. AHI of SD-101 tended to go out to a low value compared with other methods. The high utility of SD-101 became clear. However, as there was a problem in the mode of analysis as well, it will be necessary to develop analytical software with the infant in the future.

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Hypoxaemia in patients with hyperventilation syndrome

Cited by 9 publications

References 6 publications

Deep breathing and awake apnoea in a patient who had recurrent hypoxaemia and hypercapnia without sleep apnoea

Deep breathing and awake apnoea in a patient who had recurrent hypoxaemia and hypercapnia without sleep apnoea

Prolonged post-hyperventilation apnea in two young adults with hyperventilation syndrome

A sheet-type device for home-monitoring sleep apneas in children

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