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

Werder, Dina von ; Aubele, Maria; Regnath, Franziska; Tebbe, Elisabeth; Mladenov, Dejan; Rheinbaben, Victoria von; Hahn, Elisabeth; Schäfer, Daniel; Biersack, Katharina; Adorjan, Kristina ; Stubbe, Hans C.; Bogaerts, Katleen; Jörres, Rudolf A. ; Nowak, Dennis ; Bergh, Omer Van den; Glasauer, Stefan und Lehnen, Nadine (29. July 2025): Increased breathlessness in post-COVID syndrome despite normal breathing patterns in a rebreathing challenge. In: Scientific Reports, Vol. 15, No. 1, 27666

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.

• Item Type: Journal article
• EU Funded Grant Agreement Number: 956673
• EU Projects: Horizon 2020; Horizon 2020 > Marie Skłodowska Curie Actions
• Faculties: Medicine > Institute and Polyclinic for Occupational, Social and Environmental Medicine
• Research Centers: Graduate School of Systemic Neurosciences (GSN)
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 2045-2322
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 532480418