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Valentin R, Niérat M, Wattiez N, Jacq O, Decavèle M, Arnulf I, Similowski T, Attali V. Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients. Physiol Rep 2024; 12:e15951. [PMID: 38373738 PMCID: PMC10984610 DOI: 10.14814/phy2.15951] [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: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Patients with obstructive sleep apneas (OSA) do not complain from dyspnea during resting breathing. Placement of a mandibular advancement device (MAD) can lead to a sense of improved respiratory comfort ("pseudo-relief") ascribed to a habituation phenomenon. To substantiate this conjecture, we hypothesized that, in non-dyspneic awake OSA patients, respiratory-related electroencephalographic figures, abnormally present during awake resting breathing, would disappear or change in parallel with MAD-associated pseudo-relief. In 20 patients, we compared natural breathing and breathing with MAD on: breathing discomfort (transitional visual analog scale, VAS-2); upper airway mechanics, assessed in terms of pressure peak/time to peak (TTP) ratio respiratory-related electroencephalography (EEG) signatures, including slow event-related preinspiratory potentials; and a between-state discrimination based on continuous connectivity evaluation. MAD improved breathing and upper airway mechanics. The 8 patients in whom the EEG between-state discrimination was considered effective exhibited higher Peak/TTP improvement and transitional VAS ratings while wearing MAD than the 12 patients where it was not. These results support the notion of habituation to abnormal respiratory-related afferents in OSA patients and fuel the causative nature of the relationship between dyspnea, respiratory-related motor cortical activity and impaired upper airway mechanics in this setting.
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Affiliation(s)
- Rémi Valentin
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
| | - Marie‐Cécile Niérat
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Nicolas Wattiez
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Olivier Jacq
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Maxens Decavèle
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Service de Médecine Intensive et Réanimation (Département R3S)Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
| | - Isabelle Arnulf
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Paris Brain Institute (ICM)Sorbonne UniversitéParisFrance
| | - Thomas Similowski
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital, Pitié‐Salpêtrière, Département R3SAP‐HP, Groupe Hospitalier APHP‐Sorbonne UniversitéParisFrance
| | - Valérie Attali
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
- Hôpital Pitié‐Salpêtrière, Département R3S, Service des Pathologies du Sommeil (Département R3S)AP‐HP, Groupe Hospitalier Universitaire APHP‐Sorbonne UniversitéParisFrance
- Institut de Biomécanique Humaine Georges CharpakÉcole Nationale Supérieure des Arts et MétiersParisFrance
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Bogaerts K, Walentynowicz M, Van Den Houte M, Constantinou E, Van den Bergh O. The Interoceptive Sensitivity and Attention Questionnaire: Evaluating Aspects of Self-Reported Interoception in Patients With Persistent Somatic Symptoms, Stress-Related Syndromes, and Healthy Controls. Psychosom Med 2022; 84:251-260. [PMID: 34840287 DOI: 10.1097/psy.0000000000001038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to validate the Interoceptive Sensitivity and Attention Questionnaire (ISAQ), a 17-item self-report measure assessing sensitivity and attention to interoceptive signals. METHODS In study 1, exploratory and confirmatory factor analysis was performed in a student convenience sample (n = 1868). In study 2, ISAQ data of a healthy sample (n = 144) and various patient groups experiencing stress-related syndromes (overstrain, n = 63; burnout, n = 37; panic disorder [PD]. n = 60) and/or persistent somatic symptoms in daily life (irritable bowel syndrome, n = 38; fibromyalgia and/or chronic fatigue syndrome, n = 151; medically unexplained dyspnea [MUD], n = 29) were compared. RESULTS Three subscales were revealed: (F1) sensitivity to neutral bodily sensations, (F2) attention to unpleasant bodily sensations, and (F3) difficulty disengaging from unpleasant bodily sensations. Overall, patients with fibromyalgia and/or chronic fatigue syndrome and patients with MUD scored significantly higher on F1 (p = .009 and p = .027, respectively) and F2 (p = .002 and p < .001, respectively) than healthy controls. Patients with PD had higher scores on subscales F2 (p < .001) and F3 (p < .001) compared with healthy controls, as well as higher scores on F2 compared with all other patient groups (pPD versus MUD = .008; all other p values < .001). CONCLUSIONS Interoceptive sensibility-the self-reported aspect of interoception-is not a homogeneous or unitary construct. The subscales of the ISAQ differentiate healthy controls from patients with persistent somatic and/or stress-related complaints in daily life and distinguish different patient groups. The ISAQ can be used as a concise, reliable, and clinically relevant research tool to further disentangle adaptive and maladaptive aspects of interoceptive ability.
