Respiratory, autonomic, and experiential responses to repeated inhalations of 20% CO₂ enriched air in panic disorder, social phobia, and healthy controls

Abstract

Inhalation of carbon dioxide (CO₂) enriched air triggers anxiety in panic disorder (PD) patients, which is often interpreted as a sign of biological vulnerability. However, most studies have not measured respiration in these tasks. We compared patients with PD (n=20) and social phobia (SP, n=19) to healthy controls (n=18) during eight inhalations of 20% CO₂, preceded and followed by two inhalations of room air, while continuously measuring subjective anxiety and dyspnea as well as autonomic and respiratory variables. PD patients showed increased reactivity and delayed recovery during CO₂ inhalations for most measures. Unlike both other groups, the PD group's tidal volume responses did not habituate across CO₂ inhalations. However, PD patients did not differ from SP patients on most other measures, supporting a continuum model of CO₂ sensitivity across anxiety disorders. Both patient groups showed continued reactivity during the last air inhalations, which is unlikely to be due to a biological sensitivity.

Keywords: anxiety disorder; biological challenge; carbon dioxide; habituation; psychophysiology; sensitization.

Figure 1

Means and standard errors for self-reported and psychophysiological responses to air and CO₂ inhalations (each triplet consisting of averages for baseline, peak, and recovery epochs) in patients with panic disorder (PD) or social phobia (SP), and healthy controls (HC). Panels depict self-reported anxiety (a) and dyspnea (b), number N of nonspecific skin conductance responses (transformed by logarithm of N+1) (c), and tidal volume (d). Note: AIR-A = first set of two inhalations of air; CO₂-A = first set of four inhalations of CO₂; CO₂-B = second set of four inhalations of CO₂; AIR-B = second set of two inhalations of air. See text for details.