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What is Hypoventilatory Syndrome?

The most basic definition of Hypoventilatory syndrome is an abnormal retention of carbon dioxide (CO2) within the blood due to poor gas exchange within the lungs. There can be a variety of underlying reasons for the poor exchange of CO2, but the result is higher volumes of CO2 (Hypercapnia) which displaces and lowers the volume of oxygen carried in the blood (Hypoxaemia).

The abnormal retention of CO2 in the blood stream is significant as it can lead to respiratory acidosis, where the basic pH level of the blood is raised making it too acidic. The knock on effect is that basic cellular respiration is disrupted and in extreme cases it can lead to respiratory failure. Hypoventilatory syndrome is a life threatening condition that is commonly associated with serious respiratory conditions.

Therapist and client discussing assessmet results and self management stratergies.Above: Therapist and client discussing assessmet results and self management stratergies.

What causes Hypoventilatory Syndrome?

There are several possible causes of Hypoventilatory syndrome, where the common feature is a depression of the normal mechanical respiration action. This usually means that the individual’s respiratory rate (breaths per minute) is too slow, or that their individual breaths are too shallow. The most common causes of Hypoventilatory syndrome include;

  • Chronic Obstructive Pulmonary Disease

    Although common amongst people with COPD most individuals do not develop this condition. This suggests it develops more as a result of abnormal breathing patterns and related chest muscle weakness.

  • Obesity Hypoventilatory Syndrome (OHS)

    With significant additional weight resting on the chest cavity the work of breathing becomes harder and less efficient. Over the long term abnormal respiratory dive can occur, leading to temporary pauses in normal breathing (Apnoea) particularly common whilst asleep.

  • Central Alveolar Hypoventilation

    This occurs when the underlying cause is neurological and the basic central nervous system drive to breath is compromised. This can result from neurological diseases or head injuries.

  • Neuromuscular Disorders

    In these conditions the neurological breathing impulse remains intact, but due to poor muscle control and subsequent muscle wastage the breathing pattern is weak and shallow. Respiration rates are usually higher to compensate but this increases the work of breathing making it less efficient.

  • Chest Wall Deformities

    These produce a straight forward physical limitation to normal respiration rate and lung function.

What are the symptoms of Hypoventilatory Syndrome?

The early symptoms of Hypoventilatory syndrome are usually very mild and non-specific, indeed most people will have an underlying condition whose own symptoms will initially mask any signs of hypoventilation. These early signs may include shortness of breath and fatigue.

If the underlying cause is not addressed and the severity of the hypoventilation continues to rise then a person could experience some of the following symptoms;

  • Laboured breathing (Dyspnoea) during activity.
  • Increased levels of anxiety.
  • Disturbed sleep and sleep apnoea.
  • Laboured breathing even during periods of inactivity.
  • Persistent sleepiness throughout the daytime, prolonged sleep at night.
  • Blueness to the lips, fingernail beds and general complexion.
  • Delirious state, including confusion and diminished awareness of surroundings.
  • Visual disturbances and headaches.
  • Difficulty staying awake.
  • Difficulty remaining cognitively focused and responding to others.

How is Hypoventilatory Syndrome Diagnosed?

Hypoventilatory syndrome would routinely be diagnosed by your doctor based on observation of your breathing, a subjective account of your recent symptoms along with the doctors understanding of your underlying medical history. For obvious cases more detailed tests are not usually necessary.

Once you have a confirmed diagnosis we can book you in for a respiratory assessment with one of our specialist physiotherapists. They will look at your current functional ability and tailor a maintenance program for you. For more information on how physiotherapy can help treat Hypoventilatory Syndrome, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

What would a physiotherapy assessment for Hypoventilatory Syndrome involve?

At, we want to gain as much information as possible about your condition to ensure we give you the best treatment. In your first appointment with us, our physiotherapists will carry out an assessment which has two parts:


A discussion between you and our physiotherapist to find out what symptoms you are experiencing, and how your condition is affecting you and your lifestyle.


An assessment to discern the presence of any pain, your current breathing pattern, respiration rate, lung volume and a series of special tests to identify the presence of any mucus retention and lung function impairment.

There can be great variation in the symptoms displayed, depending on the progression of the condition and any complicating factors. The assessment process will be important in identifying your current symptoms and needs, so that treatments can be targeted and effective.

What would physiotherapy treatment for Hypoventilatory Syndrome involve?

At, Our physiotherapists will ensure you specialised treatment for Hypoventilatory Syndrome. Depending on the severity and duration of your condition, your treatment may involve:

  • Breathing technique retraining:

    • Controlling respiratory rate
    • Diaphragmatic breathing
    • Controlling / reducing breath volume
    • Relaxation breathing exercises

  • Education and Advice:

    • Illness cause and progression.
    • Medication management
    • Recognising signs of possible Hypoventilatory episodes.

At you will experience a personalised treatment session. Each appointment will be aimed at returning to your everyday activities and what you enjoy. It will be important to note that the respiratory physiotherapy we apply should be closely incorporated with other health care professional’s management of the client’s dietary, medical and counselling needs.

How can I arrange a physiotherapy assessment for Hypoventilatory Syndrome?

If you have been diagnosed by your doctor as having Hypoventilatory Syndrome and are suffering from symptoms affecting your breathing, you would benefit from an assessment with one of our experienced respiratory physiotherapists.

You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, and give you advice on self-management. To arrange an appointment please email or call 0330 088 7800.


At, our respiratory physiotherapists can provide specialist assessment and treatment for people with for Hypoventilatory Syndrome. We can apply a range of therapy techniques and advice to manage your symptoms and maintain the best possible level of lung function and comfort. We can also advise on activity modification to make daily living easier. Along with advice for you and your family on appropriate self-management techniques to maximise your functional ability between therapy sessions.

For more information on how physiotherapy can help treat for Hypoventilatory Syndrome, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

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