1
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Burt JS, Davenport MP, Welch JF, Davenport PW. fNIRS analysis of rostral prefrontal cortex activity and perception of inspiratory loads. Respir Physiol Neurobiol 2023; 316:104113. [PMID: 37442516 DOI: 10.1016/j.resp.2023.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 07/15/2023]
Abstract
It is well-established that the brainstem is responsible for the automatic control of breathing, however, cortical areas control perception and conscious breathing. This study investigated activity in the prefrontal cortex (PFC) during breathing difficulty using functional near-infrared spectroscopy (fNIRS). It was hypothesized that extrinsic inspiratory loads will elicit regional changes in PFC activity and increased perception ratings, as a function of load magnitude and type. Participants were exposed to varying magnitudes of resistive (R) and pressure threshold (PT) inspiratory loads to increase breathing effort. Perception ratings of breathing effort and load magnitude were positively correlated (p < 0.05). PT loads were rated more effortful than R loads (p < 0.05). Differences in perceived effort were a function of inspiratory pressure-time-product (PTP) and inspiratory work of breathing (WoB). PFC activity increased with the largest PT load (p < 0.01), suggesting that the PFC is involved in processing respiratory stimuli. The results support the hypothesis that the PFC is an element of the neural network mediating effortful breathing perception.
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Affiliation(s)
- Juliana S Burt
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA
| | - Matthew P Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA
| | - Joseph F Welch
- Department of Physical Therapy, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Drive, Gainesville, FL 32610, USA.
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2
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Vardar-Yagli N, Saglam M, Dasgin H, Karli-Oguz K. The Effects of Respiratory Muscle Training on Resting-State Brain Activity and Thoracic Mobility in Healthy Subjects: A Randomized Controlled Trial. J Magn Reson Imaging 2023; 57:403-417. [PMID: 35762913 DOI: 10.1002/jmri.28322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although inspiratory muscle training (IMT) is an effective intervention for improving breath perception, brain mechanisms have not been studied yet. PURPOSE To examine the effects of IMT on insula and default mode network (DMN) using resting-state functional MRI (RS-fMRI). STUDY TYPE Prospective. POPULATION A total of 26 healthy participants were randomly assigned to two groups as IMT group (n = 14) and sham IMT groups (n = 12). FIELD STRENGTH/SEQUENCE A 3-T, three-dimensional T2* gradient-echo echo planar imaging sequence for RS-fMRI was obtained. ASSESSMENT The intervention group received IMT at 60% and sham group received at 15% of maximal inspiratory pressure (MIP) for 8 weeks. Pulmonary and respiratory muscle function, and breathing patterns were measured. Groups underwent RS-fMRI before and after the treatment. STATISTICAL TESTS Statistical tests were two-tailed P < 0.05 was considered statistically significant. Student's t test was used to compare the groups. One-sample t-test for each group was used to reveal pattern of functional connectivity. A statistical threshold of P < 0.001 uncorrected value was set at voxel level. We used False discovery rate (FDR)-corrected P < 0.05 cluster level. RESULTS The IMT group showed more prominent alterations in insula and DMN connectivity than sham group. The MIP was significantly different after IMT. Respiratory rate (P = 0.344), inspiratory time (P = 0.222), expiratory time (P = 1.000), and inspiratory time/total breath time (P = 0.572) of respiratory patterns showed no significant change after IMT. All DMN components showed decreased, while insula showed increased activation significantly. DATA CONCLUSION Differences in brain activity and connectivity may reflect improved ventilatory perception with IMT with a possible role in regulating breathing pattern by processing interoceptive signals. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Naciye Vardar-Yagli
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Melda Saglam
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Cardiorespiratory Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Hacer Dasgin
- National Magnetic Resonance Research Center (UMRAM) Bilkent University, Ankara, Turkey
| | - Kader Karli-Oguz
- National Magnetic Resonance Research Center (UMRAM) Bilkent University, Ankara, Turkey.,Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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3
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Hudson AL, Wattiez N, Navarro-Sune X, Chavez M, Similowski T. Combined head accelerometry and EEG improves the detection of respiratory-related cortical activity during inspiratory loading in healthy participants. Physiol Rep 2022; 10:e15383. [PMID: 35818313 PMCID: PMC9273870 DOI: 10.14814/phy2.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022] Open
Abstract
Mechanical ventilation is a highly utilized life‐saving tool, particularly in the current era. The use of EEG in a brain–ventilator interface (BVI) to detect respiratory discomfort (due to sub‐optimal ventilator settings) would improve treatment in mechanically ventilated patients. This concept has been realized via development of an EEG covariance‐based classifier that detects respiratory‐related cortical activity associated with respiratory discomfort. The aim of this study was to determine if head movement, detected by an accelerometer, can detect and/or improve the detection of respiratory‐related cortical activity compared to EEG alone. In 25 healthy participants, EEG and acceleration of the head were recorded during loaded and quiet breathing in the seated and lying postures. Detection of respiratory‐related cortical activity using an EEG covariance‐based classifier was improved by inclusion of data from an Accelerometer‐based classifier, i.e. classifier ‘Fusion’. In addition, ‘smoothed’ data over 50s, rather than one 5 s window of EEG/Accelerometer signals, improved detection. Waveform averages of EEG and head acceleration showed the incidence of pre‐inspiratory potentials did not differ between loaded and quiet breathing, but head movement was greater in loaded breathing. This study confirms that compared to event‐related analysis with >5 min of signal acquisition, an EEG‐based classifier is a clinically valuable tool with rapid processing, detection times, and accuracy. Data smoothing would introduce a small delay (<1 min) but improves detection results. As head acceleration improved detection compared to EEG alone, the number of EEG signals required to detect respiratory discomfort with future BVIs could be reduced if head acceleration is included.
