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Chen X, Xiong C, Xiao W, Du L, Liu M, Yu Y, Liao C, Zhang C, Li Y, Mao B, Fu J. Efficacy and cerebral mechanisms of acupuncture for chronic obstructive pulmonary disease: study protocol for a multicenter, randomized controlled neuroimaging trial. Front Neurol 2024; 15:1363225. [PMID: 38988597 PMCID: PMC11233458 DOI: 10.3389/fneur.2024.1363225] [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: 01/23/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Although acupuncture is recommended by chronic obstructive pulmonary disease (COPD) treatment guidelines owing to its effects on dyspnea, the underlying neurobiological mechanisms of these effects remain unclear. This study aims to evaluate the efficacy of acupuncture in patients with stable COPD and explore the possible involvement of specific brain regions. Methods This is a prospective, multicenter, single-blind, randomized controlled trial. A total of 90 participants will be recruited from three centers and will be randomly assigned in a 1:1 ratio to undergo acupuncture at acupoints on the disease-affected meridian (DAM) or non-acupoints on the non-affected meridian (NAM), in addition to routine pharmacological treatments. All participants will undergo 30 min of acupuncture three times a week for 8 weeks and will be followed up for 12 months. The primary outcome will be the severity of dyspnea, as measured using the Borg Dyspnea Scale and a visual analog scale at rest and after exercise. The secondary outcomes will include the multidimensional profile of dyspnea using Dyspnea-12, the modified Medical Research Council Dyspnea Scale, and the COPD assessment test; quality of life assessments using St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale; and additional measurements of exacerbation frequency, pulmonary function, and the 6-min walking distance. Magnetic resonance imaging (MRI) will be performed before and after exercise to explore the potential neurobiological mechanisms of exertional dyspnea. Anxiety and depression will be measured and analyzed for their correlation with the activation of specific brain areas involved in dyspnea. Discussion This randomized controlled trial aims to use a multidimensional evaluation of the efficacy of acupuncture in relieving dyspnea in patients with COPD in terms of emotion and quality of life and explore the neurobiological mechanisms underlying the effects of acupuncture on dyspnea from an imaging perspective. It is expected to provide strong evidence to support the use of acupuncture in relieving dyspnea in patients with COPD and those with aother diseases involving dyspnea. Additionally, it provides novel insights into the central mechanisms of acupuncture intervention and dyspnea. Trial registration Chinese Clinical Trial Registry (https://www.chictr.org.cn/): ChiCTR2300071725.
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Affiliation(s)
- Xugui Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chan Xiong
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District)/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Xiao
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longyi Du
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meilu Liu
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Yu
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunyu Liao
- No. 3 Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District)/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chengshun Zhang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Yu Li
- Department of Respiratory, No. 3 Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (West District)/Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Bing Mao
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juanjuan Fu
- Division of Pulmonary Medicine, Department of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kent RD. The Feel of Speech: Multisystem and Polymodal Somatosensation in Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1424-1460. [PMID: 38593006 DOI: 10.1044/2024_jslhr-23-00575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE The oral structures such as the tongue and lips have remarkable somatosensory capacities, but understanding the roles of somatosensation in speech production requires a more comprehensive knowledge of somatosensation in the speech production system in its entirety, including the respiratory, laryngeal, and supralaryngeal subsystems. This review was conducted to summarize the system-wide somatosensory information available for speech production. METHOD The search was conducted with PubMed/Medline and Google Scholar for articles published until November 2023. Numerous search terms were used in conducting the review, which covered the topics of psychophysics, basic and clinical behavioral research, neuroanatomy, and neuroscience. RESULTS AND CONCLUSIONS The current understanding of speech somatosensation rests primarily on the two pillars of psychophysics and neuroscience. The confluence of polymodal afferent streams supports the development, maintenance, and refinement of speech production. Receptors are both canonical and noncanonical, with the latter occurring especially in the muscles innervated by the facial nerve. Somatosensory representation in the cortex is disproportionately large and provides for sensory interactions. Speech somatosensory function is robust over the lifespan, with possible declines in advanced aging. The understanding of somatosensation in speech disorders is largely disconnected from research and theory on speech production. A speech somatoscape is proposed as the generalized, system-wide sensation of speech production, with implications for speech development, speech motor control, and speech disorders.
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Ritz T, Kroll JL, Khan DA, Yezhuvath US, Aslan S, Pinkham A, Rosenfield D, Brown ES. fMRI BOLD responses to film stimuli and their association with exhaled nitric oxide in asthma and health. Psychophysiology 2024; 61:e14513. [PMID: 38339852 DOI: 10.1111/psyp.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 02/12/2024]
Abstract
Little is known about central nervous system (CNS) responses to emotional stimuli in asthma. Nitric oxide in exhaled breath (FENO) is elevated in asthma due to allergic immune processes, but endogenous nitric oxide is also known to modulate CNS activity. We measured fMRI blood oxygen-dependent (BOLD) brain activation to negative (blood-injection-injury themes) and neutral films in 31 participants (15 with asthma). Regions-of-interest analysis was performed on key areas relevant to central adaptive control, threat processing, or salience networks, with dorsolateral prefrontal cortex (PFC), anterior insula, dorsal anterior cingulate cortex (dACC), amygdala, ventral striatum, ventral tegmentum, and periaqueductal gray, as well as top-down modulation of emotion, with ventrolateral and ventromedial PFC. Both groups showed less BOLD deactivation from fixation cross-baseline in the left anterior insula and bilateral ventromedial PFC for negative than neutral films, and for an additional number of areas, including the fusiform gyrus, for film versus recovery phases. Less deactivation during films followed by less recovery from deactivation was found in asthma compared to healthy controls. Changes in PCO2 did not explain these findings. FENO was positively related to BOLD activation in general, but more pronounced in healthy controls and more likely in neutral film processing. Thus, asthma is associated with altered processing of film stimuli across brain regions not limited to central adaptive control, threat processing, or salience networks. Higher levels of NO appear to facilitate CNS activity, but only in healthy controls, possibly due to allergy's masking effects on FENO.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sina Aslan
- Department of Internal Medicine, Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Advance MRI LLC, Frisco, Texas, USA
- Department of Psychology, University of Texas at Dallas, Dallas, Texas, USA
| | - Amy Pinkham
- Department of Psychology, University of Texas at Dallas, Dallas, Texas, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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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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Lv L, Cheng X, Yang J, Chen X, Ni J. Novel role for non-invasive neuromodulation techniques in central respiratory dysfunction. Front Neurosci 2023; 17:1226660. [PMID: 37680969 PMCID: PMC10480838 DOI: 10.3389/fnins.2023.1226660] [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: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Respiration is a crucial steady-state function of human life. Central nervous system injury can damage the central respiratory pattern generator (CRPG) or interrupt its outflow, leading to central respiratory paralysis and dysfunction, which can endanger the patient's life. At present, there is no effective means to reverse this process. Commonly used non-invasive neuromodulation techniques include repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and so forth, which have been widely applied in nervous system diseases and their various secondary symptoms, but rarely in respiratory function. Clinical and animal studies have confirmed that TMS is also suitable for investigating the excitability and plasticity of ascending corticospinal respiratory pathways. In addition, although rTMS and tDCS differ in their respective mechanisms, both can regulate respiratory networks in healthy individuals and in diseased states. In this review, we provide an overview of the physiology of respiration, the use of TMS to assess the excitability of corticophrenic pathways in healthy individuals and in central respiratory disorders, followed by an overview of the animal and clinical studies of rTMS, tDCS and so forth in regulating respiratory circuits and the possible mechanisms behind them. It was found that the supplementary motor area (SMA) and the phrenic motor neuron (PMN) may be key regulatory areas. Finally, the challenges and future research directions of neuroregulation in respiratory function are proposed. Through understanding how neuromodulation affects the respiratory neural circuit non-invasively, we can further explore the therapeutic potential of this neuromodulation strategy, so as to promote the recovery of respiratory function after central nervous system diseases or injury.
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Affiliation(s)
- Lan Lv
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Rehabilitation Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoping Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiaying Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xinyuan Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Martin-Harris B, Kantarcigil C, Reedy EL, McFarland DH. Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions. Dysphagia 2023; 38:1049-1058. [PMID: 36378345 PMCID: PMC10266896 DOI: 10.1007/s00455-022-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Swallowing occurs preferentially in the expiratory phase of the quiet breathing cycle and at mid-to-low tidal volume. This coordinative pattern imparts important biomechanical advantages to swallowing and airway protection and facilitate laryngeal elevation, laryngeal vestibular and vocal fold closure, and cricopharyngeal sphincter opening. This preferred coordinative relationship between breathing and swallowing is impaired in a variety of patient populations, including head and neck cancer survivors with dysphagia. We developed a training protocol to re-establish more optimal phasing of swallowing with breathing in these patients with striking outcomes, including reduced swallowing physiological impairments and improved airway protection. This motivated us to continue to refine and expand this training protocol and develop new assistive technologies for swallowing monitoring outside of the lab. In this review, we highlight the origins of our optimal respiratory-swallowing coordination hypothesis, describe the biomechanical advantages it provides, carefully describe our training protocol and findings, and chart a course for the next phase of this work. Our overall goal is to harness technology combined with carefully constructed learning paradigms to improve the lives of patients with impaired respiratory-swallowing coordination consequent to a variety of pathologies including head and neck cancer and degenerative neurological conditions such as Parkinson's disease.