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Affiliation(s)
- Katleen Bogaerts
- From the Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences (Bogaerts, Van Den Houte), Hasselt University, Diepenbeek; Health Psychology, Faculty of Psychology and Educational Sciences (Bogaerts, Van den Bergh), University of Leuven, Leuven; Clinical and Health Psychology (Walentynowicz), Université Catholique de Louvain, Louvain-La-Neuve; Centre for the Psychology of Learning and Experimental Psychopathology (Walentynowicz) and Laboratory for Brain-Gut Axis Studies (LABGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine (Van Den Houte), University of Leuven, Leuven, Belgium; and Department of Psychology (Constantinou), University of Cyprus, Nicosia, Cyprus
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Perceptual sensitivity to sensory and affective aspects of dyspnea: Test-retest reliability and effects of fear of suffocation. Biol Psychol 2022; 169:108268. [DOI: 10.1016/j.biopsycho.2022.108268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 12/24/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
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A multidimensional assessment of dyspnoea in healthy adults during exercise. Eur J Appl Physiol 2020; 120:2533-2545. [DOI: 10.1007/s00421-020-04479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
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Becker S, Bräscher AK, Bannister S, Bensafi M, Calma-Birling D, Chan RCK, Eerola T, Ellingsen DM, Ferdenzi C, Hanson JL, Joffily M, Lidhar NK, Lowe LJ, Martin LJ, Musser ED, Noll-Hussong M, Olino TM, Pintos Lobo R, Wang Y. The role of hedonics in the Human Affectome. Neurosci Biobehav Rev 2019; 102:221-241. [PMID: 31071361 PMCID: PMC6931259 DOI: 10.1016/j.neubiorev.2019.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 01/06/2023]
Abstract
Experiencing pleasure and displeasure is a fundamental part of life. Hedonics guide behavior, affect decision-making, induce learning, and much more. As the positive and negative valence of feelings, hedonics are core processes that accompany emotion, motivation, and bodily states. Here, the affective neuroscience of pleasure and displeasure that has largely focused on the investigation of reward and pain processing, is reviewed. We describe the neurobiological systems of hedonics and factors that modulate hedonic experiences (e.g., cognition, learning, sensory input). Further, we review maladaptive and adaptive pleasure and displeasure functions in mental disorders and well-being, as well as the experience of aesthetics. As a centerpiece of the Human Affectome Project, language used to express pleasure and displeasure was also analyzed, and showed that most of these analyzed words overlap with expressions of emotions, actions, and bodily states. Our review shows that hedonics are typically investigated as processes that accompany other functions, but the mechanisms of hedonics (as core processes) have not been fully elucidated.
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Affiliation(s)
- Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany.
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Destany Calma-Birling
- Department of Psychology, University of Wisconsin-Oshkosh, 800 Algoma, Blvd., Clow F011, Oshkosh, WI 54901, USA.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3, Durham, UK.
| | - Dan-Mikael Ellingsen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY149-2301, 13th St, Charlestown, MA 02129, USA.
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France.
| | - Jamie L Hanson
- University of Pittsburgh, Department of Psychology, 3939 O'Hara Street, Rm. 715, Pittsburgh, PA 15206, USA.
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130, Écully, France.
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Leroy J Lowe
- Neuroqualia (NGO), 36 Arthur Street, Truro, NS, B2N 1X5, Canada.
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada.
| | - Erica D Musser
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Michael Noll-Hussong
- Clinic for Psychiatry and Psychotherapy, Division of Psychosomatic Medicine and Psychotherapy, Saarland University Medical Centre, Kirrberger Strasse 100, D-66421 Homburg, Germany.
| | - Thomas M Olino
- Temple University, Department of Psychology, 1701N. 13th St, Philadelphia, PA 19010, USA.
| | - Rosario Pintos Lobo
- Department of Psychology, Center for Childen and Families, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA.
