Preprint Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity, 2026, Qiu et al.

SNT Gatchaman

SNT Gatchaman

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Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity
Lin Qiu; Betty Raman; Mark Cassar; Emily Fraser; Lauren Z Atkinson; Stuart Clare; William T Clarke; Stephan Neubauer; Helen E Davies; Neil A Harrison; C John Evans; Martyn Ezra; Kyle T S Pattinson

Persistent breathlessness is common after COVID-19, yet its severity typically correlates weakly with objective clinical measures. This discordance is often attributed to perceptual inference amplified by anxiety. Because breathing involves a closed perception-action loop, breathlessness may also reflect alterations in interoceptive and visceromotor pathways.

We acquired 7-tesla resting-state functional MRI in 53 post-COVID patients with varying breathlessness and estimated functional connectivity across 18 pre-defined interoceptive and visceromotor regions.

Linear regression identified two connections associated with breathlessness catastrophising: reduced dorsal periaqueductal grey-posterior insula (dPAG-PoI1) and increased basolateral amygdala-dorsal anterior cingulate (BLA-dACC) connectivity. The dPAG-PoI1 association was stronger in patients who had required mechanical ventilation, whereas the BLA-dACC association was attenuated at higher generalised anxiety.

These findings are consistent with two potentially separable contributions to symptom burden: weakened interoceptive signalling between brainstem and sensory cortex, and heightened visceromotor influence of threat processing on autonomic control, rather than anxiety-driven misperception alone.

Web | DOI | PDF | Preprint: BioRxiv | Open Access
 
Even more useless analyses of useless questionnaire data. This is the Breathless Catastrophizing Scale:
  1. I worry all the time about whether the breathlessness will subside.
  2. I feel I can't go on.
  3. It's terrible and I think it's never going to get any better.
  4. It's awful and I feel that it overwhelms me.
  5. I feel I can't stand it anymore.
  6. I become afraid that the breathlessness will get worse.
  7. I keep thinking of other times I have been breathless.
  8. I anxiously want the breathlessness to go away.
  9. I can't seem to keep it out of my mind.
  10. I keep thinking about how out of breath I am.
  11. I keep thinking about how badly I want the breathlessness to stop.
  12. There's nothing I can do to reduce the intensity of the breathlessness.
  13. I wonder whether something serious might happen.
 
  1. I worry all the time about whether the infliction of questionnaires on us will subside.
  2. I feel I can't go on.
  3. It's terrible and I think it's never going to get any better.
  4. It's awful and I feel that it overwhelms me.
  5. I feel I can't stand it anymore.
  6. I become afraid that the number and quality of questionnaires will get worse.
  7. I keep thinking of other times I have been confronted by questionnaires.
  8. I anxiously want the questionniares to go away.
  9. I can't seem to keep it out of my mind.
  10. I keep thinking about how fed up with questionnaires I am.
  11. I keep thinking about how badly I want the questionnaires to stop.
  12. There's nothing I can do to reduce the intensity of the questionnaires.
  13. I wonder whether something serious might happen.
 
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