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Published ahead of print on February 8, 2008, doi:10.1164/rccm.200712-1821OC

Am. J. Respir. Crit. Care Med., Volume 177, Number 9, May 2008, 1026-1032

A more recent version of this article appeared on May 1, 2008
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Submitted on December 13, 2007
Accepted on February 7, 2008

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

Andreas von Leupoldt1*, Tobias Sommer2, Sarah Kegat3, Hans Jorg Baumann4, Hans Klose4, Bernhard Dahme3, and Christian Buchel2

1 Department of Psychology, University of Hamburg, Hamburg, Germany; Department of Systems Neuroscience /Neuroimage Nord, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 2 Department of Systems Neuroscience /Neuroimage Nord, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 3 Department of Psychology, University of Hamburg, Hamburg, Germany, 4 Department of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

* To whom correspondence should be addressed. 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 (fMRI) in fourteen 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 (BOLD) 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 to loaded breathing with concomitant positive emotional stimulation (p < 0.05). The 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, i.e. 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




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