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Sucec J, Herzog M, Van den Bergh O, Van Diest I, von Leupoldt A. The Effects of Repeated Dyspnea Exposure on Response Inhibition. Front Physiol 2019; 10:663. [PMID: 31191355 PMCID: PMC6546958 DOI: 10.3389/fphys.2019.00663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/09/2019] [Indexed: 01/03/2023] Open
Abstract
In order to treat dyspnea (=breathlessness) successfully, response inhibition (RI) as a major form of self-regulation is a premise. This is supported by research showing that self-regulation is associated with beneficial behavioral changes supporting treatment success in patients. Recent research showed that dyspnea has an impairing effect on RI, but the effects of repeated dyspnea exposure on RI remain unknown. Therefore, the present study tested the effects of repeated resistive load-induced dyspnea on RI over a 5-day period. Healthy volunteers (n = 34) performed the standard version of the Stroop task during baseline and dyspnea conditions on the first and fifth testing day and underwent an additional dyspnea exposure phase on each testing day. Variables of interest to investigate RI were reaction time, accuracy as well as the event-related potentials late positive complex (LPC) and N400 in the electroencephalogram. Reduced accuracy for incongruent compared to congruent stimuli during the dyspnea condition on the first testing day were found (p < 0.001). This was paralleled by a reduced LPC and an increased N400 for incongruent stimuli during the induction of dyspnea (p < 0.05). After undergoing dyspnea exposure, habituation of dyspnea intensity was evident. Importantly, on the fifth testing day, no differences between baseline, and dyspnea conditions were found for behavioral and electrophysiological measures of RI. These findings demonstrate that the impairing effect of dyspnea on RI disappeared after repeated dyspnea exposure in healthy participants. Translated to a clinical sample, it might cautiously be suggested that dyspnea exposure such as dyspnea perceived during physical exercise could reduce the impairing effect of dyspnea on RI which might have the potential to help increase self-regulation abilities and subsequent treatment efforts in dyspneic patients.
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Affiliation(s)
- Josef Sucec
- Health Psychology, University of Leuven, Leuven, Belgium
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Tan Y, Van den Bergh O, Qiu J, von Leupoldt A. The Impact of Unpredictability on Dyspnea Perception, Anxiety and Interoceptive Error Processing. Front Physiol 2019; 10:535. [PMID: 31130876 PMCID: PMC6509155 DOI: 10.3389/fphys.2019.00535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/15/2019] [Indexed: 12/18/2022] Open
Abstract
Dyspnea is a prevalent interoceptive sensation and the aversive cardinal symptom in many cardiorespiratory diseases as well as in mental disorders. Especially the unpredictability of the occurrence of dyspnea episodes has been suggested to be highly anxiety provoking for affected patients. Moreover, previous studies demonstrated that unpredictable exteroceptive stimuli increased self-reports and electrophysiological responses of anxiety such as the startle probe N100 as well as amplified the processing of errors as reflected by greater error-related negativity (ERN). However, studies directly examining the role of unpredictability on dyspnea perception, anxiety, and error processing are widely absent. Using high-density electroencephalography, the present study investigated whether unpredictable compared to predictable dyspnea would increase the perception of dyspnea, anxiety and interoceptive error processing. Thirty-two healthy participants performed a respiratory forced choice reaction time task to elicit an interoceptive ERN during two conditions: an unpredictable and a predictable resistive load-induced dyspnea condition. Predictability was manipulated by pairing (predictable condition) or not pairing (unpredictable condition) dyspnea with a startle tone probe. Self-reports of dyspnea and affective state as well as the startle probe N100 and interoceptive ERN were measured. The results demonstrated greater dyspnea unpleasantness in the unpredictable compared to the predictable condition. Post hoc analyses revealed that this was paralleled by greater anxiety, and greater amplitudes for the startle probe N100 and the interoceptive ERN during the unpredictable relative to the predictable condition, but only when the unpredictable condition was experienced in the first experimental block. Furthermore, higher trait-like anxiety sensitivity was associated with higher ratings for dyspnea unpleasantness and experimental state anxiety ratings. The present findings suggest that unpredictability increases the perception of dyspnea unpleasantness. This effect seems related to increased state and trait anxiety and interoceptive error processing, especially when upcoming dyspnea is particularly unpredictable, such as in early experimental phases. Future studies are required to further substantiate these findings in patients suffering from dyspnea.
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Affiliation(s)
- Yafei Tan
- Faculty of Psychology, Southwest University, Chongqing, China
- Health Psychology, KU Leuven, Leuven, Belgium
| | | | - Jiang Qiu
- Faculty of Psychology, Southwest University, Chongqing, China
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Attali V, Collet JM, Jacq O, Souchet S, Arnulf I, Rivals I, Kerbrat JB, Goudot P, Morelot-Panzini C, Similowski T. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respir Physiol Neurobiol 2019; 263:47-54. [PMID: 30872167 DOI: 10.1016/j.resp.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD). Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD. None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p = 0.007). MAD-induced change in awake Pcrit was correlated to VAS-3. In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.
