Breathing issues in hEDS patients linked to poorer mental health

Those with respiratory problems report more anxiety, depression, pain sensitivity

Steve Bryson, PhD avatar

by Steve Bryson, PhD |

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Most adults with hypermobile Ehlers-Danlos syndrome (hEDS) report notable changes in breathing patterns, called functional respiratory complaints, according to a population survey.

The survey included the Nijmegen questionnaire (NQ), which assessed these breathing-related symptoms, including chest pain, dizzy spells, shortness of breath, faster or deeper breathing, and chest tightness.

Patients also reported a high prevalence of anxiety, depression, and central sensitization, which results in hypersensitivity to pain, all of which significantly correlated with NQ scores for altered breathing.

“It is important to consider [functional respiratory complaints] in this population and observe whether there are associated symptoms, with further research to better examine the relationship between these manifestations,” researchers wrote, noting also that “it is important to consider mental health in the management of people with hEDS.”

Details of the survey were published in the journal Respiratory Medicine and Research, in the study “Assessment of functional respiratory complaints and related factors in people with hypermobile Ehlers-Danlos syndrome: Cross-sectional study.”

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Survey set out to find prevalence of breathing and mental health issues in hEDS

hEDS affects connective tissue, resulting in fragile skin, hypermobile joints, frequent joint dislocations, and abnormal spinal curvature (scoliosis).

Patients have also reported symptoms affecting the lungs, including a higher incidence of cough, excess mucus production, and nighttime cough and wheezing. Such problems can chronically alter breathing patterns, resulting in shortness of breath, dizzy spells, and faster breathing.

However, the prevalence of breathing complaints in people with EDS has not been investigated, “which would be important for public health in treatment planning,” wrote the researchers, based in Spain and Belgium.

Moreover, mood disorders, such as depression and anxiety, have also been reported in EDS, but their association with breathing problems has never been assessed.

Among the 389 invited adult EDS patients enrolled in the Ehlers-Danlos Syndrome Study and Research Group in Belgium, 186 responded to the electronic survey, most of whom were women (85.5%).

In addition to the NQ questionnaire, other questions focused on disease perception (Brief Illness Perception Questionnaire, or B-IPQ), depression and anxiety (Hospital Anxiety and Depression Scale), and central sensitization (Central Sensitization Inventory, or CSI).

Most participants (84.9%) had an NQ score higher than 22, a sign of perceived respiratory problems. Nearly all had CSI scores indicating central sensitization (88.7%), with high CSI scores, defined as extreme, reported by 62.4%. About half (48.9%) were diagnosed with depression, with probable depression in 57 cases (30.6%) and probable anxiety in 101 (54.3%) patients.

Significant correlations were seen between scores for breathing problems, central sensitization, disease perception, and anxiety and depression. The strongest relationship was between NQ scores for breathing and CSI-part A scores related to current health.

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Patients reporting emotional trauma had worse scores across majority of tests

Participants with high NQ scores (above 22) and extreme CSI scores had significantly worse results on all other questionnaires, as did those with probable anxiety or depression.

Regarding emotional trauma, 69.4% experienced bereavement, 41.9% separation, 21.5% childhood abuse, and 39.8% other traumas. Those that experienced emotional trauma also had higher scores (worse) across all questionnaires than patients without the corresponding trauma, except for bereavement and B-IPQ scores.

Finally, the team divided participants into three groups based on breathing: no functional respiratory complaints (15%), mild complaints (47.3%), and severe breathing problems (37.6%).

Consistently, people with no complaints reported the lowest values on all questionnaires, and those with severe breathing problems had the highest scores. Factors that distinguished these two groups included scores for NQ, depression, and central sensitization (part A).