Hyperventilation syndrome: an elegant but scientifically untenable concept
Open accessAbstract
The concept of hyperventilation and the principle of a vicious circle provide an elegant explanation for the development of a wide range of somatic and psychological symptoms, the so-called hyperventilation syndrome (HVS). The model has a high degree of credibility and has led to the development of therapeutic interventions that appeared beneficial. However, recent investigations dismiss hyperventilation as an important symptom-producing mechanism. First, the hyperventilation provocation test appears to be invalid as a diagnostic test. Second, studies using ambulant monitoring of pCO2 demonstrate that the vast majority of real-life attacks are not attended by decreases in pCO2. Third, the evaluation of therapy outcome studies indicate that the beneficial effect of breathing retraining is probably not mediated by reducing the tendency to hyperventilate. We conclude that a diagnosis of HVS should be avoided.
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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 [56]
The clinical community acknowledges physiotherapy as an effective treatment for HVS and, more broadly, for chronic dysfunctional breathing.
“However, the clinical community acknowledge physiotherapy as an effective treatment for HVS and, more broadly, for chronic dysfunctional breathing.”
From Physiotherapy Education and Breathing Retraining for Patients With Hyperventilation Syndrome: An Observational Study (2026) · cites this paper as [27]
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- Authors
- HORNSVELD, H., & GARSSEN, B.
- Affiliations
- Slotervaartziekenhuis (NL)
- Corresponding author
- HORNSVELD, H
- ORCID
- GARSSEN, B
- Venue
- The Netherlands Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1997-01
- Volume
- 50
- Issue
- 1
- Pages
- 13-20
- ISSN
- 0300-2977 (ISSN-L)
- OpenAlex
- W1970367291
- Cited by
- 62
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 4 · 2014: 5 · 2013: 8 · 2012: 2
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- green
- dare.uva.nl
- Licence
- Locations
- The Netherlands Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- 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, hyperventilation, vicious circle, arterial carbon dioxide, breathing retraining, somatic symptoms, psychological symptoms, diagnostic validity
- MeSH terms
- Humans, Hyperventilation, Panic, Psychophysiologic Disorders, Respiratory Function Tests, Syndrome
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