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Affiliation(s)
- Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France.
| | - Olivier Jacq
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Sandie Souchet
- Université Paris I - Panthéon-Sorbonne, laboratoire SAMM (Statistique, Analyse, Modélisation Multidisciplinaire -EA4543), F-75005, Paris, France.
| | - Isabelle Arnulf
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), F-75013, Paris, France.
| | - Isabelle Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University F-75005, Paris, France.
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Patrick Goudot
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, F-75013, Paris, France; Sorbonne Université, UMR, 8256 B2A, F-75005, Paris, France.
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département "R3S"), F-75013, Paris, France.
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Walentynowicz M, Bogaerts K, Stans L, Van Diest I, Raes F, Van den Bergh O. Retrospective memory for symptoms in patients with medically unexplained symptoms. J Psychosom Res 2018; 105:37-44. [PMID: 29332632 DOI: 10.1016/j.jpsychores.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/19/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Clinical assessment and diagnostic processes heavily rely on memory-based symptom reports. The current study investigated memory for symptoms and the peak-end effect for dyspnea in patients with medically unexplained symptoms and healthy participants. METHODS Female patients with medically unexplained dyspnea (MUD) (n=22) and matched healthy controls (n=22) participated in two dyspnea induction trials (short, long). Dyspnea ratings were collected: (1) continuously during symptom induction (concurrent with respiratory measures), (2) immediately after the experiment, and (3) after 2weeks. Symptoms, negative affect, and anxiety were assessed at baseline and after every trial. The mediating role of state anxiety in symptom reporting was assessed. The peak-end effect was tested with forced-choice questions measuring relative preference for the trials. RESULTS Compared to controls, dyspnea induction resulted in higher levels of symptoms, anxiety, concurrent dyspnea ratings, and minute ventilation in the patient group. In both groups, immediate retrospective ratings were higher than averaged concurrent ratings. No further increase in dyspnea ratings was observed at 2-week recall. Retrospective dyspnea ratings were mediated by both state anxiety and concurrent dyspnea ratings. Patients did not show a peak-end effect, whereas controls did. CONCLUSION The findings show that patients' experience of a dyspneic episode is subject to immediate memory bias, but does not change over a longer time period. The results also highlight the importance of affective state during symptom experience for both symptom perception and memory.
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Affiliation(s)
- Marta Walentynowicz
- USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, USA; Health Psychology, University of Leuven, Leuven, Belgium
| | - Katleen Bogaerts
- Health Psychology, University of Leuven, Leuven, Belgium; REVAL - Rehabilitation Research Center, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Linda Stans
- Pulmonary Department, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Health Psychology, University of Leuven, Leuven, Belgium
| | - Filip Raes
- Learning Psychology and Experimental Psychopathology, University of Leuven, Leuven, Belgium
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Reilly CC, Jolley CJ, Elston C, Moxham J, Rafferty GF. Blunted perception of neural respiratory drive and breathlessness in patients with cystic fibrosis. ERJ Open Res 2016; 2:00057-2015. [PMID: 27730171 PMCID: PMC5005154 DOI: 10.1183/23120541.00057-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/17/2016] [Indexed: 12/16/2022] Open
Abstract
The electromyogram recorded from the diaphragm (EMGdi) and parasternal intercostal muscle using surface electrodes (sEMGpara) provides a measure of neural respiratory drive (NRD), the magnitude of which reflects lung disease severity in stable cystic fibrosis. The aim of this study was to explore perception of NRD and breathlessness in both healthy individuals and patients with cystic fibrosis. Given chronic respiratory loading and increased NRD in cystic fibrosis, often in the absence of breathlessness at rest, we hypothesised that patients with cystic fibrosis would be able to tolerate higher levels of NRD for a given level of breathlessness compared to healthy individuals during exercise. 