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Chan PYS, Lee LY, Davenport PW. Neural mechanisms of respiratory interoception. Auton Neurosci 2024; 253:103181. [PMID: 38696917 DOI: 10.1016/j.autneu.2024.103181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
Respiratory interoception is one of the internal bodily systems that is comprised of different types of somatic and visceral sensations elicited by different patterns of afferent input and respiratory motor drive mediating multiple respiratory modalities. Respiratory interoception is a complex system, having multiple afferents grouped into afferent clusters and projecting into both discriminative and affective centers that are directly related to the behavioral assessment of breathing. The multi-afferent system provides a spectrum of input that result in the ability to interpret the different types of respiratory interceptive sensations. This can result in a response, commonly reported as breathlessness or dyspnea. Dyspnea can be differentiated into specific modalities. These respiratory sensory modalities lead to a general sensation of an Urge-to-Breathe, driven by a need to compensate for the modulation of ventilation that has occurred due to factors that have affected breathing. The multiafferent system for respiratory interoception can also lead to interpretation of the sensory signals resulting in respiratory related sensory experiences, including the Urge-to-Cough and Urge-to-Swallow. These behaviors are modalities that can be driven through the differentiation and integration of multiple afferent input into the respiratory neural comparator. Respiratory sensations require neural somatic and visceral interoceptive elements that include gated attention and detection leading to respiratory modality discrimination with subsequent cognitive decision and behavioral compensation. Studies of brain areas mediating cortical and subcortical respiratory sensory pathways are summarized and used to develop a model of an integrated respiratory neural network mediating respiratory interoception.
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Affiliation(s)
- Pei-Ying Sarah Chan
- Department of Occupational Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Lu-Yuan Lee
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
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2
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Yorita A, Kawayama T, Inoue M, Kinoshita T, Oda H, Tokunaga Y, Tateishi T, Shoji Y, Uchimura N, Abe T, Hoshino T, Taniwaki T. Altered Functional Connectivity during Mild Transient Respiratory Impairment Induced by a Resistive Load. J Clin Med 2024; 13:2556. [PMID: 38731091 PMCID: PMC11084533 DOI: 10.3390/jcm13092556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Previous neuroimaging studies have identified brain regions related to respiratory motor control and perception. However, little is known about the resting-state functional connectivity (FC) associated with respiratory impairment. We aimed to determine the FC involved in mild respiratory impairment without altering transcutaneous oxygen saturation. Methods: We obtained resting-state functional magnetic resonance imaging data from 36 healthy volunteers during normal respiration and mild respiratory impairment induced by resistive load (effort breathing). ROI-to-ROI and seed-to-voxel analyses were performed using Statistical Parametric Mapping 12 and the CONN toolbox. Results: Compared to normal respiration, effort breathing activated FCs within and between the sensory perceptual area (postcentral gyrus, anterior insular cortex (AInsula), and anterior cingulate cortex) and visual cortex (the visual occipital, occipital pole (OP), and occipital fusiform gyrus). Graph theoretical analysis showed strong centrality in the visual cortex. A significant positive correlation was observed between the dyspnoea score (modified Borg scale) and FC between the left AInsula and right OP. Conclusions: These results suggested that the FCs within the respiratory sensory area via the network hub may be neural mechanisms underlying effort breathing and modified Borg scale scores. These findings may provide new insights into the visual networks that contribute to mild respiratory impairments.
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Affiliation(s)
- Akiko Yorita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Masayuki Inoue
- Cognitive and Molecular Research Institute of Brain Disease, Kurume University, Kurume 830-0011, Japan; (M.I.); (Y.S.); (N.U.)
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Hanako Oda
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Yoshihisa Tokunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Takahisa Tateishi
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Yoshihisa Shoji
- Cognitive and Molecular Research Institute of Brain Disease, Kurume University, Kurume 830-0011, Japan; (M.I.); (Y.S.); (N.U.)
| | - Naohisa Uchimura
- Cognitive and Molecular Research Institute of Brain Disease, Kurume University, Kurume 830-0011, Japan; (M.I.); (Y.S.); (N.U.)
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan;
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
| | - Takayuki Taniwaki
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan; (A.Y.); (T.K.); (T.K.); (H.O.); (Y.T.); (T.T.); (T.H.)
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3
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Che L, Lai J, Huang H, Li W, Shen H. Research progress on the pathogenesis of chest tightness variant asthma characterized by chest tightness. Zhejiang Da Xue Xue Bao Yi Xue Ban 2024; 53:213-220. [PMID: 38310083 PMCID: PMC11057992 DOI: 10.3724/zdxbyxb-2023-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/17/2023] [Indexed: 02/05/2024]
Abstract
Chest tightness variant asthma (CTVA) is an atypical form of asthma with chest tightness as the sole or predominant symptom. The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors. The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex. Chest tightness is associated with sensory perception, and CTVA patients may have heightened ability to detect subtle changes in lung function, but such sensory perception is unrelated to respiratory muscle activity, lung hyperinflation, or mechanical loading of the respiratory system. Airway inflammation, pulmonary ventilation dysfunction (especially involving small airways), and airway hyperresponsiveness may underlie the sensation of chest tightness. CTVA patients are prone to comorbid anxiety and depression, which share similar central nervous system processing pathways with dyspnea, suggesting a possible neurological basis for the development of CTVA. This article examines the recognition and mechanisms of chest tightness, and explores the pathogenesis of CTVA, focusing on its association with airway inflammation, ventilation dysfunction, airway hyperresponsiveness, and psychosocial factors.
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Affiliation(s)
- Luanqing Che
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou 310009, China.
| | - Jianxing Lai
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou 310009, China.
| | - Huaqiong Huang
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou 310009, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou 310009, China
| | - Huahao Shen
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Hangzhou 310009, China.
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4
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Burki NK. Treatment of dyspnoea. Eur Respir J 2024; 63:2301565. [PMID: 38237994 DOI: 10.1183/13993003.01565-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Nausherwan K Burki
- Dept of Medicine, University of Connecticut Health Center, Farmington, CT, USA
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5
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Thomas M, Beasley R. The treatable traits approach to adults with obstructive airways disease in primary and secondary care. Respirology 2023; 28:1101-1116. [PMID: 37877554 DOI: 10.1111/resp.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
The treatable traits approach is based on the recognition that the different clinical phenotypes of asthma and chronic obstructive airways disease (COPD) are a heterogeneous group of conditions with different underlying mechanisms and clinical manifestations, and that the identification and treatment of the specific clinical features or traits facilitates a personalised approach to management. Fundamentally, it recognises two important concepts. Firstly, that treatment for obstructive lung disease can achieve better outcomes if guided by specific clinical characteristics. Secondly, that in patients with a diagnosis of asthma, and/or COPD, poor respiratory health may also be due to numerous overlapping disorders that can present with symptoms that may be indistinguishable from asthma and/or COPD, comorbidities that might require treatment in their own right, and lifestyle or environmental factors that, if addressed, might lead to better control rather than simply increasing airways directed treatment. While these concepts are well accepted, how best to implement this personalised medicine approach in primary and secondary care within existing resource constraints remains uncertain. In this review, we consider the evidence base for this management approach and propose that the priority now is to assess different prototype templates for the identification and management of treatable traits in both asthma and COPD, in primary, secondary and tertiary care, to provide the evidence that will guide their use in clinical practice in different health care systems.
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Affiliation(s)
- Mike Thomas
- Primary Care Research, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Richard Beasley
- Medicine, Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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6
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McAfee SS, Robinson G, Gajjar A, Zhang S, Bag AK, Raches D, Conklin HM, Khan RB, Scoggins MA. Cerebellar mutism is linked to midbrain volatility and desynchronization from speech cortices. Brain 2023; 146:4755-4765. [PMID: 37343136 PMCID: PMC10629755 DOI: 10.1093/brain/awad209] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Cerebellar mutism syndrome is a disorder of speech, movement and affect that can occur after tumour removal from the posterior fossa. Projections from the fastigial nuclei to the periaqueductal grey area were recently implicated in its pathogenesis, but the functional consequences of damaging these projections remain poorly understood. Here, we examine functional MRI data from patients treated for medulloblastoma to identify functional changes in key brain areas that comprise the motor system for speech, which occur along the timeline of acute speech impairment in cerebellar mutism syndrome. One hundred and twenty-four participants, all with medulloblastoma, contributed to the study: 45 with cerebellar mutism syndrome, 11 patients with severe postoperative deficits other than mutism, and 68 without either (asymptomatic). We first performed a data-driven parcellation to spatially define functional nodes relevant to the cohort that align with brain regions critical for the motor control of speech. We then estimated functional connectivity between these nodes during the initial postoperative imaging sessions to identify functional deficits associated with the acute phase of the disorder. We further analysed how functional connectivity changed over time within a subset of participants that had suitable imaging acquired over the course of recovery. Signal dispersion was also measured in the periaqueductal grey area and red nuclei to estimate activity in midbrain regions considered key targets of the cerebellum with suspected involvement in cerebellar mutism pathogenesis. We found evidence of periaqueductal grey dysfunction in the acute phase of the disorder, with abnormal volatility and desynchronization with neocortical language nodes. Functional connectivity with periaqueductal grey was restored in imaging sessions that occurred after speech recovery and was further shown to be increased with left dorsolateral prefrontal cortex. The amygdalae were also broadly hyperconnected with neocortical nodes in the acute phase. Stable connectivity differences between groups were broadly present throughout the cerebrum, and one of the most substantial differences-between Broca's area and the supplementary motor area-was found to be inversely related to cerebellar outflow pathway damage in the mutism group. These results reveal systemic changes in the speech motor system of patients with mutism, centred on limbic areas tasked with the control of phonation. These findings provide further support for the hypothesis that periaqueductal grey dysfunction (following cerebellar surgical injury) contributes to the transient postoperative non-verbal episode commonly observed in cerebellar mutism syndrome but highlights a potential role of intact cerebellocortical projections in chronic features of the disorder.
