Knowledge, attitudes, and practice patterns of obstructive sleep apnea among speech-language pathologists

Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study

Despite the high estimated prevalence of dysphagia in OSA, there is a paucity of evidence supporting behavioral interventions for treatment. The purpose of this study was to assess the impact of expiratory muscle strength training (EMST) on validated, standardized metrics of swallow and airway clearance capacity functions in moderate-to-severe OSA. 10 participants with OSA (mean age = 65.2 years) completed four weeks of EMST training employing a prospective single-arm, double-baseline interventional design. The Modified Barium Swallow Impairment Profile (MBSImP) Component and Composite (Oral Total [OT] and Pharyngeal Total [PT]) scores measured swallow physiology. Airway clearance capacity measures included maximum expiratory pressure (MEP) and peak cough flow (PCF). A historical normative database was used for OSA patient comparison of swallowing metrics. A total of 234 swallows were analyzed. At baseline, impairments in lingual control, oral residue and esophageal clearance were observed. However, no significant differences in the MBSImP Composite (OT/PT) scores were observed between the OSA and healthy referent group. After EMST intervention, there were no significant differences in pre- to post-intervention Composite (OT/PT) scores. However, large effect size was observed for MEP (p < 0.001, d = 3.0), and non-significant, but moderate effect size was observed in PCF (p = 0.19, d = 0.44). Study findings further quantify swallowing in moderate-to-severe OSA and provide preliminary evidence supporting the impact of EMST on airway clearance capacity.

Knowledge and Attitudes Toward Obstructive Sleep Apnea Among Korean Pulmonologists: A Nationwide Survey

BACKGROUND

Obstructive sleep apnea (OSA) significantly impacts cardiovascular, metabolic, and respiratory health. In Korea, OSA patients are treated by specialists in internal medicine, otolaryngology, neurology, and psychiatry, but the participation rate of pulmonologists in OSA management is relatively low compared to other specialties. This study investigated the knowledge and attitudes about OSA among Korean pulmonologists.

MATERIALS AND METHODS

An online survey was conducted, targeting respiratory specialists listed in the Korean Academy of Tuberculosis and Respiratory Diseases directory. The survey used the validated "Obstructive Sleep Apnea Knowledge and Attitudes" (OSAKA) questionnaire, which consists of questions about knowledge and attitudes on OSA. To maximize participation, email invitations were sent three times to the target audience.

RESULTS

Out of 634 queried pulmonologists, 127 (20%) responded to the survey. The mean age of respondents was 45.4 ± 8.6 years. The respondents' years of specialty acquisition ranged from the 1980s to the 2010s. Additionally, 74 (58.3%) held a doctor's degree, and 96 (75.6%) worked in hospitals with a sleep center. Furthermore, 71 (55.9%) of the pulmonologists reported having experience with OSA patients. Pulmonologists with experience managing OSA patients had significantly higher knowledge and attitude scores compared to those without such experience. Interestingly, older respondents and those who completed their pulmonology training earlier had higher attitude scores. In addition, the knowledge score significantly correlated with responses to the five items of the attitude questionnaire.

CONCLUSION

This study provides valuable insights into the knowledge and attitudes of Korean pulmonologists regarding OSA. The findings indicate that their knowledge levels are comparable to or better than those in previous studies. These results underscore the need for targeted educational programs and practical training, especially for younger pulmonologists, to enhance their proficiency in managing OSA and to encourage a more active role in its treatment.

Optogenetic stimulation of pre-Bötzinger complex reveals novel circuit interactions in swallowing-breathing coordination

The coordination of swallowing with breathing, in particular inspiration, is essential for homeostasis in most organisms. While much has been learned about the neuronal network critical for inspiration in mammals, the pre-Bötzinger complex (preBötC), little is known about how this network interacts with swallowing. Here we activate within the preBötC excitatory neurons (defined as Vglut2 and Sst neurons) and inhibitory neurons (defined as Vgat neurons) and inhibit and activate neurons defined by the transcription factor Dbx1 to gain an understanding of the coordination between the preBötC and swallow behavior. We found that stimulating inhibitory preBötC neurons did not mimic the premature shutdown of inspiratory activity caused by water swallows, suggesting that swallow-induced suppression of inspiratory activity is not directly mediated by the inhibitory neurons in the preBötC. By contrast, stimulation of preBötC Dbx1 neurons delayed laryngeal closure of the swallow sequence. Inhibition of Dbx1 neurons increased laryngeal closure duration and stimulation of Sst neurons pushed swallow occurrence to later in the respiratory cycle, suggesting that excitatory neurons from the preBötC connect to the laryngeal motoneurons and contribute to the timing of swallowing. Interestingly, the delayed swallow sequence was also caused by chronic intermittent hypoxia (CIH), a model for sleep apnea, which is 1) known to destabilize inspiratory activity and 2) associated with dysphagia. This delay was not present when inhibiting Dbx1 neurons. We propose that a stable preBötC is essential for normal swallow pattern generation and disruption may contribute to the dysphagia seen in obstructive sleep apnea.

Current medical education improves OSA-related knowledge but not confidence in residents: An underappreciated public health risk

BACKGROUND

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and induces a growing health care burden. However, a large proportion of patients with OSA do not receive appropriate treatment and are underdiagnosed or misdiagnosed in primary care. A contributing factor to the phenomenon is the lack of education, which reflects the current inadequacies in medical education. Therefore, assessing the level of knowledge and attitudes toward OSA and associated factors among resident physicians is highly warranted.

METHODS

A validated questionnaire, the OSA Knowledge and Attitudes (OSAKA) questionnaire was distributed to residents who had already completed undergraduate education and were attending an internal medicine residency training program. The questionnaire consists of 2 parts: including an assessment of (1) OSA-related knowledge involving epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment; (2) the importance of OSA and confidence in diagnosing and treating OSA patients. Other information including demographics, training experience, and questions exploring the future form of the sleep breathing disorder course was collected together.

RESULTS

Of the 160 residents who participated in the survey, 153 (95.6%) completed the survey and the mean total knowledge score was 12.6/18 (70% correct). Although all respondents believed that OSA was an important clinical disorder, only a minority of the residents felt confident in identifying patients at risk for OSA (38%), managing OSA patients (27.5%), or continuous positive airway pressure therapy (CPAP) (26.2%). We found that OSA training experience significantly increased knowledge scores (p = 0.002) but not confidence scores (p = 0.248). As for the specific form of medical education, "Small classes during residency training" was the most popular form of sleep-breathing disorder educational training in the future of the resident training program.

CONCLUSION

Despite adequate knowledge of OSA, there was still a generalized lack of confidence in the management of OSA patients among residents. Current medical education can not build enough confidence for physicians, which may in turn affect patients' trust and reduce long-term compliance. Untreated OSA places a significant health threat and economic burden on not only the patients but also their families and society, causing an underappreciated public health risk. In the future, merely increasing OSA courses is not sufficient, a more specific focus on the course format and training effect is required.