15 cystic fibrosis patients (mean forced expiratory volume in 1 s (FEV1) 53.5% predicted) and 15 age-matched, healthy controls were studied. Spirometry was measured in all subjects and lung volumes measured in the cystic fibrosis patients. EMGdi and sEMGpara were recorded at rest and during incremental cycle exercise to exhaustion and expressed as a percentage of maximum (% max) obtained from maximum respiratory manoeuvres. Borg breathlessness scores were recorded at rest and during each minute of exercise. EMGdi % max and sEMGpara % max and associated Borg breathlessness scores differed significantly between healthy subjects and cystic fibrosis patients at rest and during exercise. The relationship between EMGdi % max and sEMGpara % max and Borg score was shifted to the right in the cystic fibrosis patients, such that at comparable levels of EMGdi % max and sEMGpara % max the cystic fibrosis patients reported significantly lower Borg breathlessness scores compared to the healthy individuals. At Borg score 1 (clinically significant increase in breathlessness from baseline) corresponding levels of EMGdi % max (20.2±12% versus 32.15±15%, p=0.02) and sEMGpara % max (18.9±8% versus 29.2±15%, p=0.04) were lower in the healthy individuals compared to the cystic fibrosis patients. In the cystic fibrosis patients EMGdi % max at Borg score 1 was related to the degree of airways obstruction (FEV1) (r=−0.664, p=0.007) and hyperinflation (residual volume/total lung capacity) (r=0.710, p=0.03). This relationship was not observed for sEMGpara % max. These data suggest that compared to healthy individuals, patients with cystic fibrosis can tolerate much higher levels of NRD before increases in breathlessness from baseline become clinically significant. EMGdi % max and sEMGpara % max provide physiological tools with which to elucidate factors underlying inter-individual differences in breathlessness perception. Patients with CF can tolerate higher levels of NRD before breathlessness becomes clinically significanthttp://ow.ly/Xp2q3
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Affiliation(s)
- Charles C Reilly
- King's College London, Faculty of Life Sciences and Medicine, London, UK; King's College Hospital, Physiotherapy, London, UK
| | - Caroline J Jolley
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | | | - John Moxham
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Gerrard F Rafferty
- King's College London, Faculty of Life Sciences and Medicine, London, UK
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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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Subjective evaluation of experimental dyspnoea--effects of isocapnia and repeated exposure. Respir Physiol Neurobiol 2015; 208:21-8. [PMID: 25578628 PMCID: PMC4347539 DOI: 10.1016/j.resp.2014.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/22/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
Resistive respiratory loading is an established stimulus for the induction of experimental dyspnoea. In comparison to unloaded breathing, resistive loaded breathing alters end-tidal CO2 (P(ET)CO2), which has independent physiological effects (e.g. upon cerebral blood flow). We investigated the subjective effects of resistive loaded breathing with stabilized P(ET)CO2 (isocapnia) during manual control of inspired gases on varying baseline levels of mild hypercapnia (increased P(ET)CO2). Furthermore, to investigate whether perceptual habituation to dyspnoea stimuli occurs, the study was repeated over four experimental sessions. Isocapnic hypercapnia did not affect dyspnoea unpleasantness during resistive loading. A post hoc analysis revealed a small increase of respiratory unpleasantness during unloaded breathing at +0.6 kPa, the level that reliably induced isocapnia. We did not observe perceptual habituation over the four sessions. We conclude that isocapnic respiratory loading allows stable induction of respiratory unpleasantness, making it a good stimulus for multi-session studies of dyspnoea.
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Geriatric dyspnea: doing worse, feeling better. Ageing Res Rev 2014; 15:94-9. [PMID: 24675044 DOI: 10.1016/j.arr.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 01/03/2023]
Abstract
Older age is associated with a decline in physical fitness and reduced efficiency of the respiratory system. Paradoxically, it is also related to reduced report of dyspnea, that is, the experience of difficult and uncomfortable breathing. Reduced symptom reporting contributes to misdiagnosis or late diagnosis of underlying disease, suboptimal treatment, faster disease progression, shorter life expectancy, lower quality of life for patients, and considerably increased costs for the health care system in an aging society. However, pathways in the complex relationship between dyspnea and age are not well explored yet. We propose a model on geriatric dyspnea that integrates physiological, neurological, psychological and social pathways which link older age with dyspnea perception and expression. We suggest that the seemingly paradox of reduction of dyspnea in older age, despite physiological decline, can be solved by taking age-related changes on these multiple levels into account. In identifying these variables, the Geriatric Dyspnea Model highlights risk factors for reduced dyspnea perception and report in older age and pathways for intervention.