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Affiliation(s)
- Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Otolaryngology - Head & Neck Surgery, Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA.
| | - Cagla Kantarcigil
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Erin L Reedy
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Veterans Affairs Medical Center, Edward J. Hines, Jr., Hines, IL, USA
| | - David H McFarland
- Faculties of Medicine, Université de Montréal and McGill University, Montreal, CA, USA
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, CA, USA
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Harvey AM, Beausoleil NJ, Ramp D, Mellor DJ. Mental Experiences in Wild Animals: Scientifically Validating Measurable Welfare Indicators in Free-Roaming Horses. Animals (Basel) 2023; 13:ani13091507. [PMID: 37174544 PMCID: PMC10177449 DOI: 10.3390/ani13091507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The mental experiences of animals are what characterises their welfare status. The Five Domains Model for assessing welfare aligns with the understanding that physical and mental states are linked. Following measurement of indicators within each of the four physical/functional Domains (1. Nutrition; 2. Physical environment; 3. Health; and 4. Behavioural interactions), the anticipated negative or positive affective consequences (mental experiences) are cautiously inferred and assigned to Domain 5. Those inferences derive credibility from validated knowledge of the underlying systems of physiology, neurophysiology, neuroethology and affective neuroscience. Any indicators used for assessing welfare need to be scientifically validated. This requires, firstly, evidence of the links between a measurable/observable indicator and the physical/functional impact (in Domains 1 to 4), and secondly, a demonstrable relationship between the physical/functional impact and the mental experience it is inferred the indicators reflect (in Domain five). This review refers to indicators of physical/functional states in Domains 1 to 4, which have been shown to be measurable in free-roaming wild horses, and then evaluates the scientific evidence linking them to inferred mental experiences in Domain 5. This is the first time that the scientific evidence validating a comprehensive range of welfare indicators has been synthesised in this way. Inserting these indicators into the Five Domains Model enables transparently justifiable assessment and grading of welfare status in free-roaming horses.
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Affiliation(s)
- Andrea M Harvey
- Centre for Compassionate Conservation, TD School, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Ngaio J Beausoleil
- Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
| | - Daniel Ramp
- Centre for Compassionate Conservation, TD School, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - David J Mellor
- Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
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Kroll JL, Ritz T. Asthma, the central nervous system, and neurocognition: Current findings, potential mechanisms, and treatment implications. Neurosci Biobehav Rev 2023; 146:105063. [PMID: 36708797 DOI: 10.1016/j.neubiorev.2023.105063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Accumulating behavioral evidence suggests that asthma is associated with cognitive deficits. A number of studies have identified potential biological contributions to cognition in asthma; however, mechanistic pathways of central nervous system (CNS) involvement in asthma are yet to be established. We therefore conducted a literature review to identify studies examining potential CNS contributions to cognition in asthma. In this review, we discuss our general understanding of the CNS in asthma in the context of cognitive performance and outline a working model of mechanistic pathways linking the proposed neural influences of asthma pathology with cognition. To this extent, we incorporate neural, behavioral, psychological, social and environmental factors. Finally, we underscore the clinical significance of the CNS and neurocognitive sequelae in asthma, highlighting potential opportunities for routine monitoring, therapeutic intervention, and recommend key areas for future research.
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Affiliation(s)
- Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, USA; Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Respiratory psychophysiology and COVID-19: A research agenda. Biol Psychol 2023; 176:108473. [PMID: 36535514 PMCID: PMC9756651 DOI: 10.1016/j.biopsycho.2022.108473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
After multiple waves of the COVID-19 pandemic, it has become clear that the impact of SARS-CoV-2 will carry on for years to come. Acutely infected patients show a broad range of disease severity, depending on virus variant, vaccination status, age and the presence of underlying medical and physical conditions, including obesity. Additionally, a large number of patients who have been infected with the virus present with post-COVID syndrome. In September 2020, the International Society for the Advancement of Respiratory Psychophysiology organized a virtual interest meeting on 'Respiratory research in the age of COVID-19', which aimed to discuss how research in respiratory psychophysiology could contribute to a better understanding of psychophysiological interactions in COVID-19. In the resulting current paper, we propose an interdisciplinary research agenda discussing selected research questions on acute and long-term neurobiological, physiological and psychological outcomes and mechanisms related to respiration and the airways in COVID-19, as well as research questions on comorbidity and potential treatment options, such as physical rehabilitation.
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Schottelkotte KM, Crone SA. Forebrain control of breathing: Anatomy and potential functions. Front Neurol 2022; 13:1041887. [PMID: 36388186 PMCID: PMC9663927 DOI: 10.3389/fneur.2022.1041887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023] Open
Abstract
The forebrain plays important roles in many critical functions, including the control of breathing. We propose that the forebrain is important for ensuring that breathing matches current and anticipated behavioral, emotional, and physiological needs. This review will summarize anatomical and functional evidence implicating forebrain regions in the control of breathing. These regions include the cerebral cortex, extended amygdala, hippocampus, hypothalamus, and thalamus. We will also point out areas where additional research is needed to better understand the specific roles of forebrain regions in the control of breathing.
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Affiliation(s)
- Karl M. Schottelkotte
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Steven A. Crone
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Ciumas C, Rheims S, Ryvlin P. fMRI studies evaluating central respiratory control in humans. Front Neural Circuits 2022; 16:982963. [PMID: 36213203 PMCID: PMC9537466 DOI: 10.3389/fncir.2022.982963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
A plethora of neural centers in the central nervous system control the fundamental respiratory pattern. This control is ensured by neurons that act as pacemakers, modulating activity through chemical control driven by changes in the O2/CO2 balance. Most of the respiratory neural centers are located in the brainstem, but difficult to localize on magnetic resonance imaging (MRI) due to their small size, lack of visually-detectable borders with neighboring areas, and significant physiological noise hampering detection of its activity with functional MRI (fMRI). Yet, several approaches make it possible to study the normal response to different abnormal stimuli or conditions such as CO2 inhalation, induced hypercapnia, volitional apnea, induced hypoxia etc. This review provides a comprehensive overview of the majority of available studies on central respiratory control in humans.
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Affiliation(s)
- Carolina Ciumas
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale U1028/CNRS UMR 5292 Lyon 1 University, Bron, France
- IDEE Epilepsy Institute, Lyon, France
- *Correspondence: Carolina Ciumas
| | - Sylvain Rheims
- Lyon Neuroscience Research Center, Institut National de la Santé et de la Recherche Médicale U1028/CNRS UMR 5292 Lyon 1 University, Bron, France
- IDEE Epilepsy Institute, Lyon, France
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Zhang X, Zhang J. The human brain in a high altitude natural environment: A review. Front Hum Neurosci 2022; 16:915995. [PMID: 36188182 PMCID: PMC9520777 DOI: 10.3389/fnhum.2022.915995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022] Open
Abstract
With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.
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Affiliation(s)
- Xinjuan Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, China
- Department of Physiology, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, China
- Department of Physiology, School of Medicine, Xiamen University, Xiamen, China
- *Correspondence: Jiaxing Zhang,
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13
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Collard R, Aziz MC, Rapp K, Cutshall C, Duyvesteyn E, Metcalf CS. Galanin analogs prevent mortality from seizure-induced respiratory arrest in mice. Front Neural Circuits 2022; 16:901334. [PMID: 36051473 PMCID: PMC9425456 DOI: 10.3389/fncir.2022.901334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveSudden Unexpected Death in Epilepsy (SUDEP) accounts for 20% of mortality in those with recurrent seizures. While risk factors, monitoring systems, and standard practices are in place, the pathophysiology of SUDEP is still not well understood. Better knowledge of SUDEP and its potential mechanisms of action is crucial to reducing risk in this patient population and developing potential treatment options. Clinical studies and animal models of SUDEP suggest that diminished post-ictal respiratory control may be the dominant mechanism contributing to mortality. Recently, it was demonstrated that the depletion of the neuropeptide galanin in the amygdala occurs in human SUDEP. The amygdala plays a key role in the central integration of respiratory signaling; the depletion of galanin may represent a critical change that predisposes individuals to SUDEP.Materials and methodsTo evaluate the impact of enhancing galaninergic signaling to potentially protect against SUDEP, we studied seizure-induced respiratory arrest (S-IRA) following central (intracerebroventricular, intra-amygdala) and systemic (intraperitoneal, subcutaneous) administration of galanin analogs. Seizure naïve and seizure experienced (fully kindled) mice were tested.ResultsCentral and systemically administered galanin analogs protect against S-IRA in naïve C57Bl/6J mice. Differential efficacy between receptor subtype-selective analogs varied based on the route of administration. Sub-chronic systemic administration at doses that reduced 6 Hz seizures also protected against S-IRA. Acute treatment benefits also extended to fully kindled mice experiencing tonic extension.SignificanceThese data demonstrate that galanin analogs may be protective against post-ictal respiratory collapse.