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Affiliation(s)
- Anna L Hudson
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Neuroscience Research Australia and, University of New South Wales, Sydney, Australia.,Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Xavier Navarro-Sune
- Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France.,myBrain Technologies, Paris, France
| | - Mario Chavez
- Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Département R3S, Paris, France
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4
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Laghi F, Shaikh H, Littleton SW, Morales D, Jubran A, Tobin MJ. Inhibition of central activation of the diaphragm: a mechanism of weaning failure. J Appl Physiol (1985) 2020; 129:366-376. [PMID: 32673161 PMCID: PMC7473953 DOI: 10.1152/japplphysiol.00856.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During a T-tube trial following disconnection of mechanical ventilation, patients failing the trial do not develop contractile diaphragmatic fatigue despite increases in inspiratory pressure output. Studies in volunteers, patients, and animals raise the possibility of spinal and supraspinal reflex mechanisms that inhibit central-neural output under loaded conditions. We hypothesized that diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. Tidal transdiaphragmatic pressure (ΔPdi) and electrical activity (ΔEAdi) were recorded with esophago-gastric catheters during a T-tube trial in 20 critically ill patients. During the T-tube trial, ∆EAdi was greater in weaning failure patients than in weaning success patients (P = 0.049). Despite increases in ΔPdi, from 18.1 ± 2.5 to 25.9 ± 3.7 cm H2O (P < 0.001), rate of transdiaphragmatic pressure development (from 22.6 ± 3.1 to 37.8 ± 6.7 cm H2O/s; P < 0.0004), and concurrent respiratory distress, ∆EAdi at the end of a failed T-tube trial was half of maximum, signifying inhibition of central neural output to the diaphragm. The increase in ΔPdi in the weaning failure group, while ∆EAdi remained constant, indicates unexpected improvement in diaphragmatic neuromuscular coupling (from 46.7 ± 6.5 to 57.8 ± 8.4 cm H2O/%; P = 0.006). Redistribution of neural output to the respiratory muscles characterized by a progressive increase in rib cage and accessory muscle contribution to tidal breathing and expiratory muscle recruitment contributed to enhanced coupling. In conclusion, diaphragmatic recruitment is submaximal at the end of a failed weaning trial despite concurrent respiratory distress. This finding signifies that reflex inhibition of central neural output to the diaphragm contributes to weaning failure. NEW & NOTEWORTHY Research into pathophysiology of failure to wean from mechanical ventilation has excluded several factors, including contractile fatigue, but the precise mechanism remains unknown. We recorded transdiaphragmatic pressure and diaphragmatic electrical activity in patients undergoing a T-tube trial. Diaphragmatic recruitment was submaximal at the end of a failed trial despite concurrent respiratory distress, signifying that inhibition of central neural output to the diaphragm is an important mechanism of weaning failure.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Stephen W Littleton
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Daniel Morales
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital, Hines, Illinois.,Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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Rault C, Sangaré A, Diaz V, Ragot S, Frat JP, Raux M, Similowski T, Robert R, Thille AW, Drouot X. Impact of Sleep Deprivation on Respiratory Motor Output and Endurance. A Physiological Study. Am J Respir Crit Care Med 2020; 201:976-983. [DOI: 10.1164/rccm.201904-0819oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Christophe Rault
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Service d’Explorations fonctionnelles, Physiologie respiratoire et de l’exercice
| | | | - Véronique Diaz
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Service d’Explorations fonctionnelles, Physiologie respiratoire et de l’exercice
| | - Stéphanie Ragot
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Centre d’Investigation Clinique, Unité de méthodologie biostatistique, and
| | - Jean-Pierre Frat
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Mathieu Raux
- Sorbonne Universités, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, SSIAP, Département d’Anesthésie-Réanimation, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, SSIAP, Service de Pneumologie, Medecine Intensive et Réanimation, Département R3S, Paris, France; and
| | - René Robert
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Arnaud W. Thille
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Réanimation Médicale, CHU de Poitiers, Poitiers, France
| | - Xavier Drouot
- INSERM, CIC 1402, Equipe Alive, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Service d’Explorations fonctionnelles, Physiologie respiratoire et de l’exercice
- Service de Neurophysiologie Clinique
- INSERM U-1084, Experimental and Clinical Neurosciences Laboratory, Neurobiology and Neuroplasticity and Neuro-development Group, Poitiers, France
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6
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Azabou E, Bao G, Heming N, Bounab R, Moine P, Chevallier S, Chevret S, Resche-Rigon M, Siami S, Sharshar T, Lofaso F, Annane D. Randomized Controlled Study Evaluating Efficiency of Low Intensity Transcranial Direct Current Stimulation (tDCS) for Dyspnea Relief in Mechanically Ventilated COVID-19 Patients in ICU: The tDCS-DYSP-COVID Protocol. Front Med (Lausanne) 2020; 7:372. [PMID: 32671084 PMCID: PMC7332773 DOI: 10.3389/fmed.2020.00372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
The severe respiratory distress syndrome linked to the new coronavirus disease (COVID-19) includes unbearable dyspneic suffering which contributes to the deterioration of the prognosis of patients in intensive care unit (ICU). Patients are put on mechanical ventilation to reduce respiratory suffering and preserve life. Despite this mechanical ventilation, most patients continue to suffer from dyspnea. Dyspnea is a major source of suffering in intensive care and one of the main factors that affect the prognosis of patients. The development of innovative methods for its management, especially non-drug management is more than necessary. In recent years, numerous studies have shown that transcranial direct current stimulation (tDCS) could modulate the perception of acute or chronic pain. In the other hand, it has been shown that the brain zones activated during pain and dyspnea are close and/or superimposed, suggesting that brain structures involved in the integration of aversive emotional component are shared by these two complex sensory experiences. Therefore, it can be hypothesized that stimulation by tDCS with regard to the areas which, in the case of pain have activated one or more of these brain structures, may also have an effect on dyspnea. In addition, our team recently demonstrated that the application of tDCS on the primary cortical motor area can modulate the excitability of the respiratory neurological pathways. Indeed, tDCS in anodal or cathodal modality reduced the excitability of the diaphragmatic cortico-spinal pathways in healthy subjects. We therefore hypothesized that tDCS could relieve dyspnea in COVID-19 patients under mechanical ventilation in ICU. This study was designed to evaluate effects of two modalities of tDCS (anodal and cathodal) vs. placebo, on the relief of dyspnea in COVID-19 patients requiring mechanical ventilation in ICU. Trial Registration: This protocol is derived from the tDCS-DYSP-REA project registered on ClinicalTrials.gov NCT03640455. It will however be registered under its own NCT number.