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Affiliation(s)
- Samuel S McAfee
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Giles Robinson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Silu Zhang
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Asim K Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Darcy Raches
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Raja B Khan
- Division of Neurology, Department of Pediatrics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Matthew A Scoggins
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
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Xie Y, Zhang L, Guo S, Peng R, Gong H, Yang M. Changes in respiratory structure and function after traumatic cervical spinal cord injury: observations from spinal cord and brain. Front Neurol 2023; 14:1251833. [PMID: 37869136 PMCID: PMC10587692 DOI: 10.3389/fneur.2023.1251833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Respiratory difficulties and mortality following severe cervical spinal cord injury (CSCI) result primarily from malfunctions of respiratory pathways and the paralyzed diaphragm. Nonetheless, individuals with CSCI can experience partial recovery of respiratory function through respiratory neuroplasticity. For decades, researchers have revealed the potential mechanism of respiratory nerve plasticity after CSCI, and have made progress in tissue healing and functional recovery. While most existing studies on respiratory plasticity after spinal cord injuries have focused on the cervical spinal cord, there is a paucity of research on respiratory-related brain structures following such injuries. Given the interconnectedness of the spinal cord and the brain, traumatic changes to the former can also impact the latter. Consequently, are there other potential therapeutic targets to consider? This review introduces the anatomy and physiology of typical respiratory centers, explores alterations in respiratory function following spinal cord injuries, and delves into the structural foundations of modified respiratory function in patients with CSCI. Additionally, we propose that magnetic resonance neuroimaging holds promise in the study of respiratory function post-CSCI. By studying respiratory plasticity in the brain and spinal cord after CSCI, we hope to guide future clinical work.
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Affiliation(s)
- Yongqi Xie
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Liang Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Shuang Guo
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Rehabilitation, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Run Peng
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Huiming Gong
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Mingliang Yang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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Yorita A, Tokunaga Y, Kinoshita T, Nakakura A, Oda H, Imaoka H, Matsunaga K, Kakuma T, Hoshino T, Kawayama T. Usefulness of a 4-Grade Novel Mouthpiece Device for Increased Mouth Pressure Reproducing Artificial Difficulty in Breathing. Kurume Med J 2023; 68:229-238. [PMID: 37316289 DOI: 10.2739/kurumemedj.ms6834008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The use of a novel 4-grade mouthpiece device to reproduce difficulty in breathing was assessed in healthy individuals. METHODS A double-blind, randomized, crossover-controlled trial was conducted to investigate the efficacy and safety of the device with increasing mouth pressure. The modified Borg (mBorg) scale values, respiratory system resistance at 5 Hz (R5), and forced expiratory volume in one second (FEV1) were assessed while using the device. MATERIALS The four grades of breathing difficulty device were tested in 32 healthy participants. RESULTS The 4-grade device linearly worsened the mBorg scale with increasing mouth pressure. The mean R5 (± standard deviation [SD]) with grade I, II, III, and IV devices were 5.6 ± 0.1, 10.3 ± 0.3, 21.5 ± 0.7, and 54.8 ± 2.0 kPa/L/s, respectively. The mean %FEV1 predicted (± SD) were 83.6 ± 15.9% with grade I, 55.3 ± 11.8% with grade II, 32.0 ± 6.1% with grade III, and 15.3 ± 3.2% with the grade IV device. The mBorg scale was positively correlated with R5 (r = 0.79, p < 0.0001) and negatively with %FEV1 predicted (r = -0.81, p < 0.0001). No severe adverse events were reported during the trial. CONCLUSION We demonstrated that the novel device could effectively reproduce the semi-quantitative artificial difficulty in breathing safely and easily in healthy individuals. These devices could be helpful to understand the mechanisms of difficulty in breathing.
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Affiliation(s)
- Akiko Yorita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Yoshihisa Tokunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | | | - Hanako Oda
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Haruki Imaoka
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Kazuko Matsunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | | | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
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Dehdar K, Raoufy MR. Effects of inhaled corticosteroids on brain volumetry, depression and anxiety-like behaviors in a rat model of asthma. Respir Physiol Neurobiol 2023:104121. [PMID: 37473791 DOI: 10.1016/j.resp.2023.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
Brain functional deficits have been reported in asthma patients which can result in behavioral disorders like depression and anxiety. These deficits may be associated with factors like resistance to treatment, incorrect self-evaluation, and inadequate self-control. However, changes in the brain volume in allergic asthma and the effects of inhaled corticosteroids, the most common anti-inflammatory agents for asthma treatment, on these alterations remain largely unclear. Here, we evaluated depression and anxiety-like behavior as well as volume changes in different brain area, using magnetic resonance imaging in an animal model of allergic asthma with pretreatment of inhaled fluticasone propionate. Asthma-induced behavioral changes were partially, but not completely, prevented by pretreatment with inhaled fluticasone propionate. Volumetry findings showed that the allergen decreased volumes of the corpus callosum and subcortical white matter, as well as the septal region and hippocampus (especially CA1 and fimbria). However, volumes of neocortex, insular, and anterior cingulate cortex increased in asthmatic rats compared to controls. Namely, pretreatment with inhaled fluticasone propionate partially prevented asthma-induced brain volume changes, but not completely. These findings suggest that asthma is associated with structural alterations in the brain, which may contribute to the induction of psychological disorders. Thus, considering brain changes in the clinical assessments could have important implications for asthma treatment.
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Affiliation(s)
- Kolsoum Dehdar
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Raoufy
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Aucoin R, Lewthwaite H, Ekström M, von Leupoldt A, Jensen D. Impact of trigeminal nerve and/or olfactory nerve stimulation on activity of human brain regions involved in the perception of breathlessness. Respir Physiol Neurobiol 2023; 311:104036. [PMID: 36804472 DOI: 10.1016/j.resp.2023.104036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Breathlessness is a centrally processed symptom, as evidenced by activation of distinct brain regions such as the insular cortex and amygdala, during the anticipation and/or perception of breathlessness. Inhaled L-menthol or blowing cool air to the face/nose, both selective trigeminal nerve (TGN) stimulants, relieve breathlessness without concurrent improvements in physiological outcomes (e.g., breathing pattern), suggesting a possible but hitherto unexplored central mechanism of action. Four databases were searched to identify published reports supporting a link between TGN stimulation and activation of brain regions involved in the anticipation and/or perception of breathlessness. The collective results of the 29 studies demonstrated that TGN stimulation activated 12 brain regions widely implicated in the anticipation and/or perception of breathlessness, including the insular cortex and amygdala. Inhaled L-menthol or cool air to the face activated 75% and 33% of these 12 brain regions, respectively. Our findings support the hypothesis that TGN stimulation contributes to breathlessness relief by altering the activity of brain regions involved in its central neural processing.
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Affiliation(s)
- Rachelle Aucoin
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montréal, Quebec H2W 1S4, Canada.
| | - Hayley Lewthwaite
- College of Engineering, Science and Environment, School of Environment & Life Sciences, The University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258, Australia
| | - Magnus Ekström
- Department of Respiratory Medicine, Allergology and Palliative Medicine, Institution for Clinical Sciences in Lund, Lund University, SE-221 00 Lund, Sweden
| | - Andreas von Leupoldt
- Health Psychology, University of Leuven, Tiensestraat 102 Box 3726, 3000 Leuven, Belgium
| | - Dennis Jensen
- Clinical Exercise & Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montréal, Quebec H2W 1S4, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, 2155 Guy Street Suite 500, Montréal, Quebec H3H 2R9, Canada
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Vardar-Yagli N, Saglam M, Dasgin H, Karli-Oguz K. The Effects of Respiratory Muscle Training on Resting-State Brain Activity and Thoracic Mobility in Healthy Subjects: A Randomized Controlled Trial. J Magn Reson Imaging 2023; 57:403-417. [PMID: 35762913 DOI: 10.1002/jmri.28322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although inspiratory muscle training (IMT) is an effective intervention for improving breath perception, brain mechanisms have not been studied yet. PURPOSE To examine the effects of IMT on insula and default mode network (DMN) using resting-state functional MRI (RS-fMRI). STUDY TYPE Prospective. POPULATION A total of 26 healthy participants were randomly assigned to two groups as IMT group (n = 14) and sham IMT groups (n = 12). FIELD STRENGTH/SEQUENCE A 3-T, three-dimensional T2* gradient-echo echo planar imaging sequence for RS-fMRI was obtained. ASSESSMENT The intervention group received IMT at 60% and sham group received at 15% of maximal inspiratory pressure (MIP) for 8 weeks. Pulmonary and respiratory muscle function, and breathing patterns were measured. Groups underwent RS-fMRI before and after the treatment. STATISTICAL TESTS Statistical tests were two-tailed P < 0.05 was considered statistically significant. Student's t test was used to compare the groups. One-sample t-test for each group was used to reveal pattern of functional connectivity. A statistical threshold of P < 0.001 uncorrected value was set at voxel level. We used False discovery rate (FDR)-corrected P < 0.05 cluster level. RESULTS The IMT group showed more prominent alterations in insula and DMN connectivity than sham group. The MIP was significantly different after IMT. Respiratory rate (P = 0.344), inspiratory time (P = 0.222), expiratory time (P = 1.000), and inspiratory time/total breath time (P = 0.572) of respiratory patterns showed no significant change after IMT. All DMN components showed decreased, while insula showed increased activation significantly. DATA CONCLUSION Differences in brain activity and connectivity may reflect improved ventilatory perception with IMT with a possible role in regulating breathing pattern by processing interoceptive signals. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Naciye Vardar-Yagli
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Melda Saglam
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Hacer Dasgin
- National Magnetic Resonance Research Center (UMRAM) Bilkent University, Ankara, Turkey
| | - Kader Karli-Oguz
- National Magnetic Resonance Research Center (UMRAM) Bilkent University, Ankara, Turkey.,Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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12
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Barsky AJ, Silbersweig DA. The Amplification of Symptoms in the Medically Ill. J Gen Intern Med 2023; 38:195-202. [PMID: 35829874 PMCID: PMC9849656 DOI: 10.1007/s11606-022-07699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/07/2022] [Indexed: 01/22/2023]
Abstract
The mechanism of symptom amplification, developed in the study of somatization, may be helpful in caring for patients with symptoms that, while they have a demonstrable medical basis, are nonetheless disproportionately severe and distressing. Amplified medical symptoms are marked by disproportionate physical suffering, unduly negative thoughts and concerns about them, and elevated levels of health-related anxiety. They are accompanied by extensive and sustained illness behaviors, disproportionate difficulty compartmentalizing them and circumscribing their impact, and consequent problems and dissatisfaction with their medical care. A distinction has long been made between "medically explained" and "medically unexplained" symptoms. However, a more comprehensive view of symptom phenomenology undermines this distinction and places all symptoms along a smooth continuum regardless of cause: Recent findings in cognitive neuroscience suggest that all symptoms-regardless of origin-are processed through convergent pathways. The complete conscious experience of both medically "explained" and "unexplained" symptoms is an amalgam of a viscerosomatic sensation fused with its ascribed salience and the patient's ideas, expectations, and concerns about the sensation. This emerging empirical evidence furnishes a basis for viewing persistent, disproportionately distressing symptoms of demonstrable disease along a continuum with medically unexplained symptoms. Thus, therapeutic modalities developed for somatization and medically unexplained symptoms can be helpful in the care of seriously ill medical patients with amplified symptoms. These interventions include educational groups for coping with chronic illness, cognitive therapies for dysfunctional thoughts, behavioral strategies for maladaptive illness behaviors, psychotherapy for associated emotional distress, and consultation with mental health professionals to assist the primary care physician with difficulties in medical management.