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Affiliation(s)
- Ryley Collard
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Miriam C. Aziz
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Kevin Rapp
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Connor Cutshall
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Evalien Duyvesteyn
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Cameron S. Metcalf
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
- Epilepsy Therapy Screening Program Contract Site, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Cameron S. Metcalf,
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14
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Jung J, Bouet R, Catenoix H, Montavont A, Isnard J, Boulogne S, Guénot M, Ryvlin P, Rheims S. Peri-ictal hypoxemia during temporal lobe seizures: A SEEG study. Hum Brain Mapp 2022; 43:4580-4588. [PMID: 35703584 PMCID: PMC9491280 DOI: 10.1002/hbm.25975] [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: 02/11/2022] [Revised: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Focal seizures originating from the temporal lobe are commonly associated with peri‐ictal hypoxemia (PIH). During the course of temporal lobe seizures, epileptic discharges often not only spread within various parts of the temporal lobe but also possibly insula and frontal lobe. The link between spatial propagation of the seizure discharges and PIH is still unclear. The present study investigates the involvement of several brain structures including medial temporal structures, temporal pole, anterior insula, and frontal cortex in the occurrence of PIH. Using quantitative indices obtained during SEEG (stereoencephalography) recordings in 38 patients, we evaluated the epileptogenicity, the spatial propagation, and functional connectivity between those structures during seizures leading to PIH. Multivariate statistical analyses of SEEG quantitative indices showed that temporal lobe seizures leading to PIH are characterized by a strong involvement of amygdala and anterior insula during seizure propagation and a more widespread involvement of medial temporal lobe structures, lateral temporal lobe, temporal pole, and anterior cingulate at the end of the seizures. On the contrary, seizure‐onset zone was not associated with PIH occurrence. During seizure propagation, anterior insula, temporal pole, and temporal lateral neocortex activities were correlated with intensity of PIH. Lastly, PIH occurrence was also related to a widespread increase of synchrony between those structures. Those results suggest that PIH occurrence during temporal lobe seizures may be related to the activation of a widespread network of cortical structures, among which amygdala and anterior insula are key nodes.
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Affiliation(s)
- Julien Jung
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Romain Bouet
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Alexandra Montavont
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
| | - Marc Guénot
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France.,Department of Functional Neurosurgery, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaudois University Hospital Center, Lausanne, Switzerland
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France.,Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292 and Lyon 1 University, Lyon, France
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15
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Betka S, Adler D, Similowski T, Blanke O. Breathing control, brain, and bodily self-consciousness: Toward immersive digiceuticals to alleviate respiratory suffering. Biol Psychol 2022; 171:108329. [PMID: 35452780 DOI: 10.1016/j.biopsycho.2022.108329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
Breathing is peculiar among autonomic functions through several characteristics. It generates a very rich afferent traffic from an array of structures belonging to the respiratory system to various areas of the brain. It is intimately associated with bodily movements. It bears particular relationships with consciousness as its efferent motor control can be automatic or voluntary. In this review within the scope of "respiratory neurophysiology" or "respiratory neuroscience", we describe the physiological organisation of breathing control. We then review findings linking breathing and bodily self-consciousness through respiratory manipulations using virtual reality (VR). After discussing the currently admitted neurophysiological model for dyspnea, as well as a new Bayesian model applied to breathing control, we propose that visuo-respiratory paradigms -as developed in cognitive neuroscience- will foster insights into some of the basic mechanisms of the human respiratory system and will also lead to the development of immersive VR-based digital health tools (i.e. digiceuticals).
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Affiliation(s)
- Sophie Betka
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland.
| | - Dan Adler
- Division of Lung Diseases, University Hospital and Geneva Medical School, University of Geneva, Switzerland
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), F-75013 Paris, France
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain Mind Institute and Center for Neuroprosthetics, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, (EPFL), Geneva 1202, Switzerland; Department of Clinical Neurosciences, University Hospital and Geneva Medical School, University of Geneva, Switzerland
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16
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Pujol J, Blanco-Hinojo L, Ortiz H, Gallart L, Moltó L, Martínez-Vilavella G, Vilà E, Pacreu S, Adalid I, Deus J, Pérez-Sola V, Fernández-Candil J. Mapping the neural systems driving breathing at the transition to unconsciousness. Neuroimage 2021; 246:118779. [PMID: 34875384 DOI: 10.1016/j.neuroimage.2021.118779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
After falling asleep, the brain needs to detach from waking activity and reorganize into a functionally distinct state. A functional MRI (fMRI) study has recently revealed that the transition to unconsciousness induced by propofol involves a global decline of brain activity followed by a transient reduction in cortico-subcortical coupling. We have analyzed the relationships between transitional brain activity and breathing changes as one example of a vital function that needs the brain to readapt. Thirty healthy participants were originally examined. The analysis involved the correlation between breathing and fMRI signal upon loss of consciousness. We proposed that a decrease in ventilation would be coupled to the initial decline in fMRI signal in brain areas relevant for modulating breathing in the awake state, and that the subsequent recovery would be coupled to fMRI signal in structures relevant for controlling breathing during the unconscious state. Results showed that a slight reduction in breathing from wakefulness to unconsciousness was distinctively associated with decreased activity in brain systems underlying different aspects of consciousness including the prefrontal cortex, the default mode network and somatosensory areas. Breathing recovery was distinctively coupled to activity in deep brain structures controlling basic behaviors such as the hypothalamus and amygdala. Activity in the brainstem, cerebellum and hippocampus was associated with breathing variations in both states. Therefore, our brain maps illustrate potential drives to breathe, unique to wakefulness, in the form of brain systems underlying cognitive awareness, self-awareness and sensory awareness, and to unconsciousness involving structures controlling instinctive and homeostatic behaviors.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain.
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Héctor Ortiz
- Department of Project and Construction Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luís Moltó
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Gerard Martínez-Vilavella
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain
| | - Esther Vilà
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Susana Pacreu
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Irina Adalid
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Department of Psychobiology and Methodology in Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Víctor Pérez-Sola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain; Hospital del Mar- IMIM and Department of Psychiatry, Institute of Neuropsychiatry and Addictions, Autonomous University of Barcelona, Barcelona, Spain
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17
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Vafaee F, Shirzad S, Shamsi F, Boskabady MH. Neuroscience and treatment of asthma, new therapeutic strategies and future aspects. Life Sci 2021; 292:120175. [PMID: 34826435 DOI: 10.1016/j.lfs.2021.120175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
AIMS Asthma is an airway inflammatory disease that is affected by neurological and psychological factors. The aim of present review is to investigating the relationship between neural functions and neurobiological changes and asthma symptoms. MAIN METHODS The information in this article is provided from articles published in English and reputable database using appropriate keywords from 1970 to October 2020. KEY FINDINGS The symptoms of asthma such as cough, difficult breathing, and mucus secretion get worse when a person is suffering from stress, anxiety, and depression. The function of the insula, anterior cingulate cortex, and hypothalamic-pituitary-adrenal axis changes in response to stress and psychological disease; then the stress hormones are produced from neuroendocrine system, which leads to asthma exacerbation. The evidence represents that psychological therapies or neurological rehabilitation reduces the inflammation through modulating the activity of neurocircuitry and the function of brain centers involved in asthma. Moreover, the neurotrophins and neuropeptides are the key mediators in the neuro-immune interactions, which secrete from the airway nerves in response to brain signals, and they could be the target of many new therapies in asthma. SIGNIFICANCE This review provides an insight into the vital role of the central and peripheral nervous system in development and exacerbation of asthma and provides practical approaches and strategies on neural networks to improve the airway inflammation and asthma severity.
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Affiliation(s)
- Farzaneh Vafaee
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Shirzad
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Shamsi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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18
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Palkovic B, Marchenko V, Zuperku EJ, Stuth EAE, Stucke AG. Multi-Level Regulation of Opioid-Induced Respiratory Depression. Physiology (Bethesda) 2021; 35:391-404. [PMID: 33052772 DOI: 10.1152/physiol.00015.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Opioids depress minute ventilation primarily by reducing respiratory rate. This results from direct effects on the preBötzinger Complex as well as from depression of the Parabrachial/Kölliker-Fuse Complex, which provides excitatory drive to preBötzinger Complex neurons mediating respiratory phase-switch. Opioids also depress awake drive from the forebrain and chemodrive.