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Currow DC, Ekstrom M, Abernethy AP. Opioids for Chronic Refractory Breathlessness: Right Patient, Right Route? Drugs 2013; 74:1-6. [DOI: 10.1007/s40265-013-0162-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Parshall MB, Meek PM, Sklar D, Alcock J, Bittner P. Test-retest reliability of multidimensional dyspnea profile recall ratings in the emergency department: a prospective, longitudinal study. BMC Emerg Med 2012; 12:6. [PMID: 22624887 PMCID: PMC3464619 DOI: 10.1186/1471-227x-12-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/24/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Dyspnea is among the most common reasons for emergency department (ED) visits by patients with cardiopulmonary disease who are commonly asked to recall the symptoms that prompted them to come to the ED. The reliability of recalled dyspnea has not been systematically investigated in ED patients. METHODS Patients with chronic or acute cardiopulmonary conditions who came to the ED with dyspnea (N = 154) completed the Multidimensional Dyspnea Profile (MDP) several times during the visit and in a follow-up visit 4 to 6 weeks later (n = 68). The MDP has 12 items with numerical ratings of intensity, unpleasantness, sensory qualities, and emotions associated with how breathing felt when participants decided to come to the ED (recall MDP) or at the time of administration ("now" MDP). The recall MDP was administered twice in the ED and once during the follow-up visit. Principal components analysis (PCA) with varimax rotation was used to assess domain structure of the recall MDP. Internal consistency reliability was assessed with Cronbach's alpha. Test-retest reliability was assessed with intraclass correlation coefficients (ICCs) for absolute agreement for individual items and domains. RESULTS PCA of the recall MDP was consistent with two domains (Immediate Perception, 7 items, Cronbach's alpha = .89 to .94; Emotional Response, 5 items; Cronbach's alpha = .81 to .85). Test-retest ICCs for the recall MDP during the ED visit ranged from .70 to .87 for individual items and were .93 and .94 for the Immediate Perception and Emotional Response domains. ICCs were much lower for the interval between the ED visit and follow-up, both for individual items (.28 to .66) and for the Immediate Perception and Emotional Response domains (.72 and .78, respectively). CONCLUSIONS During an ED visit, recall MDP ratings of dyspnea at the time participants decided to seek care in the ED are reliable and sufficiently stable, both for individual items and the two domains, that a time lag between arrival and questionnaire administration does not critically affect recall of perceptual and emotional characteristics immediately prior to the visit. However, test-retest reliability of recall over a 4- to 6-week interval is poor for individual items and significantly attenuated for the two domains.
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Wan L, Stans L, Bogaerts K, Decramer M, Van den Bergh O. Sensitization in Medically Unexplained Dyspnea. Chest 2012; 141:989-995. [DOI: 10.1378/chest.11-1423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O'Donnell DE. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012; 185:435-52. [PMID: 22336677 PMCID: PMC5448624 DOI: 10.1164/rccm.201111-2042st] [Citation(s) in RCA: 1095] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. PURPOSE The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. METHODS An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. RESULTS Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. CONCLUSIONS Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
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Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O'Donnell DE. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012. [PMID: 22336677 DOI: 10.1164/rccm.201111–2042st] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. PURPOSE The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. METHODS An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. RESULTS Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. CONCLUSIONS Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
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Janssens T, Verleden G, De Peuter S, Petersen S, Van den Bergh O. The influence of fear of symptoms and perceived control on asthma symptom perception. J Psychosom Res 2011; 71:154-9. [PMID: 21843750 DOI: 10.1016/j.jpsychores.2011.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/06/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-reported asthma symptoms correlate only modestly with measures of underlying pathophysiological mechanisms. In this study, we investigated the role of fear of symptoms and perceived control on respiratory symptom perception in patients with asthma. METHODS Patients with intermittent to moderate persistent asthma (N=32) were administered 4 subsequent rebreathing challenges (one using 100% O(2) and three using 5% CO(2) and 95% O(2)). We manipulated perceived control by providing information on the availability/unavailability of rescue medication during the challenges (perceived control/no control condition). Perceived symptoms and lung function were assessed after each rebreathing challenge. RESULTS Persons with low fear of symptoms reported respiratory symptoms to be less unpleasant during the perceived control condition compared to the no control condition. The reverse was found for persons with high fear of symptoms. The interaction between fear of symptoms and the control manipulations was mediated by threat perception. CONCLUSION Messages intended to increase perceived control over symptoms may actually increase threat in persons with high fear of symptoms and eventually increase unpleasantness of respiratory sensations. This finding underlines the importance of affective processes in the perception of asthma symptoms and shows that instructions to patients should take pre-existing fear levels into account.
