Increased breathlessness in post-COVID syndrome despite normal breathing patterns in a rebreathing challenge

Increased breathlessness in post-COVID syndrome despite normal breathing patterns in a rebreathing challenge

Abstract Severe symptoms in the absence of measurable body pathology are a frequent hallmark of post-COVID syndrome. From a Bayesian Brain perspective, such symptoms can be explained by incorrect internal models that the brain uses to interpret sensory signals. In this pre-registered study, we inves...

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Main Authors: Dina von Werder, Maria Aubele, Franziska Regnath, Elisabeth Tebbe, Dejan Mladenov, Victoria von Rheinbaben, Elisabeth Hahn, Daniel Schäfer, Katharina Biersack, Kristina Adorjan, Hans C. Stubbe, Katleen Bogaerts, Rudolf A. Jörres, Dennis Nowak, Omer Van den Bergh, Stefan Glasauer, Nadine Lehnen
Format: Article
Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-025-11728-x
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Summary:Abstract Severe symptoms in the absence of measurable body pathology are a frequent hallmark of post-COVID syndrome. From a Bayesian Brain perspective, such symptoms can be explained by incorrect internal models that the brain uses to interpret sensory signals. In this pre-registered study, we investigate whether induced breathlessness perception during a controlled CO2rebreathing challenge is reflected by altered respiratory measures (physiology and breathing patterns), and propose different computational mechanisms that could explain our findings in a Bayesian Brain framework. We analysed data from 40 patients with post-COVID syndrome and 40 healthy participants. Results from lung function, neurological and neurocognitive examination of all participants were within normal limits on the day of the experiment. Using a Bayesian repeated-measures ANOVA, we found that patients’ breathlessness was strongly increased (BF10,baseline =8.029, BF10,rebreathing =11636, BF10,recovery =43662) compared to controls. When excluding patients who hyperventilated (N = 8, 20%) during the experiment from the analysis, differences in breathlessness remained (BF10,baseline =1.283, BF10,rebreathing =126.812, BF10,recovery =751.282). For physiology and breathing patterns, all evidence pointed towards no difference between the two groups (0.307 > BF10 < 0.704). In summary, we found intact breathing patterns and physiology but increased symptom perception in patients with post-COVID syndrome.
ISSN:2045-2322

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