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Thorax 1993;48:809-81 1 809
Pattern of lung volumes in patients with sighing
breathing
Gabriel Aljadeff, Morico Molho, Ido Katz, Shlomo Benzaray, Zippy Yemini,
Robert J Shiner
Abstract
Background-Sighing breathing is
observed in subjects suffering from anxi-
ety with no apparent organic disease.
Methods-Lung volumes and expiratory
flow rates were measured in 12 patients
with a sighing pattern of breathing and in
10 normal subjects matched for age, gen-
der, and anthropometric data. In both
groups the measurements were made by
spirographic and plethysmographic tech-
niques. In normal subjects functional
residual capacity (FRC) and residual vol-
ume (RV) were measured during normal
breathing and again during simulated
sighing breathing to exclude technical
artifacts resulting from hyperventilation
during measurement by the helium E
i: ,.Y
closed circuit method. l,
.,. 1, 1,
1,
Results-Patients with a sighing pattern .i-'i
i
; !: .|; i.-
-"I.
of breathing had a normal total lung I, |Time.
capacity (TLC) but significantly different I,I ., S:
.,
..
partitioning of lung compartments com-
pared with normal subjects. The vital .: ''' I'
capacity (VC) was lower when measured Normal respiration pattern on spirometry (A) and sighing
by both spirographic and plethysmo- breathing pattern (B).
graphic methods and RV was higher. The
forced expiratory volume in one second
(FEV1) was also lower in patients with patients describe their shortness of breath as
sighing breathing. The FEVJIVC and the an inability to "get enough air into their
maximal expiratory flow rates at 50% lungs". Most cases suffer from some form of
and at 25% of the forced vital capacity psychoneurosis3 with no apparent organic dis-
(V5(, and V2,) were normal and similar in ease and the diagnosis is easily made on the
both groups. In normal subjects there basis of symptoms and signs.'-10 Typically,
were no differences in RV when mea- there is no exertional dyspnoea, and these
sured during quiet or simulated sighing subjects usually feel better during exercise
breathing. and do not benefit from bronchodilator
Conclusions-Subjects with sighing therapy. With the exception of hyperven-
breathing have a normal TLC with a tilation and hypocapnoea, no other clinical
Department of higher RV and lower VC than normal abnormalities have been described in these
Clinical Respiratory patients.? In our experience a large RV is fre-
Physiology, The subjects. There was no obvious physio-
Chaim Sheba Medical logical or anatomical explanation for this quently present in the absence of lung disease
Center, Affiliated to pattern. or thoracic cage abnormalities. In one study
the Sackler School of RV was abnormally high in five of 21 patients
Medicine, Tel-Aviv (Thorax 1993;48:809-81 1) but no reference was made to the significance
University, Israel
G Aljadeff of this.3
M Molho Many patients are referred for specialist eval- We have undertaken a study to verify our
I Katz uation of shortness of breath. Not infre- observation with both spirographic and
S Benzaray
Z Yemini quently a sighing pattern of breathing is plethysmographic measurements in patients
R J Shiner observed when spirography is recorded on complaining of sighing breathing and in nor-
Reprint requests to: graph paper. Sighing breathing, otherwise mal subjects during normal respiration and
Dr R J Shiner
Received 14 July 1992
known as hyperventilation syndrome,' psy- during simulated sighing breathing.
Returned to authors chogenic hyperventilation,2 or behavioural
17 November 1992
Revised version received
breathlessness,3 is characterised by highly Methods
11 January 1993 irregular breathing punctuated by deep Lung volumes and maximal expiratory flow
Accepted 16 March 1993 periodic inspirations (fig). The majority of rates were measured in 12 patients with a
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Al8adeff, Molho, Katz, Benzaray, Yemini, Shiner
810
sighing pattern of breathing and in 10 healthy after deep breaths which may artificially
volunteers matched for age, gender, and increase FRC.
anthropometric values. All subjects under- The measurements were made during mid
went careful clinical and radiological morning in the sitting position and in the
examination to exclude lung, heart or neuro- same sequence for all subjects. A comput-
muscular diseases, thoracic deformities, obe- erised water spirometer (Godard-Statham BV
sity, smoking habits, atopy, recent respiratory type 15422) and a computerised constant
tract infection, or any other condition that volume plethysmograph (Jaeger Master Lab
could interfere with normal respiratory func- type MIJB) were used. None of the subjects
tions. The radiological examination of normal were taking any drugs at the time of the
subjects was part of the check up. Approval of study.
the ethics committee was not sought as we The thoracic gas volume was measured five
felt that the tests were consistent with our times and an average value was calculated.
usual evaluation of patients with dyspnoea. The flow-volume curves were recorded with
Informed consent was obtained from all sub- the same equipment, the flow and volume
jects. No formal psychiatric assessment was changes being measured at the mouth, and
undertaken. the best curve was automatically integrated
A consistent history, the spirographic from at least three manoeuvres. The observed
recordings, and a low mean (SD) end tidal values were compared with the predicted nor-
Pco2 of 4 40 (0 27) kPa confirmed the mal values in this laboratory.'
sighing pattern of breathing.
