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Treatment of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
It is suggested that locus ceruleus inhibition of hippocampal activity produces anxiety. Benzodiazepines may reduce generalized anxiety but not sodium lactate induced panic. Since benzodiazepine receptors are dense in limbic structures, it may be that these anxiolytics act there but not in the brain stem. There are well-known pathways from the limbic system to the locus ceruleus. Gorman et al. suggest that “repeated stimulation of limbic neurons by brain stem discharge lowers the threshold to excitatory postsynaptic stimulation in the limbic lobe until `subpanic’ stimulation is capable of maintaining the ‘kindled’ anticipatory anxiety. Thus, even without the further occurrence of panic, the limbic area continues to have a reduced threshold for response to various stressors.” It may be that the hyperventilation that accompanies panic attacks causes reduced cerebral blood flow in the limbic system and is thereby responsible for the symptoms of hyperventilation syndrome. In our CFS SPECT scan population, the patients who chronically hyperventilated (as determined by end-tidal pCO2) could be symptomatically distinguished from those who did not only by the presence of fibromyalgia tender points. Addition of agents which markedly increase cerebral blood flow, such as calcium channel blockers (except for nimodipine) and acetazolamide, do not often reduce such symptoms. Patients with anxiety disorders, however, have normal, or increased, cerebral blood flow.89 Acetazolamide lowers brain pH but causes hyperventilation.
Psychiatric Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Anxiety disorders include those such as panic disorder, agoraphobia and other phobias, obsessive-compulsive disorder, posttraumatic stress disorder, seasonal affective disorder (SAD), general anxiety disorder, hypochondriasis, and somatization disorder. The anxiety disorders, sometimes called anxiety reactions or phobic states, are characterized by exaggerated fear and anxiety that are long lasting and inappropriate to the situation. Simple anxiety states include both the psychic and physical symptoms of tension, irritability, sleep difficulties, impaired appetite, impotence and other difficulties with sexual relations, diarrhea when anticipating stress, frustration, tachycardia, and fatigability. Hyperventilation syndrome (overbreathing) may lead to tingling skin, numbness in extremities, and dizziness. Pessimism and despondency are common, and patients often have difficulty making decisions.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
One cause of dyspnea that never occurs while sleeping is hyperventilation syndrome. The primary clinical manifestations of hyperventilation syndrome are intermittent episodes of tachypnea and subjective discomfort characterized by air hunger or an urge to breathe. Despite taking large tidal volumes, patients perceive that they cannot get a deep breath. Patients with hyperventilation syndrome experience dyspnea during the day, but objective assessment reveals normal spirometry, normal DLCO, and normal chest imaging. While sleeping, these patients have normal breathing patterns and appear quite comfortable.
Asthma-related hospitalizations after implementing SABA-free asthma management with a maintenance and anti-inflammatory reliever regimen
Published in European Clinical Respiratory Journal, 2022
L. J. Nannini, N. S. Neumayer, N. Brandan, O. M. Fernández, D. M. Flores
The demographic and clinical characteristics of patients included in this analysis during both periods are presented in Table 1 [Table 1 near here]. In 1999 and 2004, 26 patients with asthma who were being treated at other centers were admitted to our hospital due to asthma exacerbations; nine patients treated at our asthma center were also admitted to hospital during that same time period. Only one of the nine patients were admitted twice and she died due to breast cancer 5 years later. Four further patients were lost for follow-up in the next study period. During the 2-year period 2017–2018, 18 patients who were being treated and followed up at other centers had asthma exacerbation-related hospitalizations, while only one patient treated at our asthma center was admitted to hospital during that same time period. This patient had a history of asthma and hyperventilation syndrome that resembled a severe asthma exacerbation. Notably, the only patient that died from this 2017 and 2018 group was a 53-year-old male patient with asthma who was being treated at one of the other centers and receiving SABA regularly following discontinuation of ICS plus long-acting β2-agonist (LABA) therapy. Our asthma patients in the 2017 and 2018 time period received: only budesonide/formoterol as needed in a 22%; while 75% were on regular maintenance budesonide/formoterol plus as needed. Twenty-two patients were under high ICS doses plus tiotropium and only two patients received omalizumab of the 869 patients.
Diagnosis and management of central sleep apnea syndrome
Published in Expert Review of Respiratory Medicine, 2019
Sébastien Baillieul, Bruno Revol, Ingrid Jullian-Desayes, Marie Joyeux-Faure, Renaud Tamisier, Jean-Louis Pépin
As mentioned by Randerath et al. in their recent task force report, idiopathic central sleep apnea is rare and of unknown prevalence and origin [1], occurring in patients without any underlying cardiac or neurological disease [9]. Described as an hypocapnic CSA, the episodes of CSB are approximatively 30–40 seconds long, mainly driven by an elevated chemosensitivity to PaCO2 (high-loop gain per se) [9]. Arousals, occurring in a characteristic manner at the peak of hyperventilation, contribute to the increase in ventilation, perpetrating cyclical breathing patterns through enhanced chemo-responsiveness [9]. Controlling PaCO2 levels, as well as reducing the arousal index are two potential therapeutic targets. Thus, added dead space, by elevating CO2 levels, or CO2 inhalation have been proposed as treatment strategies for idiopathic CSA. Zolpidem and Acetazolamide have shown efficacy in reducing arousals and central apneas in this condition [9]. Sharing the same mechanisms, hyperventilation syndrome (HVS), a frequent behavioral condition, is associated with CSA [42]. Taking into account the underlying mechanisms, ASV may be indicated for symptomatic idiopathic CSA and HVS.
Arabization of Nijmegen questionnaire and study of the prevalence of hyperventilation in dizzy patients
Published in Hearing, Balance and Communication, 2019
Hossam Saneyelbahaa Talaat, Asmaa Salah Moaty, Mai Ahmed Elsayed
Dizziness is a very common complaint. The term ‘dizzy’ is usually used nonspecifically, it is essential to realize the precise nature of symptoms. Non-vertiginous dizziness includes feeling of passing out, light- headedness, unsteadiness, presyncope or disequilibrium [1]. Hyperventilation is a major cause of non-vertigo dizziness complaints [2]. Hyperventilation syndrome (HVS) is a respiratory disorder, physiologically or psychologically based, it involves breathing too rapidly. HVS can lead to significant patient morbidity as it results in many symptoms including chest tightness, breathlessness, dizziness, tremors and paraesthesia due to decreased arterial partial pressure of carbon dioxide (PCO2) which leads to respiratory alkalosis [3]. Testing hyperventilation is one of the most important tests used in the ‘bed-side examination’ for assessment of vestibular patients [4]. Diagnosis of hyperventilation is very important for establishment of adequate vestibular rehabilitation by addition of breathing control exercises.