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Affiliation(s)
- Barbara Palkovic
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | | | - Edward J Zuperku
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Eckehard A E Stuth
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Astrid G Stucke
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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19
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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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20
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The neuronal associations of respiratory-volume variability in the resting state. Neuroimage 2021; 230:117783. [PMID: 33516896 DOI: 10.1016/j.neuroimage.2021.117783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
The desire to enhance the sensitivity and specificity of resting-state (rs-fMRI) measures has prompted substantial recent research into removing noise components. Chief among contributions to noise in rs-fMRI are physiological processes, and the neuronal implications of respiratory-volume variability (RVT), a main rs-fMRI-relevant physiological process, is incompletely understood. The potential implications of RVT in modulating and being modulated by autonomic nervous regulation, has yet to be fully understood by the rs-fMRI community. In this work, we use high-density electroencephalography (EEG) along with simultaneously acquired RVT recordings to help address this question. We hypothesize that (1) there is a significant relationship between EEG and RVT in multiple EEG bands, and (2) that this relationship varies by brain region. Our results confirm our first hypothesis, although all brain regions are shown to be equally implicated in RVT-related EEG-signal fluctuations. The lag between RVT and EEG is consistent with previously reported values. However, an interesting finding is related to the polarity of the correlation between RVT and EEG. Our results reveal potentially two main regimes of EEG-RVT association, one in which EEG leads RVT with a positive association between the two, and one in which RVT leads EEG but with a negative association between the two. We propose that these two patterns can be interpreted differently in terms of the involvement of higher cognition. These results further suggest that treating RVT simply as noise is likely a questionable practice, and that more work is needed to avoid discarding cognitively relevant information when performing physiological correction rs-fMRI.
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21
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von Leupoldt A, Farre N. The load of dyspnoea on brain and legs. Eur Respir J 2020; 56:56/2/2001096. [DOI: 10.1183/13993003.01096-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/05/2023]
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22
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Keller M, Pelz H, Perlitz V, Zweerings J, Röcher E, Baqapuri HI, Mathiak K. Neural correlates of fluctuations in the intermediate band for heart rate and respiration are related to interoceptive perception. Psychophysiology 2020; 57:e13594. [DOI: 10.1111/psyp.13594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Micha Keller
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
| | - Holger Pelz
- Deutsche Gesellschaft für Osteopathische Medizin (DGOM) Mannheim Germany
| | | | - Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
| | - Erik Röcher
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
| | - Halim Ibrahim Baqapuri
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics Medical School RWTH Aachen University Aachen Germany
- Jülich Aachen Research Alliance (JARA), Translational Brain Medicine Jülich Germany
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23
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Abstract
PURPOSE OF REVIEW Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. RECENT FINDINGS A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. SUMMARY A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.
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Affiliation(s)
- Lucy L. Marlow
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Olivia K. Faull
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Sarah L. Finnegan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kyle T.S. Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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24
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Coupling Inner and Outer Body for Self-Consciousness. Trends Cogn Sci 2019; 23:377-388. [DOI: 10.1016/j.tics.2019.02.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 02/04/2023]
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25
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Ritz T, Kroll JL, Patel SV, Chen JR, Yezhuvath US, Aslan S, Khan DA, Pinkham AE, Rosenfield D, Brown ES. Central nervous system signatures of affect in asthma: associations with emotion-induced bronchoconstriction, airway inflammation, and asthma control. J Appl Physiol (1985) 2019; 126:1725-1736. [PMID: 30920889 DOI: 10.1152/japplphysiol.01018.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The effects of asthma on affect have been noted for some time, but little is known about associated brain processes. We therefore examined whether emotion-induced bronchoconstriction, airway inflammation, and asthma control are related to specific patterns of brain activity during processing negative affective stimuli. Fifteen adults with asthma viewed alternating blocks of distressing film clips (negative condition), affectively neutral film clips (neutral condition), and a crosshair image (baseline condition) while undergoing blood oxygenation level-dependent (BOLD) functional MRI (fMRI). Block-design fMRI analysis evaluated the BOLD response to "negative-baseline" and "neutral-baseline" contrasts. Airway response to these film clips was also assessed with impulse oscillometry in a separate session. Measures of airway inflammation [fractional exhaled nitric oxide (FENO)] and asthma control [Asthma Control Questionnaire (ACQ)] were additionally obtained. A whole brain voxel-based regression analysis of contrast maps was performed against respiratory resistance increase during negative and neutral films, FENO, and ACQ. Peak airway obstruction to negative affective stimulation was associated with stronger activation of the anterior and middle cingulate gyrus, including the dorsal anterior cingulate cortex (dACC). Stronger airway inflammation and lower asthma control were associated with reduced activation to negative stimuli in the superior frontal gyrus, middle cingulate gyrus, and supplementary motor area. Activation of the dACC in negative-affect-induced airway obstruction could be part of an integrated defensive response to critical environmental change. In addition, reduced frontal and limbic activation during processing of negative affect may reflect consequences of pathophysiological processes for CNS functioning. NEW & NOTEWORTHY This functional magnetic resonance imaging study shows, for the first time, that the degree of airway constriction due to negative affective stimuli in asthma is associated with stronger response to these stimuli in the dorsal anterior and middle cingulate cortex. Asthma patients with stronger airway inflammation and reduced asthma control also show reduced activation in a number of cortical and subcortical areas relevant for affective processing and breathing control.
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Affiliation(s)
- Thomas Ritz
- Southern Methodist University , Dallas, Texas
| | | | - Sheenal V Patel
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | - Justin R Chen
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | | | - Sina Aslan
- The University of Texas Southwestern Medical Center , Dallas, Texas.,Advance MRI, LLC, Frisco, Texas.,The University of Texas at Dallas , Richardson, Texas
| | - David A Khan
- The University of Texas Southwestern Medical Center , Dallas, Texas
| | - Amy E Pinkham
- The University of Texas at Dallas , Richardson, Texas
| | | | - E Sherwood Brown
- The University of Texas Southwestern Medical Center , Dallas, Texas
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Spectral entropy indicates electrophysiological and hemodynamic changes in drug-resistant epilepsy - A multimodal MREG study. NEUROIMAGE-CLINICAL 2019; 22:101763. [PMID: 30927607 PMCID: PMC6444290 DOI: 10.1016/j.nicl.2019.101763] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 02/01/2019] [Accepted: 03/10/2019] [Indexed: 12/20/2022]
Abstract
Objective Epilepsy causes measurable irregularity over a range of brain signal frequencies, as well as autonomic nervous system functions that modulate heart and respiratory rate variability. Imaging dynamic neuronal signals utilizing simultaneously acquired ultra-fast 10 Hz magnetic resonance encephalography (MREG), direct current electroencephalography (DC-EEG), and near-infrared spectroscopy (NIRS) can provide a more comprehensive picture of human brain function. Spectral entropy (SE) is a nonlinear method to summarize signal power irregularity over measured frequencies. SE was used as a joint measure to study whether spectral signal irregularity over a range of brain signal frequencies based on synchronous multimodal brain signals could provide new insights in the neural underpinnings of epileptiform activity. Methods Ten patients with focal drug-resistant epilepsy (DRE) and ten healthy controls (HC) were scanned with 10 Hz MREG sequence in combination with EEG, NIRS (measuring oxygenated, deoxygenated, and total hemoglobin: HbO, Hb, and HbT, respectively), and cardiorespiratory signals. After pre-processing, voxelwise SEMREG was estimated from MREG data. Different neurophysiological and physiological subfrequency band signals were further estimated from MREG, DC-EEG, and NIRS: fullband (0–5 Hz, FB), near FB (0.08–5 Hz, NFB), brain pulsations in very-low (0.009–0.08 Hz, VLFP), respiratory (0.12–0.4 Hz, RFP), and cardiac (0.7–1.6 Hz, CFP) frequency bands. Global dynamic fluctuations in MREG and NIRS were analyzed in windows of 2 min with 50% overlap. Results Right thalamus, cingulate gyrus, inferior frontal gyrus, and frontal pole showed significantly higher SEMREG in DRE patients compared to HC. In DRE patients, SE of cortical Hb was significantly reduced in FB (p = .045), NFB (p = .017), and CFP (p = .038), while both HbO and HbT were significantly reduced in RFP (p = .038, p = .045, respectively). Dynamic SE of HbT was reduced in DRE patients in RFP during minutes 2 to 6. Fitting to the frontal MREG and NIRS results, DRE patients showed a significant increase in SEEEG in FB in fronto-central and parieto-occipital regions, in VLFP in parieto-central region, accompanied with a significant decrease in RFP in frontal pole and parietal and occipital (O2, Oz) regions. Conclusion This is the first study to show altered spectral entropy from synchronous MREG, EEG, and NIRS in DRE patients. Higher SEMREG in DRE patients in anterior cingulate gyrus together with SEEEG and SENIRS results in 0.12–0.4 Hz can be linked to altered parasympathetic function and respiratory pulsations in the brain. Higher SEMREG in thalamus in DRE patients is connected to disturbances in anatomical and functional connections in epilepsy. Findings suggest that spectral irregularity of both electrophysiological and hemodynamic signals are altered in specific way depending on the physiological frequency range. Simultaneous imaging methods indicate spectral irregularity in neurovascular and electrophysiological brain pulsations in DRE. Altered spectral entropy in EEG, NIRS and BOLD indicate dysfunctional brain pulsations in respiratory frequency in epilepsy. Spectral irregularity (0-5 Hz) of BOLD in right thalamus supports previous structural and functional findings in epilepsy.
