Sighing or psychogenic dyspnea

Specialty: Respiratory.

• sighing breathing
• anxiety hyperventilation syndrome
• functional sighing dyspnea

Why it occurs

• Generalized anxiety disorder or panic attack (panic) (activation of the sympathetic nervous system alters the respiratory pattern, inducing rapid shallow respirations interrupted by deep and ineffective sighs that perpetuate the feeling of lack of air)
• Chronic hyperventilation syndrome of a functional nature (central hypersensitivity to carbon dioxide that leads to predominantly upper costal breathing)
• Acute stress or somatization disorder (physical manifestation of unresolved emotional conflicts)
• Fibromyalgia or central sensitization syndromes (associated with dysfunctional breathing patterns and chronic mild hypocapnia).

Initial workup

Systematic ruling out of organicity through normal Spirometry; Arterial or capillary blood gases (typically showing respiratory alkalosis compensated or not with low PaCO2 and normal or elevated PaO2); 12-lead electrocardiogram (to rule out myocardial ischemia); Nijmegen questionnaire for screening functional hyperventilation.

Standard management

• Fast-acting benzodiazepines such as Alprazolam — 0.25-0.5 mg orally or sublingually punctually in the event of an acute panic hyperventilation crisis
• Lorazepam — 1 mg orally or sublingually
• Sertraline (SSRI antidepressant, initiated at doses of 25-50 mg orally per day as long-term maintenance treatment to control underlying anxiety).