Breath-holding syncope is caused by which physiologic change related to pre-immersion hyperventilation?

Decreased stimulus to breathe due to hypocapnia

Lowering carbon dioxide through pre-immersion hyperventilation reduces the stimulus to breathe. Breathing is driven mainly by CO2 levels and brain pH, so when CO2 is swept down (hypocapnia) the respiratory centers dial back their drive and you can hold your breath longer. But hypocapnia also causes cerebral blood vessels to constrict, decreasing blood flow to the brain. As oxygen becomes scarce during the breath hold, this combination makes the brain more vulnerable to hypoxia, increasing the risk of breath-holding syncope.

Increased stimulation to breathe due to hypercapnia

Hyperoxia-induced suppression of respiratory drive

Hypoxia-induced reflex tachypnea

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