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Lacuey N, Hampson JP, Harper RM, Miller JP, Lhatoo S. Limbic and paralimbic structures driving ictal central apnea. Neurology 2019; 92:e655-e669. [PMID: 30635481 DOI: 10.1212/wnl.0000000000006920] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To precisely identify cortical regions that modulate breathing, and delineate a network of cortical structures that underpin ictal central apnea (ICA) during epileptic seizures. METHODS We electrically stimulated multiple cortical structures in patients undergoing stereotactic EEG (SEEG) evaluation before epilepsy surgery. Structures investigated were orbitofrontal cortex, anterior and posterior cingulate and subcallosal gyri, insula, hippocampus, parahippocampal gyrus, amygdala, temporo-polar cortex, antero-mesial fusiform gyrus, and lateral and basal temporal cortices. Chest/abdominal excursions using thoracic/abdominal belts, peripheral capillary oxygen saturation, end tidal and transcutaneous carbon dioxide, and airflow were continuously monitored. RESULTS Nineteen consecutive adult patients (10 female) aged 18-69 years were investigated. Transient central apnea was elicited in 13/19 patients with amygdala, hippocampus head and body, anterior parahippocampal gyrus, and antero-mesial fusiform gyrus. Insula, cingulate, subcallosal, orbitofrontal, lateral, and basal temporal cortices stimulation did not induce apnea. Apnea duration was associated with stimulus duration (p < 0.001) and current intensity (p = 0.004). CONCLUSIONS These findings suggest a limbic/paralimbic mesial temporal breathing modulation network that includes amygdala, hippocampus, anterior parahippocampal, and antero-mesial fusiform gyri. These structures likely represent anatomical and functional substrates for ICA, a putative sudden unexpected death in epilepsy (SUDEP) breathing biomarker. Damage to such areas is known to occur in high SUDEP risk patients and SUDEP victims, and may underpin the prolonged ICA that is thought to be particularly dangerous. Furthermore, inclusive targeting of apnea-producing structures in SEEG implantations, peri-ictal breathing signal recordings, and stringent analysis of apneic sequences in seizure semiology may enhance accurate identification of symptomatogenic and seizure onset zones for epilepsy surgery.
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Affiliation(s)
- Nuria Lacuey
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH.
| | - Johnson P Hampson
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Ronald M Harper
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Jonathan P Miller
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
| | - Samden Lhatoo
- From the Epilepsy Center (N.L., J.P.H., J.P.M., S.L.), University Hospitals Cleveland Medical Center, OH; Department of Neurobiology and the Brain Research Institute (R.M.H.), University of California, Los Angeles; and NINDS Center for SUDEP Research (R.M.H., S.L.), Case Western Reserve University, Cleveland, OH
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28
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Lee SY, Chen MH, Chiang PL, Chen HL, Chou KH, Chen YC, Yu CC, Tsai NW, Li SH, Lu CH, Lin WC. Reduced gray matter volume and respiratory dysfunction in Parkinson's disease: a voxel-based morphometry study. BMC Neurol 2018; 18:73. [PMID: 29803228 PMCID: PMC5970473 DOI: 10.1186/s12883-018-1074-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022] Open
Abstract
Background The respiratory dysfunction of patients with Parkinson’s disease (PD) has drawn increasing attention. This study evaluated the relationship between gray matter volume (GMV), as determined by voxel-based morphometry (VBM), and respiratory dysfunction in patients with PD and correlated it with systemic inflammatory markers. Methods Whole-brain VBM analysis was performed on 3-dimensional T1-weighted images in 25 PD patients with abnormal pulmonary function (13 men, 12 women; mean age: 62.9 ± 10.8 years) and, for comparison, on 25 sex- and age-matched PD patients with normal pulmonary function (14 men, 11 women; mean age: 62.3 ± 6.9 years). Inflammatory markers were determined by flow cytometry. The differences and correlations in regional GMV, clinical severity and inflammatory markers were determined after adjusting for age, gender and total intracranial volume (TIV). Results Compared with the normal pulmonary function group, the abnormal pulmonary function group had smaller GMV in several brain regions, including the left parahippocampal formation, right fusiform gyrus, right cerebellum crus, and left postcentral gyri. Forced expiratory volume in 1 s (FEV1) and maximal expiratory flow after expiration of 50% of forced vital capacity (MEF50) were positively correlated with regional GMV. There were no significant differences in the level of serum inflammatory markers between two groups. Conclusion Our findings suggested that involvement of the central autonomic network and GM loss may underlie the respiratory dysfunction in PD patients.
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Affiliation(s)
- Sieh-Yang Lee
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yueh-Cheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Chiun-Chieh Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan
| | - Shau-Hsuan Li
- Department of Oncology and Hematology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
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Jerath R, Beveridge C. Top Mysteries of the Mind: Insights From the Default Space Model of Consciousness. Front Hum Neurosci 2018; 12:162. [PMID: 29755333 PMCID: PMC5932384 DOI: 10.3389/fnhum.2018.00162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/06/2018] [Indexed: 01/14/2023] Open
Abstract
Aside from the nature of consciousness itself, there are still many unsolved problems in the neurosciences. Despite the vast and quickly growing body of work in this field, we still find ourselves perplexed at seemingly simple qualities of our mental being such as why we need to sleep. The neurosciences are at least beginning to take a hold on these mysteries and are working toward solving them. We hold a perspective that metastable consciousness models, specifically the Default Space Model (DSM), provide insights into these mysteries. In this perspective article, we explore some of these curious questions in order to elucidate the interesting points they bring up. The DSM is a dynamic, global theory of consciousness that involves the maintenance of an internal, 3D simulation of the external, physical world which is the foundation and structure of consciousness. This space is created and filled by multiple frequencies of membrane potential oscillations throughout the brain and body which are organized, synchronized and harmonized by the thalamus. The veracity of the DSM is highlighted here in its ability to further understanding of some of the most puzzling problems in neuroscience.
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Affiliation(s)
- Ravinder Jerath
- Charitable Medical Healthcare Foundation, Augusta, GA, United States
| | - Connor Beveridge
- Charitable Medical Healthcare Foundation, Augusta, GA, United States
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30
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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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31
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Kroll JL, Steele AM, Pinkham AE, Choi C, Khan DA, Patel SV, Chen JR, Aslan S, Sherwood Brown E, Ritz T. Hippocampal metabolites in asthma and their implications for cognitive function. Neuroimage Clin 2018; 19:213-221. [PMID: 30035015 PMCID: PMC6051470 DOI: 10.1016/j.nicl.2018.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/07/2018] [Accepted: 04/11/2018] [Indexed: 12/16/2022]
Abstract
Emerging research indicates that individuals with asthma have an increased risk of cognitive impairment, yet the associations of asthma with neural correlates of memory remain relatively unknown. The hippocampus is the predominant neural structure involved in memory, and alterations in the hippocampal metabolic profile are observed in individuals with mild cognitive impairment. We therefore hypothesized that individuals with asthma may have altered hippocampal metabolites compared to healthy controls. Structural magnetic resonance imaging (sMRI) and proton magnetic resonance spectroscopy (1H-MRS) were used to compare hippocampal volume and metabolites of otherwise healthy adults with and without asthma (N = 40), and to study the association of these measures with cognitive function and asthma-related variables. Participants underwent 3-Tesla sMRI and 1H-MRS, with the volume of interest placed in the left hippocampus to measure levels of N-acetylaspartate (NAA), glutamate (Glu), creatine (Cr), and myo-inositol (MI), as indicators of neuronal viability, cellular activity, cellular energy reserve, as well as glial activation. Individuals with asthma had lower hippocampal NAA compared to healthy controls. For all participants, poorer cognitive function was associated with reduced NAA and Glu. For individuals with asthma, poorer cognitive function was associated with reduced disease control. Additionally, short-acting rescue bronchodilator use was associated with significantly lower NAA, and Glu, whereas inhaled corticosteroid use was related to significantly higher Cr and in tendency higher NAA and Glu. All findings controlled for left hippocampal volume, which was not different between groups. These findings highlight that asthma and/or its treatment may affect hippocampal chemistry. It is possible that the observed reductions in hippocampal metabolites in younger individuals with asthma may precede cognitive and hippocampal structural deficits observed in older individuals with asthma.