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Affiliation(s)
- Eric Azabou
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
- *Correspondence: Eric Azabou ;
| | - Guillaume Bao
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Nicholas Heming
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Rania Bounab
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Pierre Moine
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Sylvain Chevallier
- Versailles Engineering Systems Laboratory (LISV), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Velizy, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France
- Inserm U1153 CRESS, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, Paris, France
- Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France
| | - Shidaps Siami
- Critical Care Medicine Unit, CH Etampes-Dourdan, Etampes, France
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
- Laboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France
| | - Frederic Lofaso
- Clinical Neurophysiology and Neuromodulation Unit, Departments of Physiology and Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
| | - Djillali Annane
- General Intensive Care Unit-Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm UMR 1173, Infection and Inflammation (2I), University of Versailles Saint-Quentin en Yvelines (UVSQ), Paris-Saclay University, Paris, France
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7
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Launois C, Nierat M, Attali V, Raux M, Arnulf I, Similowski T, Redolfi S. Postural preinspiratory cortical activity, genioglossus activity and fluid shift in awake obstructive sleep apnoea patients. Exp Physiol 2019; 105:370-378. [DOI: 10.1113/ep087804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et Réanimation Département R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du Sommeil Département R3S Paris France
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8
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Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dubé BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich R, Rossi A, Series F, Similowski T, Spengler C, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J 2019; 53:13993003.01214-2018. [DOI: 10.1183/13993003.01214-2018] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
Abstract
Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.
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9
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Launois C, Perger E, Attali V, Nierat M, Raux M, Arnulf I, Similowski T, Redolfi S. Postural respiratory‐related cortical activation and rostral fluid shift in awake healthy humans. Exp Physiol 2019; 104:887-895. [DOI: 10.1113/ep087468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Claire Launois
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Elisa Perger
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Valérie Attali
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Marie‐Cécile Nierat
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
| | - Mathieu Raux
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixDépartement d'Anesthésie Réanimation Paris France
| | - Isabelle Arnulf
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
| | - Thomas Similowski
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de PneumologieMédecine Intensive et RéanimationDépartement R3S Paris France
| | - Stefania Redolfi
- Sorbonne UniversitéINSERM UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique Paris France
- AP‐HPGroupe Hospitalier Pitié‐Salpêtrière Charles FoixService de Pathologies du SommeilDépartement R3S Paris France
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10
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Nierat MC, Raux M, Redolfi S, Gonzalez-Bermejo J, Biondi G, Straus C, Rivals I, Morélot-Panzini C, Similowski T. Neuroergonomic and psychometric evaluation of full-face crew oxygen masks respiratory tolerance: a proof-of-concept study. J ROY ARMY MED CORPS 2018; 165:317-324. [PMID: 30415218 DOI: 10.1136/jramc-2018-001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Preventing in-flight hypoxia in pilots is typically achieved by wearing oxygen masks. These masks must be as comfortable as possible to allow prolonged and repeated use. The consequences of mask-induced facial contact pressure have been extensively studied, but little is known about mask-induced breathing discomfort. Because breathlessness is a strong distractor and engages cerebral resources, it could negatively impact flying performances. METHODS Seventeen volunteers (age 20-32) rated respiratory discomfort while breathing with no mask and with two models of quick-donning full-face crew oxygen masks with regulators (mask A, mask B). Electroencephalographic recordings were performed to detect a putative respiratory-related cortical activation in response to inspiratory constraint (experiment 1, n=10). Oxygen consumption was measured using indirect calorimetry (experiment 2, n=10). RESULTS With mask B, mild respiratory discomfort was reported significantly more frequently than with no mask or mask A (experiment 1: median respiratory discomfort on visual analogue scale 0.9 cm (0.5-1.4), experiment 1; experiment 2: 2 cm (1.7-2.9)). Respiratory-related cortical activation was present in 1/10 subjects with no mask, 1/10 with mask A and 6/10 with mask B (significantly more frequently with mask B). Breathing pattern, sigh frequency and oxygen consumption were not different. CONCLUSIONS In a laboratory setting, breathing through high-end aeronautical full-face crew oxygen masks can induce mild breathing discomfort and activate respiratory-related cortical networks. Whether or not this can occur in real-life conditions and have operational consequences remains to be investigated. Meanwhile, respiratory psychometric and neuroergonomic approaches could be worth integrating to masks development and evaluation processes.