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Affiliation(s)
- Arthur J Barsky
- Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
| | - David A Silbersweig
- Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
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13
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Chan PYS, Chang WP, Cheng CH, Liu CY, von Leupoldt A, Hsu AL, Wu CW. The impact of emotional context on neural substrates of respiratory sensory gating. Front Neurosci 2022; 16:1004271. [PMID: 36389230 PMCID: PMC9650924 DOI: 10.3389/fnins.2022.1004271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/21/2022] [Indexed: 12/04/2022] Open
Abstract
Psychological challenges have been found to impact respiratory symptom perception in healthy individuals as well as in patients with various neurological disorders. Human respiratory sensory gating is an objective measure to examine respiratory sensory information processing of repetitive respiratory mechanical stimuli in the central nervous system. With this electrophysiological method, patients with higher anxiety levels showed reduced respiratory sensory gating function in the cortex, and increased symptom perception. In addition, positive emotional contexts were found to increase the respiratory sensory gating function using RREPs. However, neural substrates related to emotional impacts on respiratory sensory gating remain still unclear. In the present study, we examined the emotion processing of respiratory sensory gating using functional magnetic resonance imaging. We hypothesized that positive compared with neutral stimuli would result in reduced brain activations in cortical areas with the paired occlusion paradigm. Thirty-five healthy adults participated in this event-designed fMRI experiment. Paired inspiratory occlusions (two transient occlusions with a 500 ms inter-stimulus-interval are delivered during one inspiration) were provided using an external trigger outside of the scanner. At least 40 paired inspiratory occlusions were collected for each trial. The experiment contained three runs during which participants underwent 12 min for the paired inspiratory occlusion paradigm while watching a fixation cross (the control condition), neutral and positive emotional picture series. The order of emotional picture series was randomized across the participants. Our results revealed an overall trend of reduction of brain activity from the neutral (minus fixation) condition, to the pleasant (minus fixation) condition. For bilateral thalamus and primary visual cortices, there was no significant difference in neural activation between the two contrasts of pleasant (ContrastP–F) and neutral condition (ContrastN–F). The activation of the mid-cingulate and the orbitofrontal cortex was lower in ContrastP–F compared to ContrastN–F. In conclusion, our results suggest that emotional context, especially positive valence, modulates neural correlates in middle cingulate cortex and orbitofrontal cortex in terms of respiratory sensory gating. Future studies are recommended to test emotional impacts on respiratory sensations in patients with neurological disorders.
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Affiliation(s)
- Pei-Ying S. Chan
- Department of Occupational Therapy, College of Medicine, and Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Pin Chang
- Department of Occupational Therapy, Rocky Mountain University of Health Professions, Provo, UT, United States
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy, College of Medicine, and Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | - Ai-Ling Hsu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Ai-Ling Hsu,
| | - Changwei W. Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Changwei W. Wu,
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14
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Santarnecchi E, Sprugnoli G, Sicilia I, Dukart J, Neri F, Romanella SM, Cerase A, Vatti G, Rocchi R, Rossi A. Thalamic altered spontaneous activity and connectivity in obstructive sleep apnea syndrome. J Neuroimaging 2022; 32:314-327. [PMID: 34964182 PMCID: PMC9094633 DOI: 10.1111/jon.12952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/30/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Obstructive sleep apnea (OSA) syndrome is a sleep disorder characterized by excessive snoring, repetitive apneas, and nocturnal arousals, that leads to fragmented sleep and intermittent nocturnal hypoxemia. Morphometric and functional brain alterations in cortical and subcortical structures have been documented in these patients via magnetic resonance imaging (MRI), even if correlational data between the alterations in the brain and cognitive and clinical indexes are still not reported. METHODS We examined the impact of OSA on brain spontaneous activity by measuring the fractional amplitude of low-frequency fluctuations (fALFF) in resting-state functional MRI data of 20 drug-naïve patients with OSA syndrome and 20 healthy controls matched for age, gender, and body mass index. RESULTS Patients showed a pattern of significantly abnormal subcortical functional activity as compared to controls, with increased activity selectively involving the thalami, specifically their intrinsic nuclei connected to somatosensory and motor-premotor cortical regions. Using these nuclei as seed regions, the subsequent functional connectivity analysis highlighted an increase in patients' thalamocortical connectivity at rest. Additionally, the correlation between fALFF and polysomnographic data revealed a possible link between OSA severity and fALFF of regions belonging to the central autonomic network. CONCLUSIONS Our results suggest a hyperactivation in thalamic diurnal activity in patients with OSA syndrome, which we interpret as a possible consequence of increased thalamocortical circuitry activation during nighttime due to repeated arousals.
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Affiliation(s)
- Emiliano Santarnecchi
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giulia Sprugnoli
- Siena Brain Investigation & Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Isabella Sicilia
- Center for Sleep Study, University of Siena School of Medicine, Siena, Italy
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Centre Jülich, Jülich, Germany,Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Francesco Neri
- Siena Brain Investigation & Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Sara M. Romanella
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Siena Brain Investigation & Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Alfonso Cerase
- Department of Medicine, Surgery and Neuroscience, Section of Neuroradiology, University of Siena, Siena, Italy
| | - Giampaolo Vatti
- Center for Sleep Study, University of Siena School of Medicine, Siena, Italy
| | - Raffaele Rocchi
- Center for Sleep Study, University of Siena School of Medicine, Siena, Italy
| | - Alessandro Rossi
- Siena Brain Investigation & Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy,Center for Sleep Study, University of Siena School of Medicine, Siena, Italy
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15
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Chan PYS, Cheng CH, Liu CY, Davenport PW. Cortical Sources of Respiratory Mechanosensation, Laterality, and Emotion: An MEG Study. Brain Sci 2022; 12:brainsci12020249. [PMID: 35204012 PMCID: PMC8870097 DOI: 10.3390/brainsci12020249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/04/2022] Open
Abstract
Airway obstruction activates mechanoreceptors that project to the cerebral cortices in humans, as evidenced by scalp encephalography recordings of cortical neuronal activation, i.e., respiratory-related evoked potential (RREP). However, neural evidence of both high spatial and temporal resolution of occlusion-elicited cortical activation in healthy individuals is lacking. In the present study, we tested our hypothesis that inspiratory mechanical stimuli elicit neural activation in cortical structures that can be recorded using magnetoencephalography (MEG). We further examined the relationship between depression and respiratory symptoms and hemispheric dominance in terms of emotional states. A total of 14 healthy nonsmoking participants completed a respiratory symptom questionnaire and a depression symptom questionnaire, followed by MEG and RREP recordings of inspiratory occlusion. Transient inspiratory occlusion of 300 ms was provided randomly every 2 to 4 breaths, and approximately 80 occlusions were collected in every study participant. Participants were required to press a button for detection when they sensed occlusion. Respiratory-related evoked fields (RREFs) and RREP peaks were identified in terms of latencies and amplitudes in the right and left hemispheres. The Wilcoxon signed-rank test was further used to examine differences in peak amplitudes between the right and left hemispheres. Our results showed that inspiratory occlusion elicited RREF M1 peaks between 80 and 100 ms after triggering. Corresponding neuromagnetic responses peaked in the sensorimotor cortex, insular cortex, lateral frontal cortex, and middle frontal cortex. Overall, the RREF M1 peak amplitude in the right insula was significantly higher than that in the left insula (p = 0.038). The RREP data also showed a trend of higher N1 peak amplitudes in the right hemisphere compared to the left (p = 0.064, one-tailed). Subgroup analysis revealed that the laterality index of sensorimotor cortex activation was significantly different between higher- and lower-depressed individuals (−0.33 vs. −0.02, respectively; p = 0.028). For subjective ratings, a significant relationship was found between an individual’s depression level and their respiratory symptoms (Spearman’s rho = 0.54, p = 0.028, one-tailed). In summary, our results demonstrated that the inspiratory occlusion paradigm is feasible to elicit an RREF M1 peak with MEG. Our imaging results showed that cortical neurons were activated in the sensorimotor, frontal, middle temporal, and insular cortices for the M1 peak. Respiratory occlusion elicited higher cortical neuronal activation in the right insula compared to the left, with a higher tendency for right laterality in the sensorimotor cortex for higher-depressed rather than lower-depressed individuals. Higher levels of depression were associated with higher levels of respiratory symptoms. Future research with a larger sample size is recommended to investigate the role of emotion and laterality in cerebral neural processing of respiratory sensation.
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Affiliation(s)
- Pei-Ying S. Chan
- Department of Occupational Therapy and Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Correspondence: (P.-Y.S.C.); (C.-H.C.); Tel.: +886-3-2118800 (ext. 5441) (P.-Y.S.C.); +886-3-2118800 (ext. 3854) (C.-H.C.)
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- BIND Lab, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (P.-Y.S.C.); (C.-H.C.); Tel.: +886-3-2118800 (ext. 5441) (P.-Y.S.C.); +886-3-2118800 (ext. 3854) (C.-H.C.)
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Paul W. Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA;
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16
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Neural substrates of respiratory sensory gating: A human fMRI study. Biol Psychol 2022; 169:108277. [DOI: 10.1016/j.biopsycho.2022.108277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
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17
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Abstract
The clinical term dyspnea (a.k.a. breathlessness or shortness of breath) encompasses at least three qualitatively distinct sensations that warn of threats to breathing: air hunger, effort to breathe, and chest tightness. Air hunger is a primal homeostatic warning signal of insufficient alveolar ventilation that can produce fear and anxiety and severely impacts the lives of patients with cardiopulmonary, neuromuscular, psychological, and end-stage disease. The sense of effort to breathe informs of increased respiratory muscle activity and warns of potential impediments to breathing. Most frequently associated with bronchoconstriction, chest tightness may warn of airway inflammation and constriction through activation of airway sensory nerves. This chapter reviews human and functional brain imaging studies with comparison to pertinent neurorespiratory studies in animals to propose the interoceptive networks underlying each sensation. The neural origins of their distinct sensory and affective dimensions are discussed, and areas for future research are proposed. Despite dyspnea's clinical prevalence and impact, management of dyspnea languishes decades behind the treatment of pain. The neurophysiological bases of current therapeutic approaches are reviewed; however, a better understanding of the neural mechanisms of dyspnea may lead to development of novel therapies and improved patient care.
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Affiliation(s)
- Andrew P Binks
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States; Faculty of Health Sciences, Virginia Tech, Blacksburg, VA, United States.