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Affiliation(s)
- Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Ashton M Steele
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA
| | - Changho Choi
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Khan
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sheenal V Patel
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Justin R Chen
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sina Aslan
- School of Behavioral and Brain Sciences, The University of Texas, Dallas, TX, USA; Advance MRI LLC, Frisco, TX, USA; Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
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32
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Analysis of generic coupling between EEG activity and P ETCO 2 in free breathing and breath-hold tasks using Maximal Information Coefficient (MIC). Sci Rep 2018. [PMID: 29540714 PMCID: PMC5851981 DOI: 10.1038/s41598-018-22573-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Brain activations related to the control of breathing are not completely known. The respiratory system is a non-linear system. However, the relationship between neural and respiratory dynamics is usually estimated through linear correlation measures, completely neglecting possible underlying nonlinear interactions. This study evaluate the linear and nonlinear coupling between electroencephalographic (EEG) signal and variations in carbon dioxide (CO2) signal related to different breathing task. During a free breathing and a voluntary breath hold tasks, the coupling between EEG power in nine different brain regions in delta (1–3 Hz) and alpha (8–13 Hz) bands and end-tidal CO2 (PET CO2) was evaluated. Specifically, the generic associations (i.e. linear and nonlinear correlations) and a “pure” nonlinear correlations were evaluated using the maximum information coefficient (MIC) and MIC-ρ2 between the two signals, respectively (where ρ2 represents the Pearson’s correlation coefficient). Our results show that in delta band, MIC indexes discriminate the two tasks in several regions, while in alpha band the same behaviour is observed for MIC-ρ2, suggesting a generic coupling between delta EEG power and PETCO2 and a pure nonlinear interaction between alpha EEG power and PETCO2. Moreover, higher indexes values were found for breath hold task respect to free breathing.
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33
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Fung PCW, Kong RKC. New Insights on Stimulating the Lung Meridian Based on Modern Neurophysiology. Chin Med 2018. [DOI: 10.4236/cm.2018.93006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Charususin N, Dacha S, Gosselink R, Decramer M, Von Leupoldt A, Reijnders T, Louvaris Z, Langer D. Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert Rev Respir Med 2017; 12:67-79. [DOI: 10.1080/17476348.2018.1398084] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Noppawan Charususin
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physical Therapy, Thammasat University, Pathumthani, Thailand
| | - Sauwaluk Dacha
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Rik Gosselink
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Andreas Von Leupoldt
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Reijnders
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Zafeiris Louvaris
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, “M. Simou, and G.P. Livanos Laboratories”, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Langer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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35
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Stoeckel MC, Esser RW, Gamer M, Büchel C, von Leupoldt A. Dyspnea catastrophizing and neural activations during the anticipation and perception of dyspnea. Psychophysiology 2017; 55. [DOI: 10.1111/psyp.13004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022]
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
| | - Christian Büchel
- Department of Systems Neuroscience; University Medical Center Hamburg-Eppendorf; Hamburg 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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36
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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: 42] [Impact Index Per Article: 6.0] [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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37
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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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Vlemincx E, Meulders M, Abelson JL. Sigh rate during emotional transitions: More evidence for a sigh of relief. Biol Psychol 2017; 125:163-172. [PMID: 28315375 DOI: 10.1016/j.biopsycho.2017.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Abstract
Evidence suggests that sighs regulate stress and emotions, e.g. by facilitating relief. This study aimed to investigate sigh rates during relief. In addition, links between sighs, anxiety sensitivity and HPA-axis activity were explored. Healthy volunteers (N=29) were presented cues predicting the valence of subsequent stimuli. By sequencing cues that predicted pleasant or unpleasant stimuli with or without certainty, transitions to certain pleasantness (relief) or to certain unpleasantness (control) were created and compared to no transitions. Salivary cortisol, anxiety sensitivity and respiration were measured. Sigh frequency was significantly higher during relief than during control transitions and no transition states, and higher during control transitions than during no transition states. Sigh frequency increased with steeper cortisol declines for high anxiety sensitive persons. Results confirm a relationship between sighs and relief. In addition, results suggest that sigh frequency is importantly related to HPA-axis activity, particularly in high anxiety sensitive persons.
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Affiliation(s)
- Elke Vlemincx
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium; Research Group on Health Psychology, KU Leuven, Leuven, Belgium.
| | - Michel Meulders
- Department of Informatics, Simulation and Modeling, KU Leuven, Leuven, Belgium; Research Group on Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - James L Abelson
- Trauma, Stress and Anxiety Research Group, University of Michigan, Ann Arbor, MI, United States
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Zhang J, Chen J, Fan C, Li J, Lin J, Yang T, Fan M. Alteration of Spontaneous Brain Activity After Hypoxia-Reoxygenation: A Resting-State fMRI Study. High Alt Med Biol 2017; 18:20-26. [PMID: 28266873 DOI: 10.1089/ham.2016.0083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Zhang, Jiaxing, Ji Chen, Cunxiu Fan, Jinqiang Li, Jianzhong Lin, Tianhe Yang, and Ming Fan. Alteration of spontaneous brain activity after hypoxia-reoxygenation: A resting-state fMRI study. High Alt Med Biol. 18:20-26, 2017.-The present study was designed to investigate the effect of hypoxia-reoxygenation on the spontaneous neuronal activity in brain. Sixteen sea-level (SL) soldiers (20.5 ± 0.7 years), who garrisoned the frontiers in high altitude (HA) (2300-4400 m) for two years and subsequently descended to sea level for one to seven days, were recruited. Control group consisted of 16 matched SL natives. The amplitude of low-frequency fluctuations (ALFF) of regional brain functional magnetic resonance imaging signal in resting state and functional connectivity (FC) between brain regions was analyzed. HA subjects showed significant increases of ALFF at several sites within the bilateral occipital cortices and significant decreases of ALFF in the right anterior insula and extending to the caudate, putamen, inferior frontal orbital cortex, temporal pole, and superior temporal gyrus; lower ALFF values in the right insula were positively correlated with low respiratory measurements. The right insula in HA subjects had increases of FC with the right superior temporal gyrus, postcentral gyrus, rolandic operculum, supramarginal gyrus, and inferior frontal triangular area. We thus demonstrated that hypoxia-reoxygenation had influence on the spontaneous neuronal activity in brain. The decrease of insular neuronal activity may be related to the reduction of ventilatory drive, while the increase of FC with insula may indicate a central compensation.
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Affiliation(s)
- Jiaxing Zhang
- 1 Department of Physiology, Medical College of Xiamen University , Xiamen, China
| | - Ji Chen
- 1 Department of Physiology, Medical College of Xiamen University , Xiamen, China
| | - Cunxiu Fan
- 1 Department of Physiology, Medical College of Xiamen University , Xiamen, China
| | - Jinqiang Li
- 2 Department of Clinical Psychology, Gulangyu Sanatorium of PLA , Xiamen, China
| | - Jianzhong Lin
- 3 Magnetic Resonance Center, Zhongshan Hospital Xiamen University , Xiamen, China
| | - Tianhe Yang
- 3 Magnetic Resonance Center, Zhongshan Hospital Xiamen University , Xiamen, China
| | - Ming Fan
- 4 Department of Cognitive Sciences, Institute of Basic Medical Sciences , Beijing, China
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Morelli MS, Giannoni A, Passino C, Landini L, Emdin M, Vanello N. A Cross-Correlational Analysis between Electroencephalographic and End-Tidal Carbon Dioxide Signals: Methodological Issues in the Presence of Missing Data and Real Data Results. SENSORS 2016; 16:s16111828. [PMID: 27809243 PMCID: PMC5134487 DOI: 10.3390/s16111828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
Electroencephalographic (EEG) irreducible artifacts are common and the removal of corrupted segments from the analysis may be required. The present study aims at exploring the effects of different EEG Missing Data Segment (MDS) distributions on cross-correlation analysis, involving EEG and physiological signals. The reliability of cross-correlation analysis both at single subject and at group level as a function of missing data statistics was evaluated using dedicated simulations. Moreover, a Bayesian-based approach for combining the single subject results at group level by considering each subject’s reliability was introduced. Starting from the above considerations, the cross-correlation function between EEG Global Field Power (GFP) in delta band and end-tidal CO2 (PETCO2) during rest and voluntary breath-hold was evaluated in six healthy subjects. The analysis of simulated data results at single subject level revealed a worsening of precision and accuracy in the cross-correlation analysis in the presence of MDS. At the group level, a large improvement in the results’ reliability with respect to single subject analysis was observed. The proposed Bayesian approach showed a slight improvement with respect to simple average results. Real data results were discussed in light of the simulated data tests and of the current physiological findings.
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Affiliation(s)
- Maria Sole Morelli
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Research Center "E. Piaggio", University of Pisa, 56122 Pisa, Italy.
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Claudio Passino
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Luigi Landini
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56124 Pisa, Italy.
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, National Research Council, 56124 Pisa, Italy.
| | - Nicola Vanello
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56124 Pisa, Italy.