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Affiliation(s)
- Thomas Janssens
- Research Group on Health Psychology, Department of Psychology, University of Leuven, Belgium
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von Leupoldt A, Brassen S, Baumann HJ, Klose H, Büchel C. Structural brain changes related to disease duration in patients with asthma. PLoS One 2011; 6:e23739. [PMID: 21886820 PMCID: PMC3158798 DOI: 10.1371/journal.pone.0023739] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/24/2011] [Indexed: 01/08/2023] Open
Abstract
Dyspnea is the impairing, cardinal symptom patients with asthma repeatedly experience over the course of the disease. However, its accurate perception is also crucial for timely initiation of treatment. Reduced perception of dyspnea is associated with negative treatment outcome, but the underlying brain mechanisms of perceived dyspnea in patients with asthma remain poorly understood. We examined whether increasing disease duration in fourteen patients with mild-to-moderate asthma is related to structural brain changes in the insular cortex and brainstem periaqueductal grey (PAG). In addition, the association between structural brain changes and perceived dyspnea were studied. By using magnetic resonance imaging in combination with voxel-based morphometry, gray matter volumes of the insular cortex and the PAG were analysed and correlated with asthma duration and perceived affective unpleasantness of resistive load induced dyspnea. Whereas no associations were observed for the insular cortex, longer duration of asthma was associated with increased gray matter volume in the PAG. Moreover, increased PAG gray matter volume was related to reduced ratings of dyspnea unpleasantness. Our results demonstrate that increasing disease duration is associated with increased gray matter volume in the brainstem PAG in patients with mild-to-moderate asthma. This structural brain change might contribute to the reduced perception of dyspnea in some patients with asthma and negatively impact the treatment outcome.
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Borkowski AH, Barnes DC, Blanchette DR, Castellanos FX, Klein DF, Wilson DA. Interaction between δ opioid receptors and benzodiazepines in CO₂-induced respiratory responses in mice. Brain Res 2011; 1396:54-9. [PMID: 21561601 DOI: 10.1016/j.brainres.2011.04.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 01/07/2023]
Abstract
The false-suffocation hypothesis of panic disorder (Klein, 1993) suggested δ-opioid receptors as a possible source of the respiratory dysfunction manifested in panic attacks occurring in panic disorder (Preter and Klein, 2008). This study sought to determine if a lack of δ-opioid receptors in a mouse model affects respiratory response to elevated CO₂, and whether the response is modulated by benzodiazepines, which are widely used to treat panic disorder. In a whole-body plethysmograph, respiratory responses to 5% CO₂ were compared between δ-opioid receptor knockout mice and wild-type mice after saline, diazepam (1mg/kg), and alprazolam (0.3mg/kg) injections. The results show that lack of δ-opioid receptors does not affect normal response to elevated CO₂, but does prevent benzodiazepines from modulating that response. Thus, in the presence of benzodiazepine agonists, respiratory responses to elevated CO₂ were enhanced in δ-opioid receptor knockout mice compared to wild-type mice. This suggests an interplay between benzodiazepine receptors and δ-opioid receptors in regulating the respiratory effects of elevated CO₂, which might be related to CO₂ induced panic.
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Affiliation(s)
- Anne H Borkowski
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Gifford AH, Mahler DA, Waterman LA, Ward J, Kraemer WJ, Kupchak BR, Baird JC. Neuromodulatory effect of endogenous opioids on the intensity and unpleasantness of breathlessness during resistive load breathing in COPD. COPD 2011; 8:160-6. [PMID: 21513438 DOI: 10.3109/15412555.2011.560132] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Endogenous opioids are naturally occurring peptides released by the brain in response to noxious stimuli. Although these naturally occurring peptides modulate pain, it is unknown whether endogenous opioids affect the perception of breathlessness associated with a specific respiratory challenge. The hypothesis is that intravenous administration of naloxone, used to block opioid signaling and inhibit neural pathways, will increase ratings of breathlessness during resistive load breathing (RLB) in patients with chronic obstructive pulmonary disease (COPD). METHODS Fourteen patients with COPD (age, 64 ± 9 years) inspired through resistances during practice sessions to identify an individualized target load that caused ratings of intensity and/or unpleasantness of breathlessness ≥ 50 mm on a 100 mm visual analog scale. At two intervention visits, serum beta-endorphins were measured, naloxone (10 mg/25 ml) or normal saline (25 ml) was administered intravenously, and patients rated the two dimensions of breathlessness each minute during RLB. RESULTS Patient ratings of intensity (p = 0.0004) and unpleasantness (p = 0.024) of breathlessness were higher with naloxone compared with normal saline. Eleven patients (79%) reported that it was easier to breathe during RLB with normal saline (p = 0.025). RLB led to significant increases in serum beta-endorphin immunoreactivity and decreases in inspiratory capacity. There were no significant differences in physiological responses between interventions. CONCLUSIONS Endogenous opioids modulate the intensity and the unpleasantness of breathlessness in patients with COPD. Differences in breathlessness ratings between interventions were clinically relevant based on the patients' global assessment.