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18
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Howell D. Enabling patients in effective self-management of breathlessness in lung cancer: the neglected pillar of personalized medicine. Lung Cancer Manag 2021; 10:LMT52. [PMID: 34899992 PMCID: PMC8656340 DOI: 10.2217/lmt-2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
Globally, engagement of patients in the self management of disease and symptom problems has become a health policy priority to improve health outcomes in cancer. Unfortunately, little attention has been focused on the provision of self-management support (SMS)in cancer and specifically for complex cancer symptoms such as breathlessness. Current management of breathlessness, which includes treatment of underlying disease, pharmacological agents to address comorbidities and opiates and anxiolytics to change perception and reduce the sense of breathing effort, is inadequate. In this perspective paper, we review the rationale and evidence for a structured, multicomponent SMS program in breathlessness including four components: breathing retraining, enhancing positive coping skills, optimizing exertional capacity and reducing symptom burden and health risks. The integration of SMS in routine lung cancer care is essential to improve breathlessness, reduce psychological distress, suffering and improve quality of life.
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Affiliation(s)
- Doris Howell
- Princess Margaret Cancer Research Centre, Toronto, ON, Canada
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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19
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Gauvrit M, Jaffré S, Morin J, Hervé C, Alami H, Blanc FX. [Central control malfunction in Wolfram syndrome: Report of one case of difficult weaning]. Rev Mal Respir 2021; 38:946-950. [PMID: 34702600 DOI: 10.1016/j.rmr.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/03/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Wolfram syndrome is a rare autosomal recessive genetic disease characterized by diabetes insipidus, diabetes mellitus, optic atrophy and deafness. A neurodegenerative syndrome is usually associated, including cerebellar ataxia. A few cases of central apnea have been reported in the literature. Here, we report a case of Wolfram syndrome with respiratory symptoms that led to the discovery of central apneas as well as complicated and delayed weaning in an intensive care unit (ICU). OBSERVATION The patient is a 39-year-old woman diagnosed with Wolfram syndrome who was admitted to an ICU for septic shock. She experienced difficult weaning before central apneas were observed while spontaneous ventilation was being attempted. After two extubation failures, cerebral MRI was performed and revealed parenchymatous atrophy of the posterior brain fossa involving the cerebral trunk, cerebellar peduncles, as well as both cerebellum hemispheres and the cerebellar vermis. Even after the patient was tracheotomized, central apneas persisted when the patient breathed spontaneously with her tracheotomy, necessitating nocturnal ventilation. CONCLUSION While central apneas Wolfram syndrome remain rare, they should be systematically investigated due to their association with severe morbimortality.
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Affiliation(s)
- M Gauvrit
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
| | - S Jaffré
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - J Morin
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - C Hervé
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France; Centre Hospitalier Erdre Loire, 44156 Ancenis, France
| | - H Alami
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - F-X Blanc
- Service de pneumologie, L'institut du thorax, Hôpital G. et R. Laennec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France; Université de Nantes, 44000 Nantes, France
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20
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Jelinčić V, Van Diest I, Torta DM, von Leupoldt A. The breathing brain: The potential of neural oscillations for the understanding of respiratory perception in health and disease. Psychophysiology 2021; 59:e13844. [PMID: 34009644 DOI: 10.1111/psyp.13844] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
Dyspnea or breathlessness is a symptom occurring in multiple acute and chronic illnesses, however, the understanding of the neural mechanisms underlying its subjective experience is limited. In this topical review, we propose neural oscillatory dynamics and cross-frequency coupling as viable candidates for a neural mechanism underlying respiratory perception, and a technique warranting more attention in respiration research. With the evidence for the potential of neural oscillations in the study of normal and disordered breathing coming from disparate research fields with a limited history of interdisciplinary collaboration, the main objective of the review was to converge the existing research and suggest future directions. The existing findings show that distinct limbic and cortical activations, as measured by hemodynamic responses, underlie dyspnea, however, the time-scale of these activations is not well understood. The recent findings of oscillatory neural activity coupled with the respiratory rhythm could provide the solution to this problem, however, more research with a focus on dyspnea is needed. We also touch on the findings of distinct spectral patterns underlying the changes in breathing due to experimental manipulations, meditation and disease. Subsequently, we suggest general research directions and specific research designs to supplement the current knowledge using neural oscillation techniques. We argue for the benefits of interdisciplinary collaboration and the converging of neuroimaging and behavioral methods to best explain the emergence of the subjective and aversive individual experience of dyspnea.
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Affiliation(s)
- Valentina Jelinčić
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Diana M Torta
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
| | - Andreas von Leupoldt
- Research Group Health Psychology, Department of Psychology, KU Leuven, Leuven, Belgium
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21
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Finnegan SL, Harrison OK, Harmer CJ, Herigstad M, Rahman NM, Reinecke A, Pattinson KTS. Breathlessness in COPD: linking symptom clusters with brain activity. Eur Respir J 2021; 58:13993003.04099-2020. [PMID: 33875493 PMCID: PMC8607925 DOI: 10.1183/13993003.04099-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/04/2021] [Indexed: 11/11/2022]
Abstract
Background Current models of breathlessness often fail to explain disparities between patients' experiences of breathlessness and objective measures of lung function. While a mechanistic understanding of this discordance has thus far remained elusive, factors such as mood, attention and expectation have all been implicated as important modulators of breathlessness. Therefore, we have developed a model to better understand the relationships between these factors using unsupervised machine learning techniques. Subsequently we examined how expectation-related brain activity differed between these symptom-defined clusters of participants. Methods A cohort of 91 participants with mild-to-moderate chronic obstructive pulmonary disease (COPD) underwent functional brain imaging, self-report questionnaires and clinical measures of respiratory function. Unsupervised machine learning techniques of exploratory factor analysis and hierarchical cluster modelling were used to model brain–behaviour–breathlessness links. Results We successfully stratified participants across four key factors corresponding to mood, symptom burden and two capability measures. Two key groups resulted from this stratification, corresponding to high and low symptom burden. Compared with the high symptom burden group, the low symptom burden group demonstrated significantly greater brain activity within the anterior insula, a key region thought to be involved in monitoring internal bodily sensations (interoception). Conclusions This is the largest functional neuroimaging study of COPD to date, and is the first to provide a clear model linking brain, behaviour and breathlessness expectation. Furthermore, it was possible to stratify participants into groups, which then revealed differences in brain activity patterns. Together, these findings highlight the value of multimodal models of breathlessness in identifying behavioural phenotypes and for advancing understanding of differences in breathlessness burden. Towards individualised treatments for chronic breathlessness with functional neuroimaging: revealing the factors underlying the breathlessness experience in COPDhttps://bit.ly/3a8fXPt
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Affiliation(s)
- Sarah L Finnegan
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K Harrison
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Catherine J Harmer
- Department of Psychiatry, Medical Sciences, University of Oxford, Oxford, UK.,Oxford Health NHS foundation Trust, Warneford Hospital, Oxford, UK
| | - Mari Herigstad
- Department of Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
| | - Najib M Rahman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrea Reinecke
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Department of Psychiatry, Medical Sciences, University of Oxford, Oxford, UK.,Oxford Health NHS foundation Trust, Warneford Hospital, Oxford, UK
| | - Kyle T S Pattinson
- Wellcome Centre for Integrative Neuroimaging and Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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22
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von Leupoldt A, Ashoori M, Jelinčić V, Herzog M, Van Diest I. The impact of unpredictability of dyspnea offset on dyspnea perception, fear, and respiratory neural gating. Psychophysiology 2021; 58:e13807. [PMID: 33682134 DOI: 10.1111/psyp.13807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023]
Abstract
Dyspnea is a debilitating and threatening symptom in various diseases. Affected patients often report the unpredictability of dyspnea episodes being particularly anxiety-provoking and amplifying the perception of dyspnea. Experimental studies testing dyspnea unpredictability together with related neural processes, physiological fear responses, and dyspnea-related personality traits are sparse. Therefore, we investigated the impact of unpredictability of dyspnea offset on dyspnea perception and fear ratings, respiratory neural gating and physiological fear indices, as well as the influence of interindividual differences in fear of suffocation (FoS). Forty healthy participants underwent a task manipulating the offset predictability of resistive load-induced dyspnea including one unloaded safety condition. Respiratory variables, self-reports of dyspnea intensity, dyspnea unpleasantness, and fear were recorded. Moreover, respiratory neural gating was measured in a paired inspiratory occlusion paradigm using electroencephalography, while electrodermal activity, startle eyeblink, and startle probe N100 were assessed as physiological fear indices. Participants reported higher dyspnea unpleasantness and fear when dyspnea offset was unpredictable compared to being predictable. Individuals with high levels of FoS showed the greatest increase in fear and overall higher levels of fear and physiological arousal across all conditions. Respiratory neural gating, startle eyeblink, and startle probe N100 showed general reductions during dyspnea conditions but no difference between unpredictable and predictable dyspnea conditions. Together, the current results suggest that the unpredictable offset of dyspnea amplifies dyspnea perception and fear, especially in individuals with high levels of FoS. These effects were unrelated to respiratory neural gating or physiological fear responses, requiring future studies on underlying mechanisms.
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Affiliation(s)
| | - Minoo Ashoori
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Michaela Herzog
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
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23
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Vlemincx E, Sprenger C, Büchel C. Expectation and dyspnea: The neurobiological basis of respiratory nocebo effects. Eur Respir J 2021; 58:13993003.03008-2020. [PMID: 33574073 DOI: 10.1183/13993003.03008-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/31/2021] [Indexed: 11/05/2022]
Abstract
Cues such as odours that do not per se evoke bronchoconstriction can become triggers of asthma exacerbations. Despite its clinical significance, the neural basis of this respiratory nocebo effect is unknown. We investigated this effect in a functional magnetic resonance imaging (fMRI) study involving 36 healthy volunteers. The experiment consisted of an Experience phase in which volunteers experienced dyspnea while being exposed to an odorous gas ("Histarinol"). Volunteers were told that "Histarinol" induces dyspnea by bronchoconstriction. This was compared to another odorous gas which did not evoke dyspnea. Actually, dyspnea was induced by a concealed, resistive load inserted into the breathing system. In a second, Expectation phase, Histarinol and the control gas were both followed by an identical, very mild load. Respiration parameters were continuously recorded and after each trial participants rated dyspnea intensity. Dyspnea ratings were significantly higher in Histarinol compared to control conditions, both in the Experience and in the Expectation phase, despite identical physical resistance in the Expectation phase. Insula fMRI signal matched the actual load, i.e. a significant difference between Histarinol and Control in the Experience phase, but no difference in the Expectation phase. The periaqueductal gray showed a significantly higher fMRI signal during the expectation of dyspnea. Finally, Histarinol related deactivations during the Expectation phase in the rostral anterior cingulate cortex mirror similar responses for nocebo effects in pain. These findings highlight the neural basis of expectation effects associated with dyspnea, which has important consequences for our understanding of the perception of respiratory symptoms.