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Fan C, Zhao Y, Yu Q, Yin W, Liu H, Lin J, Yang T, Fan M, Gesang L, Zhang J. Reversible Brain Abnormalities in People Without Signs of Mountain Sickness During High-Altitude Exposure. Sci Rep 2016; 6:33596. [PMID: 27633944 PMCID: PMC5025655 DOI: 10.1038/srep33596] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023] Open
Abstract
A large proportion of lowlanders ascending to high-altitude (HA) show no signs of mountain sickness. Whether their brains have indeed suffered from HA environment and the persistent sequelae after return to lowland remain unknown. Thirty-one sea-level college students, who had a 30-day teaching on Qinghai-Tibet plateau underwent MRI scans before, during, and two months after HA exposure. Brain volume, cortical structures, and white matter microstructure were measured. Besides, serum neuron-specific enolase (NSE), C-reactive protein, and interleukin-6 and neuropsychiatric behaviors were tested. After 30-day HA exposure, the gray and white matter volumes and cortical surface areas significantly increased, with cortical thicknesses and curvatures changed in a wide spread regions; Anisotropy decreased with diffusivities increased in multiple sites of white matter tracts. Two months after HA exposure, cortical measurements returned to basal level. However, increased anisotropy with decreased diffusivities was observed. Behaviors and serum inflammatory factor did not significant changed during three time-point tests. NSE significantly decreased during HA but increased after HA exposure. Results suggest brain swelling occurred in people without neurological signs at HA, but no negative sequelae in cortical structures and neuropsychiatric functions were left after the return to lowlands. Reoxygenation changed white matter microstructure.
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Affiliation(s)
- Cunxiu Fan
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
| | - Yuhua Zhao
- Institute of high altitude medicine, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Qian Yu
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
| | - Wu Yin
- Department of Radiology, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Haipeng Liu
- Department of Radiology, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Jianzhong Lin
- Magnetic Resonance Center, Zhongshan Hospital Xiamen University, Xiamen 361004, Fujian, China
| | - Tianhe Yang
- Magnetic Resonance Center, Zhongshan Hospital Xiamen University, Xiamen 361004, Fujian, China
| | - Ming Fan
- Department of Brain Protection and Plasticity, Institute of Basic Medical Sciences, Beijing 100850, China
| | - Luobu Gesang
- Institute of high altitude medicine, Tibet Autonomous Region People’s Hospital, Lasa 850000, Tibet Autonomous Region, China
| | - Jiaxing Zhang
- Department of Physiology, Medical College of Xiamen University, Xiamen 361102, Fujian, China
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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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Chen J, Fan C, Li J, Han Q, Lin J, Yang T, Zhang J. Increased Intraregional Synchronized Neural Activity in Adult Brain After Prolonged Adaptation to High-Altitude Hypoxia: A Resting-State fMRI Study. High Alt Med Biol 2016; 17:16-24. [PMID: 26906285 DOI: 10.1089/ham.2015.0104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The human brain is intrinsically plastic such that its functional architecture can be reorganized in response to environmental pressures and physiological changes. However, it remains unclear whether a compensatory modification of spontaneous neural activity occurs in adult brain during prolonged high-altitude (HA) adaptation. In this study, we obtained resting-state functional magnetic resonance (MR) images in 16 adults who have immigrated to Qinghai-Tibet Plateau (2300-4400 m) for 2 years and in 16 age-matched sea level (SL) controls. A validated regional homogeneity (Reho) method was employed to investigate the local synchronization of resting-state functional magnetic resonance imaging (fMRI) signals. Seed connectivity analysis was carried out subsequently. Cognitive and physiological assessments were made and correlated with the image metrics. Compared with SL controls, global mean Reho was significantly increased in HA immigrants as well as a regional increase in the right inferolateral sensorimotor cortex. Furthermore, mean z-Reho value extracted within the inferolateral sensorimotor area showed trend-level significant inverse correlation with memory search reaction time in HA immigrants. These observations, for the first time, provide evidence of adult brain resilience of spontaneous neural activity after long-term HA exposure without inherited and developmental effects. Resting-state fMRI could yield valuable information for central mechanisms underlying respiratory and cognitive compensations in adults during prolonged environmentally hypoxic adaptation, paving the way for future HA-adaptive training.
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Affiliation(s)
- Ji Chen
- 1 Department of Physiology and Neurobiology, Medical College of Xiamen University , Xiamen, Fujian, China .,2 Department of Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA , Fuzhou, Fujian, China
| | - Cunxiu Fan
- 1 Department of Physiology and Neurobiology, Medical College of Xiamen University , Xiamen, Fujian, China
| | - Jinqiang Li
- 3 Department of Clinical Psychology, Gulangyu Sanatorium of PLA , Xiamen, Fujian, China
| | - Qiaoqing Han
- 3 Department of Clinical Psychology, Gulangyu Sanatorium of PLA , Xiamen, Fujian, China
| | - Jianzhong Lin
- 4 Magnetic Resonance Center, Zhongshan Hospital, Medical College of Xiamen University , Xiamen, Fujian, China
| | - Tianhe Yang
- 4 Magnetic Resonance Center, Zhongshan Hospital, Medical College of Xiamen University , Xiamen, Fujian, China
| | - Jiaxing Zhang
- 1 Department of Physiology and Neurobiology, Medical College of Xiamen University , Xiamen, Fujian, China
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van Duijvenboden S, Hanson B, Child N, Orini M, Rinaldi CA, Gill JS, Taggart P. Effect of autonomic blocking agents on the respiratory-related oscillations of ventricular action potential duration in humans. Am J Physiol Heart Circ Physiol 2015; 309:H2108-17. [PMID: 26475587 PMCID: PMC4698427 DOI: 10.1152/ajpheart.00560.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/14/2015] [Indexed: 12/01/2022]
Abstract
Ventricular action potential repolarization is critical to electrical stability and arrhythmogenesis. Oscillations at the respiratory frequency were investigated in humans by combining endocardial electrophysiological recordings, controlled respiration with adrenergic blocking agents. Results are consistent with a partial role of the sympathetic nervous system combined with additional mechanisms, possibly involving mechano-electric feedback. Ventricular action potential duration (APD) is an important component of many physiological functions including arrhythmogenesis. APD oscillations have recently been reported in humans at the respiratory frequency. This study investigates the contribution of the autonomic nervous system to these oscillations. In 10 patients undergoing treatment for supraventricular arrhythmias, activation recovery intervals (ARI; a conventional surrogate for APD) were measured from multiple left and right ventricular (RV) endocardial sites, together with femoral artery pressure. Respiration was voluntarily regulated and heart rate clamped by RV pacing. Sympathetic and parasympathetic blockade was achieved using intravenous metoprolol and atropine, respectively. Metroprolol reduced the rate of pressure development (maximal change in pressure over time): 1,271 (± 646) vs. 930 (± 433) mmHg/s; P < 0.01. Systolic blood pressure (SBP) showed a trend to decrease after metoprolol, 133 (± 21) vs. 128 (± 25) mmHg; P = 0.06, and atropine infusion, 122 (± 26) mmHg; P < 0.05. ARI and SBP exhibited significant cyclical variations (P < 0.05) with respiration in all subjects with peak-to-peak amplitudes ranging between 0.7 and 17.0 mmHg and 1 and 16 ms, respectively. Infusion of metoprolol reduced the mean peak-to-peak amplitude [ARI, 6.2 (± 1.4) vs. 4.4 (± 1.0) ms, P = 0.008; SBP, 8.4 (± 1.6) vs. 6.2 (± 2.0) mmHg, P = 0.002]. The addition of atropine had no significant effect. ARI, SBP, and respiration showed significant coupling (P < 0.05) at the breathing frequency in all subjects. Directed coherence from respiration to ARI was high and reduced after metoprolol infusion [0.70 (± 0.17) vs. 0.50 (± 0.23); P < 0.05]. These results suggest a role of respiration in modulating the electrophysiology of ventricular myocardium in humans, which is partly, but not totally, mediated by β-adrenergic mechanisms.
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Affiliation(s)
| | - Ben Hanson
- Department of Mechanical Engineering, University College London, London, UK
| | - Nick Child
- Department of Cardiology, Guy's and St. Thomas's Hospital, London, UK; and
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Jaswinder S Gill
- Department of Cardiology, Guy's and St. Thomas's Hospital, London, UK; and
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, UK
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45
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Hu H, Li S, Li S. Pain modulation effect of breathing-controlled electrical stimulation (BreEStim) is not likely to be mediated by deep and fast voluntary breathing. Sci Rep 2015; 5:14228. [PMID: 26382644 PMCID: PMC4585654 DOI: 10.1038/srep14228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022] Open
Abstract
Voluntary breathing-controlled electrical stimulation (BreEStim), a novel non-invasive and non-pharmacological treatment protocol for neuropathic pain management, was reported to selectively reduce the affective component of pain possibly by increasing pain threshold. The underlying mechanisms involved in the analgesic effect of BreEStim were considered to result from combination of multiple internal pain coping mechanisms triggered during BreEStim. Findings from our recent studies have excluded possible roles of acupuncture and aversiveness and habituation of painful electrical stimulation in mediating the analgesia effect of BreEStim. To further investigate the possible role of voluntary breathing during BreEStim, the effectiveness of fast and deep voluntary breathing-only and BreEStim on experimentally induced pain was compared in healthy human subjects. Results showed no change in electrical pain threshold after Breathing-only, but a significant increase in electrical pain threshold after BreEStim. There was no statistically significant change in other thresholds after Breathing-only and BreEStim. The findings suggest that the analgesic effect of BreEStim is not likely attributed to fast and deep voluntary breathing. Possible mechanisms are discussed.
