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

Owens, AP; Friston, KJ; Low, DA; Mathias, CJ; Critchley, HD; (2018) Investigating the relationship between cardiac interoception and autonomic cardiac control using a predictive coding framework. Autonomic Neuroscience , 210 pp. 65-71. 10.1016/j.autneu.2018.01.001. Green open access

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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.

Type: Article
Title: Investigating the relationship between cardiac interoception and autonomic cardiac control using a predictive coding framework
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.autneu.2018.01.001
Publisher version: https://doi.org/10.1016/j.autneu.2018.01.001
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: active inference, autonomic nervous system, dysautonomia, free-energy principle, heart rate variability, homeostasis, interoception, interoceptive (active) inference, predictive coding
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Imaging Neuroscience
URI: https://discovery.ucl.ac.uk/id/eprint/10051463
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