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Affiliation(s)
- Elke Vlemincx
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany .,Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Christian Sprenger
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Abstract
The sensation that develops as a long breath hold continues is what this article is about. We term this sensation of an urge to breathe "air hunger." Air hunger, a primal sensation, alerts us to a failure to meet an urgent homeostatic need maintaining gas exchange. Anxiety, frustration, and fear evoked by air hunger motivate behavioral actions to address the failure. The unpleasantness and emotional consequences of air hunger make it the most debilitating component of clinical dyspnea, a symptom associated with respiratory, cardiovascular, and metabolic diseases. In most clinical populations studied, air hunger is the predominant form of dyspnea (colloquially, shortness of breath). Most experimental subjects can reliably quantify air hunger using rating scales, that is, there is a consistent relationship between stimulus and rating. Stimuli that increase air hunger include hypercapnia, hypoxia, exercise, and acidosis; tidal expansion of the lungs reduces air hunger. Thus, the defining experimental paradigm to evoke air hunger is to elevate the drive to breathe while mechanically restricting ventilation. Functional brain imaging studies have shown that air hunger activates the insular cortex (an integration center for perceptions related to homeostasis, including pain, food hunger, and thirst), as well as limbic structures involved with anxiety and fear. Although much has been learned about air hunger in the past few decades, much remains to be discovered, such as an accepted method to quantify air hunger in nonhuman animals, fundamental questions about neural mechanisms, and adequate and safe methods to mitigate air hunger in clinical situations. © 2021 American Physiological Society. Compr Physiol 11:1449-1483, 2021.
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Affiliation(s)
- Robert B Banzett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Lansing
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew P Binks
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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25
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AlSalahi SE, Junejo RT, Bradley C, Balanos GM, Siebenmann C, Fisher JP. The middle cerebral artery blood velocity response to acute normobaric hypoxia occurs independently of changes in ventilation in humans. Exp Physiol 2021; 106:861-867. [PMID: 33527604 DOI: 10.1113/ep089127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/28/2021] [Indexed: 12/22/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does the ventilatory response to moderate acute hypoxia increase cerebral perfusion independently of changes in arterial oxygen tension in humans? What is the main finding and its importance? The ventilatory response does not increase middle cerebral artery mean blood velocity during moderate isocapnic acute hypoxia beyond that elicited by reduced oxygen saturation. ABSTRACT Hypoxia induces ventilatory, cardiovascular and cerebrovascular adjustments to defend against reductions in systemic oxygen delivery. We aimed to determine whether the ventilatory response to moderate acute hypoxia increases cerebral perfusion independently of changes in arterial oxygenation. Eleven young healthy individuals were exposed to four 15 min experimental conditions: (1) normoxia (partial pressure of end-tidal oxygen, P ET O 2 = 100 mmHg), (2) hypoxia ( P ET O 2 = 50 mmHg), (3) normoxia with breathing volitionally matched to levels observed during hypoxia (hyperpnoea; P ET O 2 = 100 mmHg) and (4) hypoxia ( P ET O 2 = 50 mmHg) with respiratory frequency and tidal volume volitionally matched to levels observed during normoxia (i.e., restricted breathing (RB)). Isocapnia was maintained in all conditions. Middle cerebral artery mean blood velocity (MCA Vmean ), assessed by transcranial Doppler ultrasound, was increased during hypoxia (58 ± 12 cm/s, P = 0.04) and hypoxia + RB (61 ± 14 cm/s, P < 0.001) compared to normoxia (55 ± 11 cm/s), while it was unchanged during hyperpnoea (52 ± 13 cm/s, P = 0.08). MCA Vmean was not different between hypoxia and hypoxia + RB (P > 0.05). These findings suggest that the hypoxic ventilatory response does not increase cerebral perfusion, indexed using MCA Vmean , during moderate isocapnic acute hypoxia beyond that elicited by reduced oxygen saturation.
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Affiliation(s)
- Sultan E AlSalahi
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rehan T Junejo
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Chris Bradley
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - George M Balanos
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - James P Fisher
- Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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26
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Simonson TS, Baker TL, Banzett RB, Bishop T, Dempsey JA, Feldman JL, Guyenet PG, Hodson EJ, Mitchell GS, Moya EA, Nokes BT, Orr JE, Owens RL, Poulin M, Rawling JM, Schmickl CN, Watters JJ, Younes M, Malhotra A. Silent hypoxaemia in COVID-19 patients. J Physiol 2021; 599:1057-1065. [PMID: 33347610 PMCID: PMC7902403 DOI: 10.1113/jp280769] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022] Open
Abstract
The clinical presentation of COVID-19 due to infection with SARS-CoV-2 is highly variable with the majority of patients having mild symptoms while others develop severe respiratory failure. The reason for this variability is unclear but is in critical need of investigation. Some COVID-19 patients have been labelled with 'happy hypoxia', in which patient complaints of dyspnoea and observable signs of respiratory distress are reported to be absent. Based on ongoing debate, we highlight key respiratory and neurological components that could underlie variation in the presentation of silent hypoxaemia and define priorities for subsequent investigation.
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Affiliation(s)
- Tatum S Simonson
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Tracy L Baker
- Department of Comparative Biosciences, University of Wisconsin -, Madison, WI, USA
| | - Robert B Banzett
- Division of Pulmonary, Critical Care, & Sleep Medicine Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Tammie Bishop
- Target Discovery Institute, University of Oxford, Oxford, UK
| | - Jerome A Dempsey
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin -, Madison, WI, USA
| | - Jack L Feldman
- Department of Neurobiology, University of California, Los Angeles, CA, USA
| | - Patrice G Guyenet
- Department of Pharmacology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Emma J Hodson
- The Francis Crick Institute, London, UK
- The Department of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Gordon S Mitchell
- Department of Physical Therapy, Center for Respiratory Research and Rehabilitation, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Esteban A Moya
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Brandon T Nokes
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Robert L Owens
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Marc Poulin
- Departments of Physiology & Pharmacology and Clinical Neurosciences, Cumming School of Medicine and Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean M Rawling
- Departments of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Jyoti J Watters
- Department of Comparative Biosciences, University of Wisconsin -, Madison, WI, USA
| | - Magdy Younes
- Sleep Disorders Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
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27
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Fukushi I, Pokorski M, Okada Y. Mechanisms underlying the sensation of dyspnea. Respir Investig 2020; 59:66-80. [PMID: 33277231 DOI: 10.1016/j.resinv.2020.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 01/17/2023]
Abstract
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. It is a common symptom among patients with respiratory diseases that reduces daily activities, induces deconditioning, and is self-perpetuating. Although clinical interventions are needed to reduce dyspnea, its underlying mechanism is poorly understood depending on the intertwined peripheral and central neural mechanisms as well as emotional factors. Nonetheless, experimental and clinical observations suggest that dyspnea results from dissociation or a mismatch between the intended respiratory motor output set caused by the respiratory neuronal network in the lower brainstem and the ventilatory output accomplished. The brain regions responsible for detecting the mismatch between the two are not established. The mechanism underlying the transmission of neural signals for dyspnea to higher sensory brain centers is not known. Further, information from central and peripheral chemoreceptors that control the milieu of body fluids is summated at higher brain centers, which modify dyspneic sensations. The mental status also affects the sensitivity to and the threshold of dyspnea perception. The currently used methods for relieving dyspnea are not necessarily fully effective. The search for more effective therapy requires further insights into the pathophysiology of dyspnea.
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Affiliation(s)
- Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, 1639-3 Ogura-cho, Wakaba-ku, Chiba, 264-0007, Japan; Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan.
| | - Mieczyslaw Pokorski
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan; Faculty of Health Sciences, The Jan Dlugosz University in Czestochowa, 4/8 Jerzego Waszyngtona Street, 42-200, Czestochowa, Poland
| | - Yasumasa Okada
- Clinical Research Center, Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
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28
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Laghi F, Shaikh H, Littleton SW, Morales D, Jubran A, Tobin MJ. Inhibition of central activation of the diaphragm: a mechanism of weaning failure. J Appl Physiol (1985) 2020; 129:366-376. [PMID: 32673161 PMCID: PMC7473953 DOI: 10.1152/japplphysiol.00856.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During a T-tube trial following disconnection of mechanical ventilation, patients failing the trial do not develop contractile diaphragmatic fatigue despite increases in inspiratory pressure output. Studies in volunteers, patients, and animals raise the possibility of spinal and supraspinal reflex mechanisms that inhibit central-neural output under loaded conditions. We hypothesized that diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. Tidal transdiaphragmatic pressure (ΔPdi) and electrical activity (ΔEAdi) were recorded with esophago-gastric catheters during a T-tube trial in 20 critically ill patients. During the T-tube trial, ∆EAdi was greater in weaning failure patients than in weaning success patients (P = 0.049). Despite increases in ΔPdi, from 18.1 ± 2.5 to 25.9 ± 3.7 cm H2O (P < 0.001), rate of transdiaphragmatic pressure development (from 22.6 ± 3.1 to 37.8 ± 6.7 cm H2O/s; P < 0.0004), and concurrent respiratory distress, ∆EAdi at the end of a failed T-tube trial was half of maximum, signifying inhibition of central neural output to the diaphragm. The increase in ΔPdi in the weaning failure group, while ∆EAdi remained constant, indicates unexpected improvement in diaphragmatic neuromuscular coupling (from 46.7 ± 6.5 to 57.8 ± 8.4 cm H2O/%; P = 0.006). Redistribution of neural output to the respiratory muscles characterized by a progressive increase in rib cage and accessory muscle contribution to tidal breathing and expiratory muscle recruitment contributed to enhanced coupling. In conclusion, diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. This finding signifies that reflex inhibition of central neural output to the diaphragm contributes to weaning failure. NEW & NOTEWORTHY Research into pathophysiology of failure to wean from mechanical ventilation has excluded several factors, including contractile fatigue, but the precise mechanism remains unknown. We recorded transdiaphragmatic pressure and diaphragmatic electrical activity in patients undergoing a T-tube trial. Diaphragmatic recruitment was submaximal at the end of a failed trial despite concurrent respiratory distress, signifying that inhibition of central neural output to the diaphragm is an important mechanism of weaning failure.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Stephen W Littleton
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Daniel Morales
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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29
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Prescription Synthetic Oral Cannabinoid use Among Older Adults with Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. Drugs Aging 2020; 36:1035-1045. [PMID: 31552597 DOI: 10.1007/s40266-019-00707-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Synthetic oral cannabinoids (nabilone and dronabinol) may have adverse respiratory effects. Our purpose was to describe the scope, pattern, and patient characteristics associated with incident off-label synthetic oral cannabinoid use among older adults with chronic obstructive pulmonary disease (COPD) compared to older adults without COPD. METHODS This was a retrospective, population-based, cohort study using Ontario, Canada, heath administrative data. Individuals aged 66 years or older were included, and physician-diagnosed COPD was identified using a previously validated, highly specific algorithm. Incident off-label oral cannabinoid use was examined between April 1, 2005 and March 31, 2015. Descriptive statistics were used to describe drug use patterns. Multiple logistic regression was used to identify patient characteristics associated with incident drug use. RESULTS There were 172,282 older adults with COPD and 1,068,256 older adults without COPD identified between April 1, 2005 and March 31, 2015. Incident synthetic oral cannabinoid use during this period occurred with significantly greater (p < 0.001) frequency among older adults with COPD (0.6%) versus older adults without COPD (0.3%). Compared to those without COPD, older adults with COPD used synthetic cannabinoids for significantly longer durations and more frequently at higher doses. CONCLUSIONS Although incident off-label oral cannabinoid use was relatively low among all older Ontarian adults, this drug class was used with greater frequency and more often in potentially concerning ways among older adults with COPD. These findings raise possible safety concerns, but further research on the respiratory safety of oral cannabinoids among individuals with COPD is needed.