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Affiliation(s)
- Marie-Cécile Nierat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Département d'Anesthésie-Réanimation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - S Redolfi
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Pathologies du Sommeil, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - J Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - G Biondi
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - C Straus
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Explorations de la Fonction Respiratoire, de l'Exercice et de la Dyspnée, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - I Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - C Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - T Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France .,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
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11
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Hudson AL, Niérat MC, Raux M, Similowski T. The Relationship Between Respiratory-Related Premotor Potentials and Small Perturbations in Ventilation. Front Physiol 2018; 9:621. [PMID: 29899704 PMCID: PMC5988848 DOI: 10.3389/fphys.2018.00621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Respiratory-related premotor potentials from averaged electroencephalography (EEG) over the motor areas indicate cortical activation in healthy participants to maintain ventilation in the face of moderate inspiratory or expiratory loads. These experimental conditions are associated with respiratory discomfort, i.e., dyspnea. Premotor potentials are also observed in resting breathing in patients with reduced automatic respiratory drive or respiratory muscle strength due to respiratory or neurological disease, presumably in an attempt to maintain ventilation. The aim of this study was to determine if small voluntary increases in ventilation or smaller load-capacity imbalances, that generate an awareness of breathing but aren’t necessarily dyspneic, give rise to respiratory premotor potentials in healthy participants. In 15 healthy subjects, EEG was recorded during voluntary large breaths (∼3× tidal volume, that were interspersed with smaller non-voluntary breaths in the same trial; in 10 subjects) and breathing with a ‘low’ inspiratory threshold load (∼7 cmH2O; in 8 subjects). Averaged EEG signals at Cz and FCz were assessed for premotor potentials prior to inspiration. Premotor potential incidence in large breaths was 40%, similar to that in the smaller non-voluntary breaths in the same trial (20%; p > 0.05) and to that in a separate trial of resting breathing (0%; p > 0.05). The incidence of premotor potentials was 25% in the low load condition, similar to that in resting breathing (0%; p > 0.05). In contrast, voluntary sniffs were always associated with a higher incidence of premotor potentials (100%; p < 0.05). We have demonstrated that in contrast to respiratory and neurological disease, there is no significant cortical contribution to increase tidal volume or to maintain the load-capacity balance with a small inspiratory threshold load in healthy participants as detected using event-related potential methodology. A lack of cortical contribution during loading was associated with low ratings of respiratory discomfort and minimal changes in ventilation. These findings advance our understanding of the neural control of breathing in health and disease and how respiratory-related EEG may be used for medical technologies such as brain-computer interfaces.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, NSW, Australia.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France
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12
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Raux M, Demoule A, Redolfi S, Morelot-Panzini C, Similowski T. Reduced Phrenic Motoneuron Recruitment during Sustained Inspiratory Threshold Loading Compared to Single-Breath Loading: A Twitch Interpolation Study. Front Physiol 2016; 7:537. [PMID: 27891099 PMCID: PMC5102887 DOI: 10.3389/fphys.2016.00537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022] Open
Abstract
In humans, inspiratory constraints engage cortical networks involving the supplementary motor area. Functional magnetic resonance imaging (fMRI) shows that the spread and intensity of the corresponding respiratory-related cortical activation dramatically decrease when a discrete load becomes sustained. This has been interpreted as reflecting motor cortical reorganization and automatisation, but could proceed from sensory and/or affective habituation. To corroborate the existence of motor reorganization between single-breath and sustained inspiratory loading (namely changes in motor neurones recruitment), we conducted a diaphragm twitch interpolation study based on the hypothesis that motor reorganization should result in changes in the twitch interpolation slope. Fourteen healthy subjects (age: 21–40 years) were studied. Bilateral phrenic stimulation was delivered at rest, upon prepared and targeted voluntary inspiratory efforts (“vol”), upon unprepared inspiratory efforts against a single-breath inspiratory threshold load (“single-breath”), and upon sustained inspiratory efforts against the same type of load (“continuous”). The slope of the relationship between diaphragm twitch transdiaphragmatic pressure and the underlying transdiaphragmatic pressure was −1.1 ± 0.2 during “vol,” −1.5 ± 0.7 during “single-breath,” and −0.6 ± 0.4 during “continuous” (all slopes expressed in percent of baseline.percent of baseline−1) all comparisons significant at the 5% level. The contribution of the diaphragm to inspiration, as assessed by the gastric pressure to transdiaphragmatic pressure ratio, was 31 ± 17% during “vol,” 22 ± 16% during “single-breath” (p = 0.13), and 19 ± 9% during “continuous” (p = 0.0015 vs. “vol”). This study shows that the relationship between the amplitude of the transdiaphragmatic pressure produced by a diaphragm twitch and its counterpart produced by the underlying diaphragm contraction is not unequivocal. If twitch interpolation is interpreted as reflecting motoneuron recruitment, this study supports motor reorganization compatible with “diaphragm sparing” when an inspiratory threshold load becomes sustained.
