Paroxysmal nocturnal dyspnea

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Paroxysmal nocturnal dyspnea

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: Cardiac asthma; PND


Paroxysmal nocturnal dyspnea (PND) is defined as sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing. It is most closely associated with congestive heart failure. PND commonly occurs several hours after a person with heart failure has fallen asleep. PND is often relieved by sitting upright, but not as quickly as simple orthopnea. Also unlike orthopnea, it does not develop immediately upon lying down.

Historical Perspective

It was first described by Charles Lepois in the 1500s.


PND is caused by increasing amounts of fluid entering the lung during sleep and filling the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. This fluid typically rests in the legs (peripheral edema) during the day when the individual is upright. At night, when recumbent for an extended period, this fluid is reabsorbed, increasing total blood volume and blood pressure, leading to pulmonary hypertension in people with underlying heart failure. The consequent pulmonary hypertension leads to the accumulation of fluid in the lungs, or pulmonary edema.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute decompensated heart failure, aortic regurgitation, aortic stenosis, atypical myocardial infarction, cardiac amyloidosis, cardiac ischemia, cardiac tamponade, cardiac tumors, cardiomyopathies, chronic heart failure, congenital heart disease, cor pulmonale, dilated cardiomyopathy, endomyocardial fibrosis, giant atrial myxoma, heart failure, hypertrophic cardiomyopathy, hurler syndrome, left ventricular failure (non-valvular), mitral stenosis, pacemaker syndrome, pericardial effusion, pericarditis, peripartum cardiomyopathy, peripheral edema, pulmonary embolism, Q fever myocarditis, restrictive cardiomyopathy, rheumatic heart disease, systemic hypertension
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Antidepressants, calcium channel blockers, diltiazem, nifedipine, trazodone
Ear Nose Throat No underlying causes
Endocrine Adrenal carcinoma, Cushing's syndrome, thyroid disease
Environmental Pneumoconiosis
Gastroenterologic Gastroesophageal reflux disease, Hurler syndrome
Genetic Hurler syndrome
Hematologic Anemia, tropical pulmonary eosinophilia
Iatrogenic No underlying causes
Infectious Disease Chagas disease, Q fever myocarditis, Tropical pulmonary eosinophilia
Musculoskeletal/Orthopedic No underlying causes
Neurologic Myasthenia gravis, obstructive sleep apnea
Nutritional/Metabolic Hurler syndrome, metabolic acidosis, obesity
Obstetric/Gynecologic Pregnancy
Oncologic Adrenal carcinoma, paraneoplastic syndromes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety, Hurler syndrome, panic disorder
Pulmonary Cor pulmonale, emphysema, interstitial lung disease, pulmonary edema, pulmonary embolism, severe chronic obstructive pulmonary disease, tropical pulmonary eosinophilia
Renal/Electrolyte Renal failure
Rheumatology/Immunology/Allergy Myasthenia gravis, paraneoplastic syndromes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order



The experience of PND is often described as awakening suddenly to a feeling that one is suffocating, with wheezing respirations and coughing. It can be quite frightening.


Treatment depends upon the underlying cause. The treatment of congestive heart failure can be found here.

Related Chapters


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