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30
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Spinelli E, Mauri T, Beitler JR, Pesenti A, Brodie D. Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions. Intensive Care Med 2020; 46:606-618. [PMID: 32016537 PMCID: PMC7224136 DOI: 10.1007/s00134-020-05942-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
Abstract
Neural respiratory drive, i.e., the activity of respiratory centres controlling breathing, is an overlooked physiologic variable which affects the pathophysiology and the clinical outcome of acute respiratory distress syndrome (ARDS). Spontaneous breathing may offer multiple physiologic benefits in these patients, including decreased need for sedation, preserved diaphragm activity and improved cardiovascular function. However, excessive effort to breathe due to high respiratory drive may lead to patient self-inflicted lung injury (P-SILI), even in the absence of mechanical ventilation. In the present review, we focus on the physiological and clinical implications of control of respiratory drive in ARDS patients. We summarize the main determinants of neural respiratory drive and the mechanisms involved in its potentiation, in health and ARDS. We also describe potential and pitfalls of the available bedside methods for drive assessment and explore classical and more “futuristic” interventions to control drive in ARDS patients.
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Affiliation(s)
- Elena Spinelli
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, Via F. Sforza 35, 20122, Milan, Italy
| | - Tommaso Mauri
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, Via F. Sforza 35, 20122, Milan, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, Via F. Sforza 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Daniel Brodie
- Center for Acute Respiratory Failure, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA
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31
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Azabou E, Bao G, Heming N, Bounab R, Moine P, Chevallier S, Chevret S, Resche-Rigon M, Siami S, Sharshar T, Lofaso F, Annane D. Randomized Controlled Study Evaluating Efficiency of Low Intensity Transcranial Direct Current Stimulation (tDCS) for Dyspnea Relief in Mechanically Ventilated COVID-19 Patients in ICU: The tDCS-DYSP-COVID Protocol. Front Med (Lausanne) 2020; 7:372. [PMID: 32671084 PMCID: PMC7332773 DOI: 10.3389/fmed.2020.00372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
The severe respiratory distress syndrome linked to the new coronavirus disease (COVID-19) includes unbearable dyspneic suffering which contributes to the deterioration of the prognosis of patients in intensive care unit (ICU). Patients are put on mechanical ventilation to reduce respiratory suffering and preserve life. Despite this mechanical ventilation, most patients continue to suffer from dyspnea. Dyspnea is a major source of suffering in intensive care and one of the main factors that affect the prognosis of patients. The development of innovative methods for its management, especially non-drug management is more than necessary. In recent years, numerous studies have shown that transcranial direct current stimulation (tDCS) could modulate the perception of acute or chronic pain. In the other hand, it has been shown that the brain zones activated during pain and dyspnea are close and/or superimposed, suggesting that brain structures involved in the integration of aversive emotional component are shared by these two complex sensory experiences. Therefore, it can be hypothesized that stimulation by tDCS with regard to the areas which, in the case of pain have activated one or more of these brain structures, may also have an effect on dyspnea. In addition, our team recently demonstrated that the application of tDCS on the primary cortical motor area can modulate the excitability of the respiratory neurological pathways. Indeed, tDCS in anodal or cathodal modality reduced the excitability of the diaphragmatic cortico-spinal pathways in healthy subjects. We therefore hypothesized that tDCS could relieve dyspnea in COVID-19 patients under mechanical ventilation in ICU. This study was designed to evaluate effects of two modalities of tDCS (anodal and cathodal) vs. placebo, on the relief of dyspnea in COVID-19 patients requiring mechanical ventilation in ICU. Trial Registration: This protocol is derived from the tDCS-DYSP-REA project registered on ClinicalTrials.gov NCT03640455. It will however be registered under its own NCT number.
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Affiliation(s)
- Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
- *Correspondence: Eric Azabou ;
| | - Guillaume Bao
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Rania Bounab
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Pierre Moine
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Sylvain Chevallier
- Versailles Engineering Systems Laboratory (LISV), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Velizy, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Shidaps Siami
- Critical Care Medicine Unit, CH Etampes-Dourdan, Etampes, France
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France
| | - Frederic Lofaso
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Djillali Annane
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
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The effect of anxiety on brain activation patterns in response to inspiratory occlusions: an fMRI study. Sci Rep 2019; 9:15045. [PMID: 31636310 PMCID: PMC6803655 DOI: 10.1038/s41598-019-51396-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022] Open
Abstract
Respiratory sensations such as breathlessness are prevalent in many diseases and are amplified by increased levels of anxiety. Cortical activation in response to inspiratory occlusions in high- and low-anxious individuals was found different in previous studies using the respiratory-related evoked potential method. However, specific brain areas showed different activation patterns remained unknown in these studies. Therefore, the purpose of this study was to compare cortical and subcortical neural substrates of respiratory sensation in response to inspiratory mechanical occlusion stimuli between high- and low-anxious individuals using functional magnetic resonance imaging (fMRI). In addition, associations between brain activation patterns and levels of anxiety, and breathlessness were examined. Thirty-four (17 high- and 17 low-anxious) healthy non-smoking adults with normal lung function completed questionnaires on anxiety (State Trait Anxiety Inventory - State), and participated in a transient inspiratory occlusion fMRI experiment. The participants breathed with a customized face-mask while respiration was repeatedly interrupted by a transient inspiratory occlusion of 150-msec, delivered every 2 to 4 breaths. Breathlessness was assessed by self-report. At least 32 occluded breaths were collected for data analysis. The results showed that compared to the low-anxious group, the high-anxious individuals demonstrated significantly greater neural activations in the hippocampus, insula, and middle cingulate gyrus in response to inspiratory occlusions. Moreover, a significant relationship was found between anxiety levels and activations of the right inferior parietal gyrus, and the right precuneus. Additionally, breathlessness levels were significantly associated with activations of the bilateral thalamus, bilateral insula and bilateral cingulate gyrus. The above evidences support stronger recruitment of emotion-related cortical and subcortical brain areas in higher anxious individuals, and thus these areas play an important role in respiratory mechanosensation mediated by anxiety.
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Becker S, Bräscher AK, Bannister S, Bensafi M, Calma-Birling D, Chan RCK, Eerola T, Ellingsen DM, Ferdenzi C, Hanson JL, Joffily M, Lidhar NK, Lowe LJ, Martin LJ, Musser ED, Noll-Hussong M, Olino TM, Pintos Lobo R, Wang Y. The role of hedonics in the Human Affectome. Neurosci Biobehav Rev 2019; 102:221-241. [PMID: 31071361 PMCID: PMC6931259 DOI: 10.1016/j.neubiorev.2019.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 01/06/2023]
Abstract
Experiencing pleasure and displeasure is a fundamental part of life. Hedonics guide behavior, affect decision-making, induce learning, and much more. As the positive and negative valence of feelings, hedonics are core processes that accompany emotion, motivation, and bodily states. Here, the affective neuroscience of pleasure and displeasure that has largely focused on the investigation of reward and pain processing, is reviewed. We describe the neurobiological systems of hedonics and factors that modulate hedonic experiences (e.g., cognition, learning, sensory input). Further, we review maladaptive and adaptive pleasure and displeasure functions in mental disorders and well-being, as well as the experience of aesthetics. As a centerpiece of the Human Affectome Project, language used to express pleasure and displeasure was also analyzed, and showed that most of these analyzed words overlap with expressions of emotions, actions, and bodily states. Our review shows that hedonics are typically investigated as processes that accompany other functions, but the mechanisms of hedonics (as core processes) have not been fully elucidated.
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Affiliation(s)
- Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany.
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Destany Calma-Birling
- Department of Psychology, University of Wisconsin-Oshkosh, 800 Algoma, Blvd., Clow F011, Oshkosh, WI 54901, USA.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3, Durham, UK.
| | - Dan-Mikael Ellingsen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY149-2301, 13th St, Charlestown, MA 02129, USA.
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Jamie L Hanson
- University of Pittsburgh, Department of Psychology, 3939 O'Hara Street, Rm. 715, Pittsburgh, PA 15206, USA.
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130, Écully, France.
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Leroy J Lowe
- Neuroqualia (NGO), 36 Arthur Street, Truro, NS, B2N 1X5, Canada.
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Erica D Musser
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Michael Noll-Hussong
- Clinic for Psychiatry and Psychotherapy, Division of Psychosomatic Medicine and Psychotherapy, Saarland University Medical Centre, Kirrberger Strasse 100, D-66421 Homburg, Germany.
| | - Thomas M Olino
- Temple University, Department of Psychology, 1701N. 13th St, Philadelphia, PA 19010, USA.
| | - Rosario Pintos Lobo
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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34
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The presence of others reduces dyspnea and cortical neural processing of respiratory sensations. Biol Psychol 2019; 140:48-54. [DOI: 10.1016/j.biopsycho.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
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Chan PYS, Cheng CH, Wu YT, Wu CW, Liu HLA, Shaw FZ, Liu CY, Davenport PW. Cortical and Subcortical Neural Correlates for Respiratory Sensation in Response to Transient Inspiratory Occlusions in Humans. Front Physiol 2018; 9:1804. [PMID: 30618816 PMCID: PMC6305490 DOI: 10.3389/fphys.2018.01804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
Cortical and subcortical mechanosensation of breathing can be measured by short respiratory occlusions. However, the corresponding neural substrates involved in the respiratory sensation elicited by a respiratory mechanical stimulus remained unclear. Therefore, we applied the functional magnetic resonance imaging (fMRI) technique to study cortical activations of respiratory mechanosensation. We hypothesized that thalamus, frontal cortex, somatosensory cortex, and inferior parietal cortex would be significantly activated in response to respiratory mechanical stimuli. We recruited 23 healthy adults to participate in our event-designed fMRI experiment. During the 12-min scan, participants breathed with a specialized face-mask. Single respiratory occlusions of 150 ms were delivered every 2–4 breaths. At least 32 successful occlusions were collected for data analysis. The results showed significant neural activations in the thalamus, supramarginal gyrus, middle frontal gyrus, inferior frontal triangularis, and caudate (AlphaSim corrected p < 0.05). In addition, subjective ratings of breathlessness were significantly correlated with the levels of neural activations in bilateral thalamus, right caudate, right supramarginal gyrus, left middle frontal gyrus, left inferior triangularis. Our results demonstrated cortical sources of respiratory sensations elicited by the inspiratory occlusion paradigm in healthy adults were located in the thalamus, supramarginal gyrus, and the middle frontal cortex, inferior frontal triangularis, suggesting subcortical, and cortical neural sources of the respiratory mechanosensation are thalamo-cortical based, especially the connections to the premotor area, middle and ventro-lateral prefrontal cortex, as well as the somatosensory association cortex. Finally, level of neural activation in thalamus is associated with the subjective rating of breathlessness, suggesting respiratory sensory information is gated at the thalamic level.
