{
  "abstract": "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.",
  "abstract_shown": true,
  "affiliations": [
    "University of Oxford"
  ],
  "article_type": "New results",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "name": "L. Qiu"
    },
    {
      "name": "B. Raman"
    },
    {
      "name": "M. Cassar"
    },
    {
      "name": "E. Fraser"
    },
    {
      "name": "L. Z. Atkinson"
    },
    {
      "name": "S. Clare"
    },
    {
      "name": "W. T. Clarke"
    },
    {
      "name": "S. Neubauer"
    },
    {
      "name": "H. E. Davies"
    },
    {
      "name": "N. A. Harrison"
    },
    {
      "name": "C. J. Evans"
    },
    {
      "name": "M. Ezra"
    },
    {
      "affs": [
        0
      ],
      "name": "K. T. S. Pattinson"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e2qg7cte97g6k.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.11.750997",
  "fulltext_url": "https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1.full",
  "id": "e2qg7cte97g6k",
  "issns": [],
  "landing_url": "https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "biorxiv",
      "neuroscience"
    ],
    [
      "openalex",
      "2728|Long-Term Effects of COVID-19"
    ]
  ],
  "openalex": "W7213356043",
  "pdf_url": "https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-11",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/e2qg7cte97g6k.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:22Z",
      "native_id": "10.64898/2026.09.11.750997",
      "source": "biorxiv",
      "url": "https://www.biorxiv.org/content/10.64898/2026.09.11.750997v2"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "biorxiv:neuroscience",
      "subfield": "neuroscience"
    }
  ],
  "title": "Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity",
  "title_text": "Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity",
  "type": "preprint",
  "updated_at": "2026-10-30T12:22:37Z",
  "url": "https://research.draconitic.com/paper/e2qg7cte97g6k",
  "venue": "bioRxiv",
  "versions": []
}