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Affiliation(s)
- Alex H Gifford
- Section of Pulmonary & Critical Care Medicine, Dartmouth Medical School, Lebanon, New Hampshire 03756-0001, USA
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von Leupoldt A, Vovk A, Bradley MM, Lang PJ, Davenport PW. Habituation in neural processing and subjective perception of respiratory sensations. Psychophysiology 2010; 48:808-12. [PMID: 21039587 DOI: 10.1111/j.1469-8986.2010.01141.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Reduced perception of respiratory sensations is associated with negative treatment outcome in asthma. We examined whether habituation in the neural processing of repeatedly experienced respiratory sensations may underlie subjective reports of reduced respiratory perception. Respiratory-related evoked potentials (RREP) elicited by inspiratory occlusions and reports of respiratory perception were compared between early and late experimental periods in healthy subjects. Reports of respiratory perception were reduced during late, compared to early, experimental periods. This was paralleled by reduced magnitudes in RREP components N1, P2, and P3 in late, compared to early, experimental periods. Habituation in the neural processing of respiratory sensations is a potential mechanism that underlies subjective reports of reduced respiratory perception and might represent a risk factor for reduced perception of respiratory sensations in asthma.
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Affiliation(s)
- Andreas von Leupoldt
- Department of Physiological Sciences, University of Florida, Gainesville, Florida, USA.
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De Peuter S, Van den Bergh O, Vlaeyen JW. Breathtaking! About the comparison of the subjective sensations of pain and dyspnea. Pain 2010; 149:411-412. [PMID: 20363076 DOI: 10.1016/j.pain.2010.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 03/16/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Steven De Peuter
- Research Group Health Psychology, Department of Psychology, University of Leuven, Tiensestraat 102, Box 3726, B-3000 Leuven, Belgium Research Group Health Psychology, Department of Psychology, University of Leuven, Tiensestraat 102, Box 3726, B-3000 Leuven, Belgium Department of Clinical Psychological Science, Maastricht University, Netherlands
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von Leupoldt A, Sommer T, Kegat S, Eippert F, Baumann HJ, Klose H, Dahme B, Büchel C. Down-regulation of insular cortex responses to dyspnea and pain in asthma. Am J Respir Crit Care Med 2009; 180:232-8. [PMID: 19483110 DOI: 10.1164/rccm.200902-0300oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Dyspnea is the impairing cardinal symptom of asthma but its accurate perception is also crucial for timely initiation of treatment. However, the underlying brain mechanisms of perceived dyspnea in patients with asthma are unknown. OBJECTIVES To study brain mechanisms of dyspnea in asthma. METHODS By using functional magnetic resonance imaging we compared the neuronal responses to experimentally induced dyspnea in patients with asthma and healthy controls. These brain activations were compared with neuronal responses evoked by pain to study neuronal generalization processes to another, similarly unpleasant, physiological sensation. MEASUREMENTS AND MAIN RESULTS While lying in the scanner, fourteen patients with mild-to-moderate asthma and fourteen matched healthy controls repeatedly underwent conditions of mild dyspnea, severe dyspnea, mild pain and severe pain. Dyspnea was induced by resistive loaded breathing. Heat pain of similar intensity was induced by a contact thermode. Whereas the sensory intensity of both sensations was rated similar by patients and controls, ratings of the affective unpleasantness of dyspnea and pain were reduced in patients. This perceptual difference was mirrored by reduced insular cortex activity, but increased activity in the periaqueductal gray (PAG) in patients during both increased dyspnea and pain. Connectivity analyses showed that asthma-specific down-regulation of the insular cortex during dyspnea and pain was moderated by increased PAG activity. CONCLUSIONS The results suggest a down-regulation of affect-related insular cortex activity by the PAG during perceived dyspnea and pain in patients with asthma. This might represent a neuronal habituation mechanism reducing the affective unpleasantness of dyspnea in asthma, which generalizes to other unpleasant physiological sensations such as pain.
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