Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity
- 1University of Oxford
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.
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BibTeX
@misc{qiu2026breathlessness,
title = {{Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity}},
author = {L. Qiu and B. Raman and M. Cassar and E. Fraser and L. Z. Atkinson and S. Clare and W. T. Clarke and S. Neubauer and H. E. Davies and N. A. Harrison and C. J. Evans and M. Ezra and K. T. S. Pattinson},
howpublished = {bioRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.11.750997},
url = {https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Breathlessness catastrophising after COVID-19 involves both interoceptive and visceromotor connectivity
AU - L. Qiu
AU - B. Raman
AU - M. Cassar
AU - E. Fraser
AU - L. Z. Atkinson
AU - S. Clare
AU - W. T. Clarke
AU - S. Neubauer
AU - H. E. Davies
AU - N. A. Harrison
AU - C. J. Evans
AU - M. Ezra
AU - K. T. S. Pattinson
PY - 2026
DA - 2026/09/11
PB - bioRxiv
DO - 10.64898/2026.09.11.750997
UR - https://www.biorxiv.org/content/10.64898/2026.09.11.750997v1
AB - 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.
ER -