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The Unpleasantness of Perceived Dyspnea Is Processed in the Anterior Insula and Amygdala

¹ Department of Psychology, University of Hamburg, Hamburg, Germany; and ² Department of Systems Neuroscience/Neuroimage Nord and ³ Department of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Correspondence and requests for reprints should be addressed to Andreas von Leupoldt, Ph.D., Department of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany. E-mail: andreas.vonleupoldt{at}uni-hamburg.de

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.

Key Words: brain • dyspnea • emotions • magnetic resonance imaging • perception

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Dyspnea is an impairing symptom in various cardiopulmonary and other diseases, but little is known about the cortical mechanisms underlying the perception of this sensation. What This Study Adds to the Field This study indicates that the affective dimension (unpleasantness) of perceived dyspnea in humans is processed in the right anterior insula and the amygdala.

 

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Dyspnea and Emotion: What Can We Learn from Functional Brain Imaging?

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AJRCCM 2008 177: 937-939. [Full Text]  

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