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Investigating the relationship between cardiac interoception and autonomic cardiac control using a predictive coding framework

Owens, A, Friston, K, Low, DA, Mathias, CJ and Critchley, HD (2018) Investigating the relationship between cardiac interoception and autonomic cardiac control using a predictive coding framework. Autonomic Neuroscience: Basic and Clinical. ISSN 1566-0702

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Abstract

Predictive coding models, such as the ‘free-energy principle’ (FEP), have recently been discussed in relation to how interoceptive (afferent visceral feedback) signals update predictions about the state of the body, thereby driving autonomic mediation of homeostasis. . This study appealed to ‘interoceptive inference’, under the FEP, to seek new insights into autonomic (dys)function and brain-body integration by examining the relationship between cardiac interoception and autonomic cardiac control in healthy controls and patients with forms of orthostatic intolerance (OI); to (i) seek empirical support for interoceptive inference and (ii) delineate if this relationship was sensitive to increased interoceptive prediction error in OI patients during head-up tilt (HUT)/symptom provocation. Measures of interoception and heart rate variability (HRV) were recorded whilst supine and during HUT in healthy controls (N=20), postural tachycardia syndrome (PoTS, N=20) and vasovagal syncope (VVS, N=20) patients. Compared to controls, interoceptive accuracy was reduced in both OI groups. Healthy controls’ interoceptive sensibility positively correlated with HRV whilst supine. Conversely, both OI groups’ interoceptive awareness negatively correlated with HRV during HUT. Our pilot study offers initial support for interoceptive inference and suggests OI cohorts share a central pathophysiology underlying interoceptive deficits expressed across distinct cardiovascular autonomic pathophysiology. From a predictive coding perspective, OI patients’ data indicates a failure to attenuate/modulate ascending interoceptive prediction errors, reinforced by the concomitant failure to engage autonomic reflexes during HUT. Our findings offer a potential framework for conceptualising how the human nervous system maintains homeostasis and how both central and autonomic processes are ultimately implicated in dysautonomia.

Item Type: Article
Uncontrolled Keywords: 1109 Neurosciences, 1115 Pharmacology And Pharmaceutical Sciences, 1103 Clinical Sciences
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Elsevier
Date Deposited: 08 Jan 2018 08:53
Last Modified: 15 Sep 2018 05:29
DOI or Identification number: 10.1016/j.autneu.2018.01.001
URI: http://researchonline.ljmu.ac.uk/id/eprint/7783

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