The Unpleasantness of Perceived Dyspnea Is Processed in the Anterior Insula and Amygdala
Abstract
Rationale: The subjective perception of dyspnea, which is an impairing symptom in various cardiopulmonary diseases, consists of sensory (intensity) and affective aspects (unpleasantness). However, little is known about the cortical processing of the perception of dyspnea. Objectives: To investigate the cortical areas associated with the processing of the affective unpleasantness of perceived dyspnea. Methods: Brain imaging study using functional magnetic resonance imaging in 14 healthy volunteers. Measurements and Main Results: Dyspnea was induced by inspiratory resistive loaded breathing with concomitant positive and negative emotional stimulation by viewing standardized emotional picture series. The blood oxygen level–dependent contrast was measured as an index of local neuronal activity while respiration was continuously monitored. Negative emotional stimulation during loaded breathing was associated with higher unpleasantness of perceived dyspnea when compared with loaded breathing with concomitant positive emotional stimulation (P < 0.05). The levels of intensity of perceived dyspnea, respiratory responses, and load magnitude were similar between both conditions. Higher unpleasantness of dyspnea was associated with neuronal activations in the limbic system—that is, in the right anterior insula and in the right amygdala (respective Z values = 3.93 and 3.15; P < 0.05). Conclusions: The results of the present brain imaging study suggest that the unpleasantness of subjectively perceived dyspnea is processed in the right human anterior insula and amygdala.
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The neural processing for the anxiety-breathlessness feedback loop likely occurs in cortico-limbic areas involved in both breathlessness perception and emotion processing.
“The neural processing for this feedback loop is likely to occur in the cortico-limbic areas of the brain, involved in both breathlessness perception and processing of emotion.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [34]
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Self-citation
- Authors
- von Leupoldt, A., Sommer, T., Kegat, S., Baumann, H. J., Klose, H., Dahme, B., & Büchel, C.
- Affiliations
- Department of Psychology, University of Hamburg, Hamburg, Germany; and
- Department of Systems Neuroscience/Neuroimage Nord and
- Universität Hamburg (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-05-01
- Volume
- 177
- Issue
- 9
- Pages
- 1026-1032
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1965760332
- Cited by
- 302
- References
- 10
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 19 · 2023: 14 · 2022: 16 · 2021: 17 · 2020: 12 · 2019: 20 · 2018: 15 · 2017: 14 · 2016: 19 · 2015: 19 · 2014: 29 · 2013: 16 · 2012: 17
- FWCI
- 13.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- dyspnea, unpleasantness, anterior insula, amygdala, emotion perception, emotional arousal, inspiratory resistance, limbic system, respiratory sensation
- MeSH terms
- Adult, Amygdala, Cerebral Cortex, Dyspnea, Female, Humans, Magnetic Resonance Imaging, Male, Perception, Reference Books, Respiratory Function Tests, Severity of Illness Index
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