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Affiliation(s)
- Huijing Hu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA.,Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA.,Guangdong Provincial Work Injury Rehabilitation Center, Guangzhou, China
| | - Shengai Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA.,Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, USA.,Neurorehabilitation Research Laboratory, TIRR Memorial Hermann Research Center, Houston, TX, USA
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Jerath R, Crawford MW, Barnes VA. A unified 3D default space consciousness model combining neurological and physiological processes that underlie conscious experience. Front Psychol 2015; 6:1204. [PMID: 26379573 PMCID: PMC4550793 DOI: 10.3389/fpsyg.2015.01204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/29/2015] [Indexed: 12/28/2022] Open
Abstract
The Global Workspace Theory and Information Integration Theory are two of the most currently accepted consciousness models; however, these models do not address many aspects of conscious experience. We compare these models to our previously proposed consciousness model in which the thalamus fills-in processed sensory information from corticothalamic feedback loops within a proposed 3D default space, resulting in the recreation of the internal and external worlds within the mind. This 3D default space is composed of all cells of the body, which communicate via gap junctions and electrical potentials to create this unified space. We use 3D illustrations to explain how both visual and non-visual sensory information may be filled-in within this dynamic space, creating a unified seamless conscious experience. This neural sensory memory space is likely generated by baseline neural oscillatory activity from the default mode network, other salient networks, brainstem, and reticular activating system.
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Affiliation(s)
| | | | - Vernon A Barnes
- Department of Pediatrics, Georgia Prevention Institute, Georgia Regents University Augusta, GA, USA
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47
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Management of acute breathlessness in the person with chronic refractory breathlessness. Curr Opin Support Palliat Care 2015; 9:212-6. [PMID: 26147913 DOI: 10.1097/spc.0000000000000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize the current literature on classification and management of acute breathlessness that occurs in patients who are living with chronic refractory breathlessness related to cancer, cardiopulmonary, or neuromuscular disease. RECENT FINDINGS In the context of chronic refractory breathlessness, acute breathlessness can be classified as either episodic breathlessness or breathlessness crisis. Episodic breathlessness is characterized by the severity, duration, and predictability of the symptom, and by the presence or absence of a trigger such as exertion, emotion, or an environmental factor. Breathlessness crisis is more sustained, occurs at rest, and overwhelms the patient's and caregivers' coping abilities, similar to the nontriggered unpredictable types of episodic breathlessness. Treatment of acute breathlessness focuses on alleviating the episode as quickly as possible without escalating medical intervention that may not be consistent with the patient's treatment preferences. SUMMARY Attention to breathlessness in the published literature has increased exponentially in the past two decades. The challenge is now to translate the research findings into relief of symptoms, suffering, and distress in those who suffer from acute and chronic breathlessness because of chronic illness.
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Stoeckel MC, Esser RW, Gamer M, Büchel C, von Leupoldt A. Brain mechanisms of short-term habituation and sensitization toward dyspnea. Front Psychol 2015; 6:748. [PMID: 26082746 PMCID: PMC4451234 DOI: 10.3389/fpsyg.2015.00748] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/19/2015] [Indexed: 01/27/2023] Open
Abstract
Dyspnea is a prevalent and threatening cardinal symptom in many diseases including asthma. Whether patients suffering from dyspnea show habituation or sensitization toward repeated experiences of dyspnea is relevant for both quality of life and treatment success. Understanding the mechanisms, including the underlying brain activation patterns, that determine the dynamics of dyspnea perception seems crucial for the improvement of treatment and rehabilitation. Toward this aim, we investigated the interplay between short-term changes of dyspnea perception and changes of related brain activation. Healthy individuals underwent repeated blocks of resistive load induced dyspnea with parallel acquisition of functional magnetic resonance imaging data. Late vs. early ratings on dyspnea intensity and unpleasantness were correlated with late vs. early brain activation for both, dyspnea anticipation and dyspnea perception. Individual trait and state anxiety were determined using questionnaire data. Our results indicate an involvement of the orbitofrontal cortex (OFC), midbrain/periaqueductal gray (PAG) and anterior insular cortex in habituation/sensitization toward dyspnea. Changes in the anterior insular cortex were particularly linked to changes in dyspnea unpleasantness. Changes of both dyspnea intensity and unpleasantness were positively correlated with state and trait anxiety. Our findings are in line with the suggested relationship between the anterior insular cortex and dyspnea unpleasantness. They further support the notion that habituation/sensitization toward dyspnea is influenced by anxiety. Our study extends the known role of the midbrain/PAG in anti-nociception to an additional involvement in habituation/sensitization toward dyspnea and suggests an interplay with the OFC.
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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
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas von Leupoldt
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven Leuven, Belgium
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Critchley HD, Nicotra A, Chiesa PA, Nagai Y, Gray MA, Minati L, Bernardi L. Slow breathing and hypoxic challenge: cardiorespiratory consequences and their central neural substrates. PLoS One 2015; 10:e0127082. [PMID: 25973923 PMCID: PMC4431729 DOI: 10.1371/journal.pone.0127082] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/11/2015] [Indexed: 11/19/2022] Open
Abstract
Controlled slow breathing (at 6/min, a rate frequently adopted during yoga practice) can benefit cardiovascular function, including responses to hypoxia. We tested the neural substrates of cardiorespiratory control in humans during volitional controlled breathing and hypoxic challenge using functional magnetic resonance imaging (fMRI). Twenty healthy volunteers were scanned during paced (slow and normal rate) breathing and during spontaneous breathing of normoxic and hypoxic (13% inspired O2) air. Cardiovascular and respiratory measures were acquired concurrently, including beat-to-beat blood pressure from a subset of participants (N = 7). Slow breathing was associated with increased tidal ventilatory volume. Induced hypoxia raised heart rate and suppressed heart rate variability. Within the brain, slow breathing activated dorsal pons, periaqueductal grey matter, cerebellum, hypothalamus, thalamus and lateral and anterior insular cortices. Blocks of hypoxia activated mid pons, bilateral amygdalae, anterior insular and occipitotemporal cortices. Interaction between slow breathing and hypoxia was expressed in ventral striatal and frontal polar activity. Across conditions, within brainstem, dorsal medullary and pontine activity correlated with tidal volume and inversely with heart rate. Activity in rostroventral medulla correlated with beat-to-beat blood pressure and heart rate variability. Widespread insula and striatal activity tracked decreases in heart rate, while subregions of insular cortex correlated with momentary increases in tidal volume. Our findings define slow breathing effects on central and cardiovascular responses to hypoxic challenge. They highlight the recruitment of discrete brainstem nuclei to cardiorespiratory control, and the engagement of corticostriatal circuitry in support of physiological responses that accompany breathing regulation during hypoxic challenge.
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Affiliation(s)
- Hugo D. Critchley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- Sackler Centre for Consciousness Science, University of Sussex, Brighton, United Kingdom
- * E-mail:
| | - Alessia Nicotra
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Patrizia A. Chiesa
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- Ghermann Laboratory, University of Queensland, Queensland, Australia
| | - Yoko Nagai
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | | | - Luciano Bernardi
- Department of Internal Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Abstract
BACKGROUND The Respiratory Distress Observation Scale(©) is an innovative solution to assessment when a dyspnea report cannot be elicited. The Respiratory Distress Observation Scale has acceptable reliability and validity psychometrics. AIM To identify distress-intensity cut-points of the Respiratory Distress Observation Scale. DESIGN Receiver operating characteristic curve analysis was conducted with inpatients stratified by four levels of respiratory distress-none, mild, moderate, or severe. Patients provided three self-report measures of dyspnea: dichotomous (yes/no); a ranking of none, mild, moderate, or severe; and a numerical rating scale. Respiratory distress was assessed using the Respiratory Distress Observation Scale instrument. SETTING/PARTICIPANTS Participants were 136 adult inpatients, mean age 61.8 years (standard deviation = 13.18 years), 89.7% African American, and 56.6% female, who were recruited from an urban, tertiary care hospital in the Midwest of the United States. RESULTS In all, 47% (n = 64) self-reported dyspnea (yes/no). Ranking was distributed as follows: none = 36, mild = 35, moderate = 40, and severe = 25. Numerical rating scale scores ranged from 0 to 10, mean = 4.99 (standard deviation = 2.9). Respiratory Distress Observation Scale scores ranged from 0 to 7, median (interquartile range) = 2 (1-3). Receiver operating characteristic curve analysis-determined Respiratory Distress Observation Scale score of 0-2 suggests little or no respiratory distress; score ≥3 signified moderate to severe distress. CONCLUSION A Respiratory Distress Observation Scale score ≥3 signifies a patient's need for palliation of respiratory distress. An end-point for identifying responsiveness to treatment, in other words, respiratory comfort, is Respiratory Distress Observation Scale <3. Because patients with imminent respiratory failure, as typified by dying patients, were not represented yielding lower than expected Respiratory Distress Observation Scale scores, further substantiation is needed to determine moderate or severe cut-points.
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