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Affiliation(s)
- Mathieu Raux
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-RéanimationParis, France
| | - Alexandre Demoule
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
| | - Stefania Redolfi
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S")Paris, France
| | - Capucine Morelot-Panzini
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC - University Pierre and Marie Curie Univ Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et cliniqueParis, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département"R3S")Paris, France
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13
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Nierat MC, Demiri S, Dupuis-Lozeron E, Allali G, Morélot-Panzini C, Similowski T, Adler D. When Breathing Interferes with Cognition: Experimental Inspiratory Loading Alters Timed Up-and-Go Test in Normal Humans. PLoS One 2016; 11:e0151625. [PMID: 26978782 PMCID: PMC4792478 DOI: 10.1371/journal.pone.0151625] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022] Open
Abstract
Human breathing stems from automatic brainstem neural processes. It can also be operated by cortico-subcortical networks, especially when breathing becomes uncomfortable because of external or internal inspiratory loads. How the “irruption of breathing into consciousness” interacts with cognition remains unclear, but a case report in a patient with defective automatic breathing (Ondine's curse syndrome) has shown that there was a cognitive cost of breathing when the respiratory cortical networks were engaged. In a pilot study of putative breathing-cognition interactions, the present study relied on a randomized design to test the hypothesis that experimentally loaded breathing in 28 young healthy subjects would have a negative impact on cognition as tested by “timed up-and-go” test (TUG) and its imagery version (iTUG). Progressive inspiratory threshold loading resulted in slower TUG and iTUG performance. Participants consistently imagined themselves faster than they actually were. However, progressive inspiratory loading slowed iTUG more than TUG, a finding that is unexpected with regard to the known effects of dual tasking on TUG and iTUG (slower TUG but stable iTUG). Insofar as the cortical networks engaged in response to inspiratory loading are also activated during complex locomotor tasks requiring cognitive inputs, we infer that competition for cortical resources may account for the breathing-cognition interference that is evidenced here.
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Affiliation(s)
- Marie-Cécile Nierat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Suela Demiri
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - Elise Dupuis-Lozeron
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
- Research Center for Statistics, Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Capucine Morélot-Panzini
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), F-75013, Paris, France
- * E-mail:
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospital and University of Geneva, Geneva, Switzerland
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14
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Hudson AL, Navarro-Sune X, Martinerie J, Pouget P, Raux M, Chavez M, Similowski T. Electroencephalographic detection of respiratory-related cortical activity in humans: from event-related approaches to continuous connectivity evaluation. J Neurophysiol 2016; 115:2214-23. [PMID: 26864771 DOI: 10.1152/jn.01058.2015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
The presence of a respiratory-related cortical activity during tidal breathing is abnormal and a hallmark of respiratory difficulties, but its detection requires superior discrimination and temporal resolution. The aim of this study was to validate a computational method using EEG covariance (or connectivity) matrices to detect a change in brain activity related to breathing. In 17 healthy subjects, EEG was recorded during resting unloaded breathing (RB), voluntary sniffs, and breathing against an inspiratory threshold load (ITL). EEG were analyzed by the specially developed covariance-based classifier, event-related potentials, and time-frequency (T-F) distributions. Nine subjects repeated the protocol. The classifier could accurately detect ITL and sniffs compared with the reference period of RB. For ITL, EEG-based detection was superior to airflow-based detection (P < 0.05). A coincident improvement in EEG-airflow correlation in ITL compared with RB (P < 0.05) confirmed that EEG detection relates to breathing. Premotor potential incidence was significantly higher before inspiration in sniffs and ITL compared with RB (P < 0.05), but T-F distributions revealed a significant difference between sniffs and RB only (P < 0.05). Intraclass correlation values ranged from poor (-0.2) to excellent (1.0). Thus, as for conventional event-related potential analysis, the covariance-based classifier can accurately predict a change in brain state related to a change in respiratory state, and given its capacity for near "real-time" detection, it is suitable to monitor the respiratory state in respiratory and critically ill patients in the development of a brain-ventilator interface.
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Affiliation(s)
- Anna L Hudson
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia;
| | - Xavier Navarro-Sune
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jacques Martinerie
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Pierre Pouget
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Mathieu Raux
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hopitaux de Paris (AP-HP), Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and
| | - Mario Chavez
- Centre National de la Recherche Scientifique UMR7225 at the Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, Université Pierre et Marie Curie, University of Paris 06, Institut National de la Santé et de la Recherche Médicale, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitie-Salpêtrière-Charles Foix, Service de Pneumologie et Réanimation Medicale, Paris, France
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15
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Morawiec E, Raux M, Kindler F, Laviolette L, Similowski T. Expiratory load compensation is associated with electroencephalographic premotor potentials in humans. J Appl Physiol (1985) 2015; 118:1023-30. [PMID: 25663669 DOI: 10.1152/japplphysiol.00201.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
In normal humans during quiet breathing, expiration is mostly driven by elastic recoil of the lungs. Expiration becomes active when ventilation must be increased to meet augmented metabolic demands, or in response to expiratory loading, be it experimental or disease-related. The response to expiratory loading is considered to be mediated by both reflex and cortical mechanisms, but the latter phenomenon have not been neurophysiologically characterized. We recorded the EEG in 20 healthy volunteers (9 men, 11 women, age: 22 to 50 yr) during unloaded breathing, voluntary expirations, and in response to 50 cmH2O·l(-1)·s expiratory resistive load (ERL), 20 cmH2O expiratory threshold load (high ETL), and 10 cmH2O expiratory threshold load (low ETL). EEGs were processed by ensemble averaging expiratory time-locked segments and examined for pre-expiratory potentials, defined as a slow negative shift from the baseline signal preceding expiration, and suggestive of cortical preparation of expiration involving the supplementary motor area. Four subjects were excluded because of technical EEG problems. Pre-expiratory potentials were present in one subject at baseline and in all subjects during voluntary expirations. They were present in eight subjects during low ETL, in 15 subjects during high ETL, and in 13 subjets during ERL (control vs. low ETL, P = 0.008; control vs. high ETL, P < 0.001; and control vs. ERL, P < 0.001). Respiratory discomfort was more intense in the presence of pre-expiratory potentials (P < 0.001). These results provide a neurophysiological substrate to a cortical component of the physiological response to experimental expiratory loads in humans.
