Turkish Journal of Psychiatry

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A Meta-Analysis of Efficacy of Carbon Dioxide Inhalation as a Challenge Test in Panic Disorder Ümit TURAL, Firdevs ALİOĞLU 2019 30(2): 99-108
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Objective: The objective of this study is to perform a systematic review
and meta-analysis on whether patients with panic disorder (PD) and
their healthy first-degree relatives have an increased sensitivity to carbon
dioxide inhalation test compared to healthy controls (HC) or patients
with psychiatric disorders other than panic disorder.
Method: The databases of PubMed, EMBASE and PsycNET were
searched using Boolean operators “panic AND carbon dioxide” and
“panic AND CO2”. Selected research articles were classified according
to the carbon dioxide concentrations used in testing and the clinical
characteristics of the samples. The assumption of heterogeneity
across the studies was assessed by chi square based Q and I2 statistics.
Publication biases were explored by Begg-Mazumdar’s and Egger’s tests
in addition to funnel graphics. Odds ratios representing effect size of the
carbon dioxide inhalation procedure were calculated according to fixed
effect and random effect models after obtaining percent weight effects
of each study.
Results: Meta-Analysis was conducted on 33 research studies that
include 2114 participants totally. Participants with PD experienced
significantly more frequent panic attacks (PA) compared to HC
following in both 5% (OR=14.713, 95% CI 7.532 – 28.739) and 35%
carbon dioxide inhalation (OR=11.507, 95% CI 7.775 – 17.031). HC
who have a first-degree relative with PD experienced PA approximately
3 times more than HC who have not a first-degree relative with
PD (OR=2.658, 95% CI 1.678 – 4.212) following carbon dioxide
inhalation test. Participants with PD experienced significantly more
frequent PA than the patients with other psychiatric disorders following
the carbon dioxide inhalation test (OR = 3.524, 95% CI 1.945 - 6.384).
Conclusion: There is an increased sensitivity of carbon dioxide
inhalation in patients with PD and their healthy first-degree relatives.
The role and possible mechanisms of carbon dioxide in etiology and
physiopathology of PD should be studied extensively.