Hyperventilation & Chronic Fatigue Syndrome (CFS)

We studied the link between chronic fatigue syndrome (CFS) and

hyperventilation in 31 consecutive attenders at a chronic

fatigue clinic (19 females, 12 males) who fulfilled criteria

for CFS based on both Oxford and Joint CDC/NIH criteria. All

experienced profound fatigue and fatigability associated with

minimal exertion, in 66% developing after an infective

episode. Alternative causes of fatigue were excluded.

Hyperventilation was studied during a 43-min protocol in which

end-tidal PCO2 (PETCO2) was measured non-invasively by

capnograph or mass spectrometer via a fine catheter taped in a

nostril at rest, during and after exercise (10-50 W) and for

10 min during recovery from voluntary overbreathing to

approximately 2.7 kPa (20 mmHg). PETCO2 < 4 kPa (30 mmHg) at
rest, during or after exercise, or at 5 min after the end of

voluntary overbreathing, suggested either hyperventilation or

a tendency to hyperventilate. Most patients were able

voluntarily to overbreathe, but not all were able to exercise.

Twenty-two patients (71%) had no evidence of hyperventilation

during any aspect of the test. Only four patients had

unequivocal hyperventilation, in one associated with asthma

and in three with panic. Only one patient with severe

functional disability and agoraphobia had hyperventilation

with no other obvious cause. A further five patients had

borderline hyperventilation, in which PETCO2 was < 4 kPa (30
mmHg) for no more than 2 min, when we would have expected it

to be normal. There was no association between level of

functional impairment and degree of hyperventilation. There is

only a weak association between hyperventilation and chronic

fatigue syndrome.

Saisch SG, Deale A, Gardner WN, Wessely S

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