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Affiliation(s)
- Elise Morawiec
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hópitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France
| | - Mathieu Raux
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Felix Kindler
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie-Réanimation, Paris, France; and Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Louis Laviolette
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Thomas Similowski
- Sorbonne Universités, Pierre and Marie Curie University, Univ Paris 06, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Institut National de la Santé et de la Recherche Médicale, UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique-Hópitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département R3S), Paris, France;
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16
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Sharman M, Gallea C, Lehongre K, Galanaud D, Nicolas N, Similowski T, Cohen L, Straus C, Naccache L. The cerebral cost of breathing: an FMRI case-study in congenital central hypoventilation syndrome. PLoS One 2014; 9:e107850. [PMID: 25268234 PMCID: PMC4182437 DOI: 10.1371/journal.pone.0107850] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/16/2014] [Indexed: 11/19/2022] Open
Abstract
Certain motor activities - like walking or breathing - present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks - including various frontal lobe areas - subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the “resting state” pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS), a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB), mechanical ventilation (MV) restored the default mode network (DMN) associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the active maintenance of cortical control over a continuous motor activity impacts on brain functioning and cognition.
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Affiliation(s)
- Mike Sharman
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
| | - Cécile Gallea
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, (CENIR), Paris, France
| | - Katia Lehongre
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
| | - Damien Galanaud
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, (CENIR), Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Department of Neuroradiology, Paris, France
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Nathalie Nicolas
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Centre d'Investigation Clinique 1421, Paris, France
| | - Thomas Similowski
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
| | - Laurent Cohen
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurology, Paris, France
| | - Christian Straus
- Université Pierre et Marie Curie-Paris 6, Faculté de Médecine Pitié-Salpêtrière, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche 1158 “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département “R3S”), Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Centre de Référence Maladies Rares “syndrome d'Ondine”, Paris, France
| | - Lionel Naccache
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institut du Cerveau et de la Moelle Epinière (ICM), Unité Mixte de Recherche 1127, PICNIC Lab, Paris, France
- Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau et de la Moelle Epinière (ICM), Unité 7225, PICNIC Lab, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié- Salpêtrière Charles Foix, Centre d'Investigation Clinique 1421, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurology, Paris, France
- Assistance Publique–Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Department of Neurophysiology, Paris, France
- * E-mail:
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Diaphragmatic neuromechanical coupling and mechanisms of hypercapnia during inspiratory loading. Respir Physiol Neurobiol 2014; 198:32-41. [DOI: 10.1016/j.resp.2014.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/25/2014] [Accepted: 03/12/2014] [Indexed: 12/26/2022]
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Tremoureux L, Raux M, Hudson AL, Ranohavimparany A, Straus C, Similowski T. Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake? PLoS One 2014; 9:e84534. [PMID: 24475031 PMCID: PMC3901646 DOI: 10.1371/journal.pone.0084534] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/15/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Congenital central hypoventilation syndrome (CCHS) is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area. METHODS We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2)) during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential) was considered suggestive of supplementary motor area activation. RESULTS In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected). In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls. CONCLUSIONS This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon. Whether or not this "cortical breathing" can be taken advantage of therapeutically, or has clinical consequences (like competition with attentional resources) remains to be determined.
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Affiliation(s)
| | - Mathieu Raux
- UMR_S1158, Inserm-Université Paris 6, Paris, France
- Département d'Anesthésie Réanimation—Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Anna L. Hudson
- UMR_S1158, Inserm-Université Paris 6, Paris, France
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | | | - Christian Straus
- UMR_S1158, Inserm-Université Paris 6, Paris, France
- Service Central des Explorations Fonctionelles Respiratoires de l'Exercice et de la Dyspnée—Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique—Hôpitaux de Paris, Paris, France
- Centre National de Référence Maladies Rares pour le syndrome d'Ondine (adultes)—Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Thomas Similowski
- UMR_S1158, Inserm-Université Paris 6, Paris, France
- Centre National de Référence Maladies Rares pour le syndrome d'Ondine (adultes)—Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique—Hôpitaux de Paris, Paris, France
- Service de Pneumologie et Réanimation Médicale—Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique—Hôpitaux de Paris, Paris, France
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Grave de Peralta R, Gonzalez Andino S, Perrig S. Patient machine interface for the control of mechanical ventilation devices. Brain Sci 2013; 3:1554-68. [PMID: 24961620 PMCID: PMC4061889 DOI: 10.3390/brainsci3041554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/12/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022] Open
Abstract
The potential of Brain Computer Interfaces (BCIs) to translate brain activity into commands to control external devices during mechanical ventilation (MV) remains largely unexplored. This is surprising since the amount of patients that might benefit from such assistance is considerably larger than the number of patients requiring BCI for motor control. Given the transient nature of MV (i.e., used mainly over night or during acute clinical conditions), precluding the use of invasive methods, and inspired by current research on BCIs, we argue that scalp recorded EEG (electroencephalography) signals can provide a non-invasive direct communication pathway between the brain and the ventilator. In this paper we propose a Patient Ventilator Interface (PVI) to control a ventilator during variable conscious states (i.e., wake, sleep, etc.). After a brief introduction on the neural control of breathing and the clinical conditions requiring the use of MV we discuss the conventional techniques used during MV. The schema of the PVI is presented followed by a description of the neural signals that can be used for the on-line control. To illustrate the full approach, we present data from a healthy subject, where the inspiration and expiration periods during voluntary breathing were discriminated with a 92% accuracy (10-fold cross-validation) from the scalp EEG data. The paper ends with a discussion on the advantages and obstacles that can be forecasted in this novel application of the concept of BCI.