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Affiliation(s)
- Pei-Ying S Chan
- Department of Occupational Therapy and Healthy Aging Center, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Healthy Aging Center, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Laboratory of Brain Imaging and Neural Dynamics (BIND Lab), Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ting Wu
- Department of Occupational Therapy and Healthy Aging Center, Chang Gung University, Taoyuan, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Ho-Ling A Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Fu-Zen Shaw
- Department of Psychology, National Cheng-Kung University, Tainan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
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36
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The impairing effect of dyspnea on response inhibition. Int J Psychophysiol 2018; 133:41-49. [DOI: 10.1016/j.ijpsycho.2018.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 01/28/2023]
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37
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Faull OK, Cox PJ, Pattinson KT. Cortical processing of breathing perceptions in the athletic brain. Neuroimage 2018; 179:92-101. [DOI: 10.1016/j.neuroimage.2018.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/14/2023] Open
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Sucec J, Herzog M, Van Diest I, Van den Bergh O, von Leupoldt A. The impact of dyspnea and threat of dyspnea on error processing. Psychophysiology 2018; 56:e13278. [PMID: 30252140 DOI: 10.1111/psyp.13278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/21/2022]
Abstract
Dyspnea (breathlessness) is a threatening and aversive bodily sensation and a major symptom of various diseases. It has been suggested to impair several aspects of functioning in affected patients, but experimental proof for this assumption is widely absent. Error processing is an important domain of functioning and has intensively been studied using electrophysiological measures. Specifically, the error-related negativity (ERN) has been suggested to reflect early performance monitoring and error detection, while the error positivity (Pe) has been linked to subsequent error awareness. So far, little is known about the effects of anticipated or perceived dyspnea on error processing. Therefore, in 49 healthy participants, we studied the effects of experimentally induced dyspnea and threat of dyspnea on the ERN/Pe and behavioral task performance. Participants performed the arrowhead version of the flanker task during three experimental conditions: an unloaded baseline condition, a dyspnea condition, and a threat of dyspnea condition. Dyspnea was induced by breathing through inspiratory resistive loads, while high-density EEG was continuously measured. No differences in task performance (reaction times, error rates) and ERN mean amplitudes were found between conditions. However, mean amplitudes for the Pe differed between conditions with smaller Pe amplitudes during threat of dyspnea compared to baseline and dyspnea conditions, with the latter two conditions showing no difference. These results may suggest that threat of dyspnea, but not dyspnea itself, reduces error awareness, while both seem to have no impact on early error processing and related behavioral performance.
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Affiliation(s)
- Josef Sucec
- Health Psychology, University of Leuven, Leuven, Belgium
| | | | - Ilse Van Diest
- Health Psychology, University of Leuven, Leuven, Belgium
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Nair D, Ramesh V, Gozal D. Cognitive Deficits Are Attenuated in Neuroglobin Overexpressing Mice Exposed to a Model of Obstructive Sleep Apnea. Front Neurol 2018; 9:426. [PMID: 29922222 PMCID: PMC5996123 DOI: 10.3389/fneur.2018.00426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a highly prevalent disease manifesting as intermittent hypoxia during sleep (IH) and is increasingly recognized as being independently associated with neurobehavioral deficits. These deficits may be due to increased apoptosis in the hippocampus and cerebral cortex, as well as increased oxidative stress and inflammation. It has been reported that neuroglobin (Ngb) is upregulated in response to hypoxia-ischemia insults and exhibits a protective role in ischemia-reperfusion brain injury. We hypothesized that transgenic overexpression of Ngb would attenuate spatial learning deficits in a murine model of OSA. Methods:Wild-type mice and Ngb overexpressing male mice (Ngb-TG) were randomly assigned to either IH or room air (RA) exposures. The effects of IH during the light period on performance in a water maze spatial task were assessed, as well as anxiety and depressive-like behaviors using elevated plus maze (EPM) and forced swim tests. Cortical tissues from all the mice were extracted for biochemical studies for lipid peroxidation. Results:Ngb TG mice exhibited increased Ngb immunoreactivity in brain tissues and IH did not elicit significant changes in Ngb expression in either Ngb-TG mice or WT mice. On a standard place training task in the water maze, Ngb-TG mice displayed preserved spatial learning, and were protected from the reduced spatial learning performances observed in WT mice exposed to IH. Furthermore, anxiety and depression levels were enhanced in WT mice exposed to IH as compared to RA controls, while alterations emerged in Ngb-TG mice exposed to IH. Furthermore, WT mice, but not Ngb-TG mice had significantly elevated levels of malondialdehyde in cortical lysates following IH exposures. Conclusions:In a murine model of OSA, oxidative stress responses and neurocognitive and behavioral impairments induced by IH during sleep are attenuated by the neuroprotective effects of Ngb.
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Affiliation(s)
- Deepti Nair
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States.,Atlantic Health System, Morristown, NJ, United States.,Biomedical Research Institute of New Jersey, Cedar Knolls, NJ, United States
| | - Vijay Ramesh
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - David Gozal
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
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40
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Herzog M, Sucec J, Van Diest I, Van den Bergh O, Chan PYS, Davenport P, von Leupoldt A. Reduced neural gating of respiratory sensations is associated with increased dyspnoea perception. Eur Respir J 2018; 52:13993003.00559-2018. [DOI: 10.1183/13993003.00559-2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/11/2018] [Indexed: 11/05/2022]
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41
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Stoeckel MC, Esser RW, Gamer M, von Leupoldt A. Breathlessness amplifies amygdala responses during affective processing. Psychophysiology 2018; 55:e13092. [PMID: 29667212 DOI: 10.1111/psyp.13092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
Breathlessness is an aversive symptom in many prevalent somatic and psychiatric diseases and is usually experienced as highly threatening. It is strongly associated with negative affect, but the underlying neural processes remain poorly understood. Therefore, using fMRI, the present study examined the effects of breathlessness on the neural processing of affective visual stimuli within candidate brain areas including the amygdala, insula, and anterior cingulate cortex (ACC). During scanning, 42 healthy volunteers, mean (SD) age: 29.0 (6.0) years, 14 female, were presented with affective picture series of negative, neutral, and positive valence while experiencing either no breathlessness (baseline conditions) or resistive-load induced breathlessness (breathlessness conditions). Respiratory measures and self-reports suggested successful induction of breathlessness and affective experiences. Self-reports of breathlessness intensity and unpleasantness were significantly higher during breathlessness conditions, mean (SD): 45.0 (16.6) and 32.3 (19.8), as compared to baseline conditions, mean (SD): 1.9 (3.0) and 2.9 (5.5). Compared to baseline conditions, stronger amygdala activations were observed during breathlessness conditions for both negative and positive affective picture series relative to neutral picture series, while no such effects were observed in insula and ACC. The present findings demonstrate that breathlessness amplifies amygdala responses during affective processing, suggesting an important role of the amygdala for mediating the interactions between breathlessness and affective states.
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Affiliation(s)
- M Cornelia Stoeckel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland W Esser
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Gamer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology 1, University of Würzburg, Würzburg, Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Health Psychology, University of Leuven, Leuven, Belgium
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42
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Similowski T. Treat the lungs, fool the brain and appease the mind: towards holistic care of patients who suffer from chronic respiratory diseases. Eur Respir J 2018; 51:51/2/1800316. [DOI: 10.1183/13993003.00316-2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022]
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43
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Allard E, Canzoneri E, Adler D, Morélot-Panzini C, Bello-Ruiz J, Herbelin B, Blanke O, Similowski T. Interferences between breathing, experimental dyspnoea and bodily self-consciousness. Sci Rep 2017; 7:9990. [PMID: 28855723 PMCID: PMC5577140 DOI: 10.1038/s41598-017-11045-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022] Open
Abstract
Dyspnoea, a subjective experience of breathing discomfort, is a most distressing symptom. It implicates complex cortical networks that partially overlap with those underlying bodily self-consciousness, the experience that the body is one’s own within a given location (self-identification and self-location, respectively). Breathing as an interoceptive signal contributes to bodily self-consciousness: we predicted that inducing experimental dyspnoea would modify or disrupt this contribution. We also predicted that manipulating bodily self-consciousness with respiratory-visual stimulation would possibly attenuate dyspnoea. Twenty-five healthy volunteers were exposed to synchronous and asynchronous respiratory-visual illumination of an avatar during normal breathing and mechanically loaded breathing that elicited dyspnoea. During normal breathing, synchronous respiratory-visual stimulation induced illusory self-identification with the avatar and an illusory location of the subjects’ breathing towards the avatar. This did not occur when respiratory-visual stimulation was performed during dyspnoea-inducing loaded breathing. In this condition, the affective impact of dyspnoea was attenuated by respiratory-visual stimulation, particularly when asynchronous. This study replicates and reinforces previous studies about the integration of interoceptive and exteroceptive signals in the construction of bodily self-consciousness. It confirms the existence of interferences between experimental dyspnoea and cognitive functions. It suggests that respiratory-visual stimulation should be tested as a non-pharmacological approach of dyspnoea treatment.
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Affiliation(s)
- Etienne Allard
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Elisa Canzoneri
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
| | - Javier Bello-Ruiz
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Bruno Herbelin
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.,Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France. .,Division of Pulmonary Diseases, Geneva University Hospital, Geneva, Switzerland.
