5 Minutes
New research suggests that many people living with chronic fatigue syndrome (CFS) have unrecognized breathing abnormalities that could amplify exhaustion and cognitive fog, and help explain the severe symptom flare-ups after exertion known as post-exertional malaise.
Scientists have discovered that most people with chronic fatigue syndrome also struggle with hidden breathing problems. These abnormalities may intensify fatigue and could help explain why symptoms worsen after exertion.
Uncovering a silent contributor to chronic fatigue
Chronic fatigue syndrome — also called myalgic encephalomyelitis (ME/CFS) — leaves many patients profoundly tired, mentally clouded, and frequently worse after relatively small amounts of physical or mental stress. While immune, metabolic and autonomic factors have drawn most attention, a new study points to a more basic physiologic problem: dysfunctional breathing and episodes of hyperventilation that patients often do not notice.
The research, led by investigators at the Icahn School of Medicine, examined breathing patterns and cardiopulmonary responses in people with CFS and in healthy controls. The team found that abnormal breathing is common in CFS and may be linked to dysautonomia — disruption of the autonomic nervous system that controls heart rate, blood vessel tone, and other involuntary functions.
How the study tested breath and exertion
To probe the link, researchers recruited 57 people diagnosed with chronic fatigue syndrome and 25 age- and activity-matched healthy volunteers. All participants underwent cardiopulmonary exercise testing (CPET) on two consecutive days — a rigorous way to assess how heart, lungs and muscles respond to exertion. During testing the team tracked heart rate, blood pressure, oxygen uptake (including peak VO2), oxygen extraction efficiency, breathing rate, breathing pattern, and end-tidal CO2 (an indicator of how much CO2 is exhaled).
CPET can identify common causes of breathlessness and fatigue, but it also reveals patterns that suggest dysfunctional breathing: rapid or shallow breaths, frequent deep sighs, chest-dominant breathing that fails to use the diaphragm efficiently, or poor coordination between abdominal and chest movements.
What the researchers found — and why it matters
Peak oxygen consumption (VO2 max) was similar between the groups — meaning aerobic capacity alone did not explain the symptoms. But breathing abnormalities were far more common in the CFS group: 71% showed signs of dysfunctional breathing, hyperventilation, or both. Nearly half the CFS participants had irregular breathing patterns during testing, compared with only four people in the control group. About one-third hyperventilated, while just one control participant did. Nine participants with CFS experienced both dysfunctional breathing and hyperventilation simultaneously, a combination not observed in healthy volunteers.
Why is this important? Both dysfunctional breathing and hyperventilation can produce dizziness, shortness of breath, palpitations, chest discomfort, poor concentration and exhaustion — symptoms that mimic or aggravate chronic fatigue. When breathing and autonomic control are disrupted together, they may also contribute to post-exertional malaise, the characteristic and often prolonged worsening after activity.
Investigators suggested a plausible mechanistic link: dysautonomia — commonly present in CFS patients as orthostatic intolerance (feeling worse when upright) — can raise heart rate and trigger irregular, faster breathing. That cascade may feed back to increase symptoms rather than relieve them.
Pulmonary physiotherapy and low-risk interventions to try
Although further studies are needed before large-scale clinical recommendations, the findings point to practical, low-risk strategies that could help some patients. Suggested approaches include structured breathing retraining (often used in pulmonary physiotherapy), gentle breath-focused conditioning such as swimming or yoga, and biofeedback that monitors exhaled CO2 to guide slower, shallower breathing when hyperventilation is detected.
Dr. Benjamin Natelson, senior author on the study, noted that identifying breathing abnormalities opens a pathway to new treatment trials aimed at symptom reduction. Dr. Donna Mancini, first author, emphasized that dysfunctional breathing can occur at rest and often goes unnoticed by patients — making careful assessment essential.
What clinicians and patients should know
- Assessment: Consider screening for dysfunctional breathing in people with unexplained fatigue or post-exertional malaise, especially if orthostatic symptoms are present.
- Testing: Cardiopulmonary exercise testing and simple measures of end-tidal or exhaled CO2 can help distinguish hyperventilation from other causes of breathlessness.
- Treatment options: Breathing retraining, paced respiration, yoga-based practices, and graded physical conditioning that emphasize breath control are reasonable next steps to test in clinical trials.
Expert Insight
"Breathing is an accessible therapeutic target," says Dr. Rachel Kim, a respiratory physiologist and clinician not involved in the study. "Retraining breath mechanics can change symptoms and improve autonomic balance for some patients — it’s not a cure-all, but it’s an inexpensive, low-risk intervention that deserves controlled testing in ME/CFS populations."
This line of work reframes a part of chronic fatigue as potentially modifiable through respiratory and autonomic-focused therapies. The next steps will be randomized trials testing whether targeted breathing exercises, biofeedback, or combined rehabilitation programs can reduce the frequency or severity of post-exertional malaise and improve day-to-day functioning for people with ME/CFS.
Source: scitechdaily
Comments
atomwave
I work in rehab and ive seen this: after tiny tasks ppl hyperventilate and then crash. Breathing retraining helped some, yoga too. Not a miracle but worth testing fast
bioNix
if breathing problems really drive PEM thatd change things… but are those CO2 measures consistent across clinics? sounds promising, need randomized trials not just guesses
Leave a Comment