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Affiliation(s)
| | | | - Stephen Perrig
- Geneva Sleep Lab, Department of Neuropsychiatry, Geneva University Hospital (HUG), Geneva 1225, Switzerland.
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Raux M, Tyvaert L, Ferreira M, Kindler F, Bardinet E, Karachi C, Morelot-Panzini C, Gotman J, Pike GB, Koski L, Similowski T. Functional magnetic resonance imaging suggests automatization of the cortical response to inspiratory threshold loading in humans. Respir Physiol Neurobiol 2013; 189:571-80. [PMID: 23994177 DOI: 10.1016/j.resp.2013.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 08/13/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
Inspiratory threshold loading (ITL) induces cortical activation. It is sustained over time and is resistant to distraction, suggesting automaticity. We hypothesized that ITL-induced changes in cerebral activation may differ between single-breath ITL and continuous ITL, with differences resembling those observed after cortical automatization of motor tasks. We analyzed the brain blood oxygen level dependent (BOLD) signal of 11 naive healthy volunteers during 5 min of random, single-breath ITL and 5 min of continuous ITL. Single-breath ITL increased BOLD in many areas (premotor cortices, bilateral insula, cerebellum, reticular formation of the lateral mesencephalon) and decreased BOLD in regions co-localizing with the default mode network. Continuous ITL induced signal changes in a limited number of areas (supplementary motor area). These differences are comparable to those observed before and after overlearning of motor tasks. We conclude that the respiratory-related cortical activation observed in response to ITL is likely due to automated, attention-independent mechanisms. Also, ITL activates cortical circuits right from the first breath.
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Affiliation(s)
- Mathieu Raux
- Department of Experimental Medicine, Transcranial Magnetic Stimulation Laboratory McGill University Health Centre, Montréal, QC, Canada; Université Paris 6, ER10UPMC Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Assistance Publique - Hôpitaux de Paris, Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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21
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Laviolette L, Niérat MC, Hudson AL, Raux M, Allard É, Similowski T. The supplementary motor area exerts a tonic excitatory influence on corticospinal projections to phrenic motoneurons in awake humans. PLoS One 2013; 8:e62258. [PMID: 23614046 PMCID: PMC3628339 DOI: 10.1371/journal.pone.0062258] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction In humans, cortical mechanisms can interfere with autonomic breathing. Respiratory-related activation of the supplementary motor area (SMA) has been documented during voluntary breathing and in response to inspiratory constraints. The SMA could therefore participate in the increased resting state of the respiratory motor system during wake (i.e. "wakefulness drive to breathe"). Methods The SMA was conditioned by continuous theta burst magnetic stimulation (cTBS, inhibitory) and 5 Hz conventional rTMS (5 Hz, excitatory). The ensuing effects were described in terms of the diaphragm motor evoked response (DiMEPs) to single-pulse transcranial magnetic stimulation over the motor cortex. DiMEPs were recorded at baseline, and at 3 time-points ("post1", "post2", "post3") up to 15 minutes following conditioning of the SMA. Results cTBS reduced the amplitude of DiMEPs from 327.5±159.8 µV at baseline to 243.3±118.7 µV, 217.8±102.9 µV and 240.6±123.9 µV at post 1, post 2 and post 3, respectively (F = 6.341, p = 0.002). 5 Hz conditioning increased the amplitude of DiMEPs from 184.7±96.5 µV at baseline to 270.7±135.4 µV at post 3 (F = 4.844, p = 0.009). Conclusions The corticospinal pathway to the diaphragm can be modulated in both directions by conditioning the SMA. This suggests that the baseline respiratory activity of the SMA represents an equipoise from which it is possible to move in either direction. The resting corticofugal outflow from the SMA to phrenic motoneurones that this study evidences could putatively contribute to the wakefulness drive to breathe.
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Affiliation(s)
| | | | - Anna L. Hudson
- Université Paris 6, ER10UPMC, Paris, France
- Neuroscience Research Australia and University of New South Wales, Sydney, Australia
| | | | | | - Thomas Similowski
- Université Paris 6, ER10UPMC, Paris, France
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Pneumologie et Réanimation Médicale, Paris, France
- * E-mail:
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Paulus MP. The breathing conundrum-interoceptive sensitivity and anxiety. Depress Anxiety 2013; 30:315-20. [PMID: 23468141 PMCID: PMC3805119 DOI: 10.1002/da.22076] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 01/11/2023] Open
Abstract
Cognitive and affective processing has been the central focus of brain-related functions in psychology and psychiatry for many years. Much less attention has been paid to what could be considered the primary function of the brain, to regulate the function of the body. Recent developments, which include the conceptualization of interoception as a process consisting of integrating the information coming from the inside of the body in the central nervous system and the appreciation that complex emotional processes are fundamentally affected by the processing and regulation of somatic states, have profoundly changed the view of the function and dysfunction of the brain. This review focuses on the relationship between breathing and anxiety. Several anxiety disorders have been associated with altered breathing, perception of breathing, and response to manipulations of breathing. Both clinical and experimental research studies are reviewed that relate breathing dysfunctions to anxiety. Altered breathing may be useful as a physiological marker of anxiety as well as a treatment target using interoceptive interventions.