Lung volumes were assessed by both spiro- STATISTICAL ANALYSIS
graphic (with helium closed circuit technique Normal distribution goodness of fit test was
for FRC) and plethysmographic methods. In performed on each variable in each group.
normal subjects FRC was measured during Since the variables were normally distributed
quiet breathing and during artificial sighing at the 95% confidence level, the hypothesis
breathing. Subjects were asked to take one test of the means was used to determine sig-
deep breath every 30 seconds, except during nificant differences in the measurements
the last minute, after which they were between the two groups. The possibility of a
requested to breathe normally to avoid type II statistical error (as a small number of
changes in the expiratory level. This double subjects were involved) is unlikely in view of
checking was to avoid spirometric pitfalls; we the high a (>0 05) and the small variability of
suspected that sighing during measurements the population.
by the helium closed circuit technique could Regression analysis of spirometric and
lead to artificially high values of FRC. The plethysmographic measurements was used to
amount of helium absorbed during this tech- determine the correlation between them.
nique is generally minimal and depends on
the duration of the test and the weight of the
subject [helium absorbed (ml) = W (kg)/3 x Results
t (min)]. This volume was subtracted from There were no significant differences in age,
the observed FRC value. The time correction sex distribution, and anthropometric data
factor, which is only one component of venti- between the two groups. The lung volumes
lation, may be insufficient to avoid inexact measured by both methods were within nor-
measurement in the presence of hyperventila- mal values. However, all the patients had a
tion or sighing. Deep breaths recruit more significantly lower VC (p < 0-01 by spirogra-
respiratory units and some helium can be phy and p < 005 by plethysmography) and a
absorbed or trapped in a larger ventilated significantly higher RV (p < 0-01 by both
area. Spirographic records frequently show an methods) than the normal subjects, while
upward movement of the expiratory level TLC and FRC were similar in both groups.
There were no differences between spiro-
graphic and plethysmographic measurements.
The forced expiratory volume in one second
Mean (SD) anthropometric data, spirographic and plethysmographic measurements (% (FEV,) was significantly lower in the patient
predicted) in normal subjects and patients with sighing breathing. group (p < 0-01) but the FEV1/VC ratio and
Normal subjects Sighing patients maximal flow rates at 50% and 25% of forced
VC (Vmax5, and Vmax25) were similar in
Age (y) 36 (6) 33 (12) both groups (table).
M:F 8:2 8:4 In the normal subjects RV and FRC were
Height (cm) 173 (8) 170 (11)
Body surface area (m2) 1-85 (0-02) 1-85 (0 02) similar with normal breathing and with artifi-
FEV, 109 (12) 97 (9) cial sighing when measured with the helium
FEVN/VC 105 (6) 104 (5) closed circuit technique.
V50 105 (29) 96 (17)
V25 99 (28) 96 (17)
Spirographic Plethysmographic Spirographic Plethysmographic
VG 105 (12) 108 (12) 93 (10)* 98 (13)** Discussion
RV 95 (12) 104 (23) 123 (21)* 138 (37)* Our results provide convincing evidence that
TLC 102 (9) 107 (10) 100 (12) 108 (15)
FRC 109 (11) 119 (16) 107 (17) 121 (17) patients with a sighing breathing pattern have
different partitioning of lung volumes from
FEV,-forced expiratory volume in one second; VC-vital capacity; RV-residual vol- normal subjects, having a smaller VC and
ume; TLC-total lung capacity; FRC-functional residual capacity; V,,-maximal expi-
ratory flow rate at 50% of forced VC; V,5-maximal expiratory flow rate at 25% of forced larger RV, but a similar TLC and FRC. The
VC. *p < 001; **p < 005. fact that there were no differences in the
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Paern oflung volumes in patients with sighing breathing 81
measurements of FRC during normal and RV include changes in the thoracic cage, res-
sighing breathing in the normal subjects piratory muscles, or in lung tissues,'2 but
proves that this is not an artifact. there was no evidence for any of these in our
The different partitioning of lung volumes patients although they were not specifically
in the two groups can be explained by differ- sought.
ences in the shape and compliance of the We conclude that the pattern of lung
thoracic cage.12 Although we cannot entirely volumes in patients with sighing breathing is
exclude this possibility as chest wall compli- characterised by a lower VC and a higher RV
ance measurements were not performed, than in normal subjects. No obvious physio-
thoracic abnormalities were not noted and logical or anatomical explanation for this
there were no differences in age, sex distribu- pattern could be found.
tion, and anthropometric data between the
two groups. Anatomical reasons can hardly
explain the respiratory symptomatology 1 Rice RL. Symptom patterns of the hyperventilation syn-
drome. Am J Med 1950;8:691.
which is characterised by periodic episodes 2 Fraser RG, Pare' JAPP. Diagnosis of diseases of the chest.
and not by constant symptoms aggravated by 2nd edn, vol 3. Philadelphia: Saunders, 1979: 1944-5.
3 Howell JBL. Behavioral breathlessness. Thorax 1990;45:
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The normal expiratory flow rates in the 4 Mechanic D. Social psychologic factors affecting the pre-
patients exclude air trapping resulting from sentation of body complaints. N Engl J Med 1972;
286:1132-9.
airway obstruction. Their lower FEV1 is 5 Ker WJ. Some physical phenomena associated with the
related to the lower VC since the FEV1NC anxiety states and their relation to hyperventilation. Ann
Intern Med 1937;2:962.
ratio is normal. Moreover, if airflow limita- 6 Comroe JH. Physiology of respiration. 2nd edn. Chicago:
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In a study of patients with chronic hyper- recognized common expressions of anxiety and stress.
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Downloaded from thorax.bmj.com on December 31, 2011 - Published by group.bmj.com
Pattern of lung volumes in patients with
sighing breathing.
G Aljadeff, M Molho, I Katz, et al.
Thorax 1993 48: 809-811
doi: 10.1136/thx.48.8.809
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