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44
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Esser RW, Stoeckel MC, Kirsten A, Watz H, Taube K, Lehmann K, Magnussen H, Büchel C, von Leupoldt A. Brain Activation during Perception and Anticipation of Dyspnea in Chronic Obstructive Pulmonary Disease. Front Physiol 2017; 8:617. [PMID: 28878693 PMCID: PMC5572159 DOI: 10.3389/fphys.2017.00617] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Dyspnea is the impairing cardinal symptom in COPD, but the underlying brain mechanisms and their relationships to clinical patient characteristics are widely unknown. This study compared neural responses to the perception and anticipation of dyspnea between patients with stable moderate-to-severe COPD and healthy controls. Moreover, associations between COPD-specific brain activation and clinical patient characteristics were examined. Methods: During functional magnetic resonance imaging, dyspnea was induced in patients with stable moderate-to-severe COPD (n = 17) and healthy control subjects (n = 21) by resistive-loaded breathing. Blocks of severe and mild dyspnea were alternating, with each block being preceded by visually cued anticipation phases. Results: During the perception of increased dyspnea, both patients and controls showed comparable brain activation in common dyspnea-relevant sensorimotor and cortico-limbic brain regions. During the anticipation of increased dyspnea, patients showed higher activation in hippocampus and amygdala than controls which was significantly correlated with reduced exercise capacity, reduced health-related quality of life, and higher levels of dyspnea and anxiety. Conclusions: This study suggests that patients with stable moderate-to-severe COPD show higher activation in emotion-related brain areas than healthy controls during the anticipation, but not during the actual perception of experimentally induced dyspnea. These brain activations were related to important clinical characteristics and might contribute to an unfavorable course of the disease via maladaptive psychological and behavioral mechanisms.
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Affiliation(s)
- Roland W Esser
- Department of Systems Neuroscience, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Maria C Stoeckel
- Department of Systems Neuroscience, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Anne Kirsten
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, German Center for Lung ResearchGrosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, German Center for Lung ResearchGrosshansdorf, Germany
| | | | | | - Helgo Magnussen
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, German Center for Lung ResearchGrosshansdorf, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience, University Medical Center Hamburg-EppendorfHamburg, Germany.,Research Group Health Psychology, University of LeuvenLeuven, Belgium
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45
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Niérat MC, Laviolette L, Hudson A, Similowski T, Sévoz-Couche C. Experimental dyspnea as a stressor: differential cardiovegetative responses to inspiratory threshold loading in healthy men and women. J Appl Physiol (1985) 2017; 123:205-212. [DOI: 10.1152/japplphysiol.00078.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 01/21/2023] Open
Abstract
Dyspnea is associated with an emotional reaction that involves limbic activation. The inspiratory threshold load (ITL) is known to elicit a dyspneic response in healthy subjects. Laboratory-induced stress conditions have been shown to elicit sex-related differences in cardiovascular responses. The aim of this study was to evaluate how healthy men ( n = 8) and women ( n = 9) react and adapt to 5-min periods of ITL at three levels (low, medium, and high) in terms of heart rate (HR), temporal (RMSSD) and spectral (LF, HF, LF/HF ratio) HRV indexes, and rating of breathing discomfort. HR increased with low, medium, and high ITL in men, whereas it increased only with high ITL in women. LF/HF ratio increased at low ITL in both men and women. Modifications appear to depend essentially on increased LF in men and on reduced HF in women. In addition, HRV modifications differ between men and women, following the order of presentation of ITLs. Our results show a continuous and sustained stress in men (increased HR, LF, and LF/HF ratio across ITL presentation) and a stress adaptation in women. Subjective responses of breathing discomfort were not correlated with sympatho-vagal balance modifications for a subgroup of subjects ( n = 10). Breathing against the ITL induced autonomic modifications that are different between men and women, i.e., driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity. These results highlight the role of the mechanical inspiratory load in the heart rate variability seen in chronic obstructive pulmonary disease. NEW & NOTEWORTHY Breathing against the ITL induced autonomic modifications driven by sympathetic mediated responses in men, whereas women showed a greater parasympathetic modulation of cardiovascular activity, even for low load. A stress circuit could be at the origin of autonomic modifications induced by ITL. Our results would underline the role of the mechanic inspiratory load in the abnormalities in heart rate variability seen in COPD patients.
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Affiliation(s)
- Marie-Cécile Niérat
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
| | - Louis Laviolette
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada; and
| | - Anna Hudson
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- Neuroscience Research Australia and University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Similowski
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (“Département R3S”), Paris, France
| | - Caroline Sévoz-Couche
- Sorbonne Universités, UPMC Universite Paris 06, INSERM, UMRS1158 “Neurophysiologie respiratoire expérimentale et clinique”, Paris, France
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46
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van der Meulen M, Anton F, Petersen S. Painful decisions: How classifying sensations can change the experience of pain. Eur J Pain 2017; 21:1602-1610. [DOI: 10.1002/ejp.1061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | - F. Anton
- Institute for Health and Behaviour; University of Luxembourg; Luxembourg
| | - S. Petersen
- Institute for Health and Behaviour; University of Luxembourg; Luxembourg
- Research Group Health Psychology; KU Leuven; Belgium
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Barbetta C, Currow DC, Johnson MJ. Non-opioid medications for the relief of chronic breathlessness: current evidence. Expert Rev Respir Med 2017; 11:333-341. [PMID: 28282499 DOI: 10.1080/17476348.2017.1305896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION To evaluate systematically randomised clinical trials investigating non-opioid medications for the management and treatment of chronic breathlessness. Areas covered: The evidence for the role of benzodiazepines, anxiolytics, selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, cannabinoids, nebulized furosemide and herbal-based treatments were critically reviewed. Search of the Clinical Trials Registry (Clinicaltrial.gov) identified ongoing studies expected to generate new data in the near future in several classes of non-opioid medications for their net effect on chronic breathlessness. Expert commentary: Morphine still has the best level of evidence for the symptomatic treatment of chronic breathlessness. Non-opioid treatments for chronic breathlessness are less studied than morphine and morphine-related medications although evidence is emerging in relation to some options. Currently, there is insufficient evidence to recommend non-opioids in the routine treatment of chronic breathlessness. There is a need to find agents, new as well as re-purposed, that can be used as alternative therapies to opioids for chronic breathlessness for people who are unable to tolerate morphine.
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Affiliation(s)
- Carlo Barbetta
- a Respiratory Unit , AAS5 Friuli Occidentale, S. Maria degli Angeli Hospital , Pordenone , Italy
| | - David C Currow
- b Centre for Cardiovascular & Chronic Care, University of Technology , Sydney , Australia.,c Wolfson Palliative Care Research Centre , Hull York Medical School, The University of Hull , Hull , United Kingdom
| | - Miriam J Johnson
- c Wolfson Palliative Care Research Centre , Hull York Medical School, The University of Hull , Hull , United Kingdom
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Audrit KJ, Delventhal L, Aydin Ö, Nassenstein C. The nervous system of airways and its remodeling in inflammatory lung diseases. Cell Tissue Res 2017; 367:571-590. [PMID: 28091773 DOI: 10.1007/s00441-016-2559-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/13/2016] [Indexed: 12/20/2022]
Abstract
Inflammatory lung diseases are associated with bronchospasm, cough, dyspnea and airway hyperreactivity. The majority of these symptoms cannot be primarily explained by immune cell infiltration. Evidence has been provided that vagal efferent and afferent neurons play a pivotal role in this regard. Their functions can be altered by inflammatory mediators that induce long-lasting changes in vagal nerve activity and gene expression in both peripheral and central neurons, providing new targets for treatment of pulmonary inflammatory diseases.
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Affiliation(s)
- Katrin Julia Audrit
- Institute of Anatomy and Cell Biology, Aulweg 123, 35385, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Lucas Delventhal
- Institute of Anatomy and Cell Biology, Aulweg 123, 35385, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Öznur Aydin
- Institute of Anatomy and Cell Biology, Aulweg 123, 35385, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Christina Nassenstein
- Institute of Anatomy and Cell Biology, Aulweg 123, 35385, Giessen, Germany. .,German Center for Lung Research (DZL), Giessen, Germany.
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Pan ML, Tsao HM, Hsu CC, Wu KM, Hsu TS, Wu YT, Hu GC. Bidirectional association between obstructive sleep apnea and depression: A population-based longitudinal study. Medicine (Baltimore) 2016; 95:e4833. [PMID: 27631236 PMCID: PMC5402579 DOI: 10.1097/md.0000000000004833] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An association may exist between obstructive sleep apnea (OSA) and depression. However, results regarding this association are inconsistent, and the direction of the association between OSA and depression remains unknown. Therefore, we used the Taiwan National Health Insurance Research Database to investigate the bidirectional association between OSA and depression.A total of 6427 OSA patients and 32,135 age and sex-matched control subjects were enrolled to analyze the risk of depression among patients with OSA, where 27,073 patients with depression and 135,365 control subjects were enrolled to address the risk of OSA among patients with depression. All subjects were followed to identify their outcomes of interest from January 1, 1997 to December 31, 2012.Cox proportional-hazards models, after adjusting for potential confounders, demonstrated that patients with OSA had an increased risk (adjusted hazard ratio 2.48, 95% confidence interval 2.20-2.79) of developing depression, whereas those with depression were associated with an increased risk of future OSA (adjusted hazard ratio 2.30, 95% confidence interval 2.11-2.50).Our results suggested that a strong bidirectional relationship exists between OSA and depression, with each disease influencing the development of the other. Health providers are recommended to ensure the early detection and management of depression among patients with OSA and vice versa.
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Affiliation(s)
- Mei-Lien Pan
- Institute of Information Science, Academia Sinica Department of Psychiatry Chest Division, Department of Internal Medicine Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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Brain Responses during the Anticipation of Dyspnea. Neural Plast 2016; 2016:6434987. [PMID: 27648309 PMCID: PMC5018326 DOI: 10.1155/2016/6434987] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/06/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023] Open
Abstract
Dyspnea is common in many cardiorespiratory diseases. Already the anticipation of this aversive symptom elicits fear in many patients resulting in unfavorable health behaviors such as activity avoidance and sedentary lifestyle. This study investigated brain mechanisms underlying these anticipatory processes. We induced dyspnea using resistive-load breathing in healthy subjects during functional magnetic resonance imaging. Blocks of severe and mild dyspnea alternated, each preceded by anticipation periods. Severe dyspnea activated a network of sensorimotor, cerebellar, and limbic areas. The left insular, parietal opercular, and cerebellar cortices showed increased activation already during dyspnea anticipation. Left insular and parietal opercular cortex showed increased connectivity with right insular and anterior cingulate cortex when severe dyspnea was anticipated, while the cerebellum showed increased connectivity with the amygdala. Notably, insular activation during dyspnea perception was positively correlated with midbrain activation during anticipation. Moreover, anticipatory fear was positively correlated with anticipatory activation in right insular and anterior cingulate cortex. The results demonstrate that dyspnea anticipation activates brain areas involved in dyspnea perception. The involvement of emotion-related areas such as insula, anterior cingulate cortex, and amygdala during dyspnea anticipation most likely reflects anticipatory fear and might underlie the development of unfavorable health behaviors in patients suffering from dyspnea.
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