title: Brain Responses during the Anticipation of Dyspnea.
abstract: Dyspnea is common in many cardiorespiratory diseases. Already the anticipation of this aversive symptom elicits fear in many patients resulting in unfavorable health behaviors such as activity avoidance and sedentary lifestyle. This study investigated brain mechanisms underlying these anticipatory processes. We induced dyspnea using resistive-load breathing in healthy subjects during functional magnetic resonance imaging. Blocks of severe and mild dyspnea alternated, each preceded by anticipation periods. Severe dyspnea activated a network of sensorimotor, cerebellar, and limbic areas. The left insular, parietal opercular, and cerebellar cortices showed increased activation already during dyspnea anticipation. Left insular and parietal opercular cortex showed increased connectivity with right insular and anterior cingulate cortex when severe dyspnea was anticipated, while the cerebellum showed increased connectivity with the amygdala. Notably, insular activation during dyspnea perception was positively correlated with midbrain activation during anticipation. Moreover, anticipatory fear was positively correlated with anticipatory activation in right insular and anterior cingulate cortex. The results demonstrate that dyspnea anticipation activates brain areas involved in dyspnea perception. The involvement of emotion-related areas such as insula, anterior cingulate cortex, and amygdala during dyspnea anticipation most likely reflects anticipatory fear and might underlie the development of unfavorable health behaviors in patients suffering from dyspnea.
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: M Cornelia
authors.initials: MC
authors.lastname: Stoeckel
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Esser
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; Department of Psychology 1, University of Würzburg, Marcusstraße 9-11, 97070 Würzburg, Germany.
authors.forename: Matthias
authors.identifier: 0000-0002-9676-9038
authors.initials: M
authors.lastname: Gamer
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Büchel
authors.affiliation: Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
authors.forename: Andreas
authors.identifier: 0000-0001-8539-8131
authors.initials: A
authors.lastname: von Leupoldt
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D004417:Dyspnea / Q000503:physiopathology*; D005239:Fear / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000502:physiology / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology; D055815:Young Adult