Which of the following is a typical manifestation of chronic hyperventilation?

In all cases of chronic hyperventilation, the mechanism involves an increase in the respiratory drive that may well be physiologic (e.g., chronic hypoxemia) but can be detrimental because of the ensuing alkalemia. This disturbance in blood pH can produce neurologic symptoms such as dizziness, syncope, and seizure activity caused by cerebral vasoconstriction. The neuromuscular side effects of chronic alkalemia can include paresthesia, muscle weakness (from hypophosphatemia), and hypocalcemia-induced carpopedal spasm tetany. The primary respiratory alkalosis can lead to central sleep apnea. The disorders that most frequently lead to unexplained hyperventilation are pulmonary vascular diseases such as chronic thromboembolism and anxiety. In patients who have symptoms clearly secondary to hyperventilation, inhalation of a low concentration of carbon dioxide can be helpful. Both hypoxemia and chronic thromboembolic disease can lead to a chronic hyperventilation syndrome but are not a manifestation of the disorder. Ref - Harrison's internal medicine 20e pg 3344