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Cited by 168Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesRespiratory and Cough-Related Research

Double-blind placebo-controlled study of the hyperventilation provocation test and the validity of the hyperventilation syndrome

Hornsveld, HK, Garssen, B, Dop, MJC Fiedeldij, van Spiegel, PI, de Haes, JCJM·1996·The Lancet
DOI 10.1016/s0140-6736(96)02024-7
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Abstract

Background Hyperventilation syndrome (HVS) describes a set of somatic and psychological symptoms thought to result from episodic or chronic hyperventilation. Recognition of symptoms during the hyperventilation provocation test (HVPT) is the most widely used criterion for diagnosis of HVS. We have investigated the validity of the HVPT and of the concept of HVS. Methods In a randomised, double-blind, crossover design, the ability of 115 patients with suspected HVS to recognise symptoms during the HVPT was compared with the ability to recognise symptoms during a placebo test (isocapnic overbreathing, with carbon dioxide levels maintained by manual titration). 30 patients who had positive results on the HVPT underwent ambulatory transcutaneous monitoring of pCO2 to ascertain whether they hyperventilated during spontaneous symptom attacks. Findings Of the 115 patients who underwent the HVPT and the placebo test, 85 (74%) reported symptom recognition during the HVPT (positive diagnosis HVS). Of that subset, 56 were also positive on the placebo test (false-positive), and 29 were negative on the placebo test (true-positive). False-positive and true-positive patients did not differ in symptom profile or in physiological variables. During ambulatory monitoring (15 true-positive, 15 false-positive) 22 attacks were registered. Transcutaneous end-tidal, pCO2 decreased during only seven. The decreases were slight and apparently followed the onset of the attack, which suggests that hyperven…

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Crossref · 10.1016/s0140-6736(96)02024-7

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  • The hyperventilation provocation test is no longer considered a reliable way of diagnosing HVS.

    “A score of >23 is commonly used as a cut-off for HVS, although this was calculated using a positive hyperventilation provocation test as the gold standard, which itself is no longer considered a reliable way of diagnosing HVS [26].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [26]

  • A score of >23 is commonly used as a cut-off for HVS.

    “A score of >23 is commonly used as a cut-off for HVS, although this was calculated using a positive hyperventilation provocation test as the gold standard, which itself is no longer considered a reliable way of diagnosing HVS [26].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [26]

  • The >23 cut-off was calculated using a positive hyperventilation provocation test as the gold standard.

    “A score of >23 is commonly used as a cut-off for HVS, although this was calculated using a positive hyperventilation provocation test as the gold standard, which itself is no longer considered a reliable way of diagnosing HVS [26].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [26]

  • A study in the Lancet found a high rate of false positives in patients where end-tidal carbon dioxide was controlled via a facemask.

    “It was felt these symptoms were due to low end-tidal carbon dioxide, but a study in the Lancet found a high rate of false positives in patients where end-tidal carbon dioxide was controlled via a facemask [26].”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [26]

  • Many symptoms of hyperventilation syndrome can occur in normocapnia.

    “many of these symptoms can occur in normocapnia [26, 55, 56]”

    From Dysfunctional breathing: a review of the literature and proposal for classification (2016) · cites this paper as [26]

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Authors
Hornsveld, H., Garssen, B., Dop, M. F., van Spiegel, P., & de Haes, J.
Affiliations
Amsterdam UMC Location University of Amsterdam (NL)
ORCID
Garssen, B
Venue
The Lancet
Publisher
Elsevier BV
Published
1996-07
Volume
348
Issue
9021
Pages
154-158
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(96)02024-7
OpenAlex
W2102303952
Cited by
168
References
34
Citations by year
2026: 4 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 4 · 2014: 6 · 2013: 6 · 2012: 8
FWCI
6.58
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
Keywords
hyperventilation syndrome, diagnostic validity, false-positive diagnosis, transcutaneous carbon dioxide monitoring, end-tidal PCO2, hyperventilation, symptom recognition, ambulatory monitoring
MeSH terms
Adult, Blood Gas Monitoring, Transcutaneous, Double-Blind Method, False Positive Reactions, Female, Humans, Hyperventilation, Male, Reproducibility of Results, Case-Control Studies, Cross-Over Studies

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