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The association between respiratory physiology and self-reported respiratory symptoms in patients with persistent
Saya Niwa1, Karolina Fila-Pawlowska1, Marta Rymaszewska2
1Department of Clinical Neurosciences, Wrocław University of Science and Technology, Poland.
Background:
Persistent somatic symptoms (PSS) comprise a spectrum of physical complaints arising from complex interactions between various biomedical and psychosocial factors. This study aimed to investigate both physiological and self-reported respiratory measures in individuals with PSS compared to healthy controls, and examine factors associated with dyspnea and functional respiratory complaints in patients with PSS.
Materials/Methods:
38 patients meeting DSM-5 criteria for Somatic Symptom Disorder and 38 matched healthy controls completed respiratory assessments, including spirometry, capnography (etCO₂), and manual evaluation of thoracic versus diaphragmatic breathing patterns. Self-report measures included the Dyspnea-12 and Nijmegen Questionnaire for functional respiratory complaints. Psychological and somatic symptoms were assessed using the PHQ-9, GAD-7, PHQ-15, and SSD-12.
Results:
Patients with PSS reported significantly higher dyspnea (M = 11.12, SD = 8.42) and functional respiratory complaints (M = 24.4, SD = 9.46) than healthy controls (dyspnea: M = 1.03, SD = 1.59; functional complaints: M = 6.26, SD = 5.4), with large effect sizes (r = 0.72-0.78, p < .001). Spirometry measures (FVC, FEV₁) were slightly lower in patients but not associated with respiratory symptoms when adjusted for normative values. Thoracic-dominant breathing was more frequent among patients and was linked to higher dyspnea scores. In regression analyses, somatic symptom severity (PHQ-15, SSD-12) as significantly associated with both dyspnea and functional respiratory complaints, whereas respiratory function and psychological distress were not significantly associated.
Conclusions:
The findings highlight the complex interplay behind respiratory symptom perception in PSS. The discordance between physiologic and self-reported respiratory measures underscores the importance of a biopsychosocial approach in managing respiratory complaints in PSS, focusing on cognitive-perceptual processes and maladaptive breathing patterns as potential targets for intervention. Future research should investigate interventions such as breathing retraining, interoceptive modulation, and cognitive approaches that address symptom perception and somatic hypervigilance in PSS.
Funding:
This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 956673.
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