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Affiliation(s)
- Martin P. Paulus
- University of California, San Diego
,San Diego Veterans Affairs Health Care System
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Jeran J, Koritnik B, Zidar I, Belič A, Zidar J. Sniffing-related motor cortical potential: topography and possible generators. Respir Physiol Neurobiol 2012; 185:249-56. [PMID: 23078972 DOI: 10.1016/j.resp.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 10/04/2012] [Accepted: 10/05/2012] [Indexed: 11/19/2022]
Abstract
This study estimated the whole-scalp topography and possible generators of the cortical potential associated with volitional self-paced inspirations (sniffs). In 17 healthy subjects we recorded a 32-channel electroencephalogram (EEG) during sniffing, for comparison during finger flexions. We averaged the EEG with respect to movement onset, and performed current source density and principal component analysis on the grand averaged data. We identified an early negative sniffing-related cortical potential starting ∼1.5s before movement at the vertex, which, in its time-course and dipole orientation, closely resembled Bereitshaftspotential preceding finger flexions. Around the movement onset, its topography became unique with three negative current sources: one at the vertex, and two bilaterally over the fronto-temporal derivations. We conclude that sequential cortical activation in preparation for sniffing is similar to other volitional movements. The current sources at sniff onset at the vertex likely reflect somatotopic motor representation of the diaphragm, neck and intercostal muscles, whereas current sources over fronto-temporal derivations likely reflect the somatotopic representation of the orofacial muscles.
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Affiliation(s)
- Judita Jeran
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia.
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Jutand L, Tremoureux L, Pichon A, Delpech N, Denjean A, Raux M, Straus C, Similowski T. Ventilatory response to exercise does not evidence electroencephalographical respiratory-related activation of the cortical premotor circuitry in healthy humans. Acta Physiol (Oxf) 2012; 205:356-62. [PMID: 22356255 DOI: 10.1111/j.1748-1716.2012.02427.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/10/2011] [Accepted: 02/12/2012] [Indexed: 11/26/2022]
Abstract
AIM The neural structures responsible for the coupling between ventilatory control and pulmonary gas exchange during exercise have not been fully identified. Suprapontine mechanisms have been hypothesized but not formally evidenced. Because the involvement of a premotor circuitry in the compensation of inspiratory mechanical loads has recently been described, we looked for its implication in exercise-induced hyperpnea. METHODS Electroencephalographical recordings were performed to identify inspiratory premotor potentials (iPPM) in eight physically fit normal men during cycling at 40 and 70% of their maximal oxygen consumption ((V)·O(2max) ). Relaxed pedalling (0 W) and voluntary sniff manoeuvres were used as negative and positive controls respectively. RESULTS Voluntary sniffs were consistently associated with iPPMs. This was also the case with voluntarily augmented breathing at rest (in three subjects tested). During the exercise protocol, no respiratory-related activity was observed whilst performing bouts of relaxed pedalling. Exercise-induced hyperpnea was also not associated with iPPMs, except in one subject. CONCLUSION We conclude that if there are cortical mechanisms involved in the ventilatory adaptation to exercise in physically fit humans, they are distinct from the premotor mechanisms activated by inspiratory load compensation.
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Affiliation(s)
| | | | - A. Pichon
- Université Paris 13; UFR SMBH, STAPS, UPRES EA 2363; Laboratoire Réponses Cellulaires et Fonctionnelles à l'Hypoxie; 74 rue Marcel Cachin; 93017; Bobigny; France
| | - N. Delpech
- Université de Poitiers; Laboratoire des Adaptations Physiologiques aux Activités Physiques; Faculté des Sciences du Sport; UPRES EA 3813; 4 Allée Jean Monnet; 86000; Poitiers; France
| | - A. Denjean
- Assistance Publique - Hôpitaux de Paris; Hôpital Robert Debré; Service de physiologie, Explorations Fonctionnelles; 75019; Paris; France
| | | | | | - T. Similowski
- Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Service de Pneumologie et Réanimation; 75013; Paris; France
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Bizovičar N, Zidar I, Koritnik B, Zidar J. Inspiratory- and finger-flexion-related cortical potentials in patients with amyotrophic lateral sclerosis – An exploratory study. Clin Neurol Neurosurg 2012; 114:455-9. [DOI: 10.1016/j.clineuro.2012.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/13/2012] [Accepted: 02/21/2012] [Indexed: 12/11/2022]
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Hill K, Eastwood P. Effects of loading on upper airway and respiratory pump muscle motoneurons. Respir Physiol Neurobiol 2011; 179:64-70. [DOI: 10.1016/j.resp.2011.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
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La dyspnée, symptôme cardinal pour le pneumologue. Rev Mal Respir 2011; 28:393-4. [DOI: 10.1016/j.rmr.2011.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 11/18/2022]
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