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Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, Xiong K, Murray BJ, Chen JL, Thorpe K, Yunusova Y, Boulos MI. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res 2024; 33:e14086. [PMID: 37909249 DOI: 10.1111/jsr.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.
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Affiliation(s)
- Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - C J Lindo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Yakdehikandage S Costa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Nemet M, Vukoja M. Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review. Antibiotics (Basel) 2024; 13:532. [PMID: 38927198 PMCID: PMC11200551 DOI: 10.3390/antibiotics13060532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden of comorbidities. In this narrative review, we evaluated the current evidence on the association between OSA and the incidence and outcomes of acute LRTIs in adults, specifically community-acquired pneumonia and viral pneumonia caused by influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have demonstrated that OSA patients are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease. The risk intensifies with the severity of OSA, influencing hospitalization rates and the need for intensive care. OSA is also associated with an increased risk of contracting influenza and suffering more severe disease, potentially necessitating hospitalization. Similarly, OSA contributes to increased COVID-19 disease severity, reflected by higher rates of hospitalization, longer hospital stays, and a higher incidence of acute respiratory failure. The effect of OSA on mortality rates from these infections is, however, somewhat ambiguous. Finally, we explored antibiotic therapy for OSA patients with LRTIs, addressing care settings, empirical regimens, risks, and pharmacokinetic considerations. Given the substantial burden of OSA and its significant interplay with acute LRTIs, enhanced screening, targeted vaccinations, and optimized management strategies for OSA patients should be prioritized.
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Affiliation(s)
- Marko Nemet
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Marija Vukoja
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, 21204 Novi Sad, Serbia
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Huff AD, Karlen-Amarante M, Oliveira LM, Ramirez JM. Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production. eLife 2024; 12:RP92175. [PMID: 38655918 PMCID: PMC11042803 DOI: 10.7554/elife.92175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurological and systemic comorbidities, including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently, we showed the postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests that glutamatergic-cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.
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Affiliation(s)
- Alyssa D Huff
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological Surgery, University of Washington School of MedicineSeattleUnited States
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Crescimanno G, Lupica A, Tommasello V, Di Stefano V, Brighina F, Marrone O. Spectrum of sleep-disordered breathing and quality of sleep in adolescent and adult patients with spinal muscular atrophy. J Sleep Res 2024:e14222. [PMID: 38654474 DOI: 10.1111/jsr.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
Sleep-disordered breathing is common among children with spinal muscular atrophy, but has been hardly studied among adult subjects. Little is known about sleep quality in spinal muscular atrophy. The aims of this study were to evaluate occurrence and characteristics of sleep-disordered breathing and subjective sleep quality among adolescent and adult patients with spinal muscular atrophy type 2 or 3. Twenty patients aged 33.9 ± 15.2 years were studied. They underwent nocturnal cardiorespiratory monitoring, lung and muscular function evaluation, and were administered the Pittsburgh Sleep Quality Index questionnaire. Nineteen patients showed sleep-disordered breathing, with obstructive events in seven subjects and non-obstructive events in the remaining 12. In the latter group, 10 patients showed pseudo-obstructive hypopneas. Patients with non-obstructive sleep-disordered breathing were younger (p = 0.042), had a lower body mass index (p = 0.0001), were more often affected by spinal muscular atrophy type 2 (p = 0.001), and showed worse impairment of respiratory function than patients with obstructive sleep-disordered breathing. Ten patients were classified as poor sleepers and 10 patients good sleepers. In the whole sample, sniff nasal inspiratory pressure proved to be the only independent predictor of sleep quality (p = 0.009). In conclusion, sleep-disordered breathing is common even among adult patients with spinal muscular atrophy type 2 and 3, and may show either obstructive or different types on non-obstructive features. A worse respiratory muscle function is associated to non-obstructive sleep-disordered breathing and poorer sleep quality. Sleep quality should receive greater attention especially in patients with spinal muscular atrophy type 2, who have a poorer respiratory muscle function, as it could affect their quality of life.
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Affiliation(s)
- Grazia Crescimanno
- National Research Council, Institute of Biomedical Research and Innovation (IRIB-CNR), Palermo, Italy
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Antonino Lupica
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Vito Tommasello
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Vincenzo Di Stefano
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Regional Center for Diagnosis and Treatment of Neuromuscular Disease, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council, Institute of Biomedical Research and Innovation (IRIB-CNR), Palermo, Italy
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Sgaria VP, Cielo CA, Bortagarai FM, Fleig AHD, Callegaro CC. CPAP Treatment Improves Quality of Life and Self-perception of Voice Impairment in Patients with OSA. J Voice 2024:S0892-1997(24)00026-2. [PMID: 38519333 DOI: 10.1016/j.jvoice.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. METHODS Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. RESULTS The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. CONCLUSION Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.
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Affiliation(s)
- Victória Possebon Sgaria
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil; UFSM Federal University of Santa Maria, Department of Speech Therapy, Voice Laboratory, Santa Maria, Rio Grande do Sul, Brazil
| | - Francine Manara Bortagarai
- UFSM Federal University of Santa Maria, Laboratory of Physiology and Rehabilitation, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Carine Cristina Callegaro
- UFSM Federal University of Santa Maria, Graduate Program in Human Communication Disorders, Santa Maria, Rio Grande do Sul, Brazil; UFSM Federal University of Santa Maria, Department of Physiotherapy, Laboratory of Physiology and Rehabilitation, Santa Maria, Rio Grande do Sul, Brazil.
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López-Fernández MD, Fernández-Lao C, Ruíz-Martínez AM, Fernández-Gualda MÁ, Lozano-Lozano M, Ortiz-Comino L, Galiano-Castillo N. Exploring predictors of dysphagia in survivors of head and neck cancer: A cross-sectional study. Support Care Cancer 2024; 32:162. [PMID: 38366091 PMCID: PMC10873441 DOI: 10.1007/s00520-024-08358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate the prevalence of dysphagia in survivors of head and neck cancer (sHNC) and to identify the predictors contributing to the development of dysphagia. METHODS We enrolled 62 sHNC in a cross-sectional study to check the prevalence of dysphagia in sHNC and to evaluate which factors were influencing the presence of this side effect. Besides dysphagia, sociodemographic and clinical characteristics, oral symptoms, maximal mouth opening (MMO), sleep quality and physical condition were evaluated, and a linear regression analysis was performed to verify which of these outcomes impact dysphagia. RESULTS Among all the sHNC, 85.5% presented dysphagia. The linear regression analysis confirmed that 44.9% of the variance in dysphagia was determined by coughing, MMO and sleep quality, being MMO the most powerful predictor, followed by coughing and sleep quality. CONCLUSION Dysphagia affected the great majority of sHNC. Moreover, symptoms as coughing, reduced MMO and sleep disorders may act as predictors contributing to the development of dysphagia. Our results emphasize the importance of an early and proper identification of the symptoms as well as an adequate treatment strategy to address the cluster of symptoms that sHNC undergo.
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Affiliation(s)
- María Dolores López-Fernández
- UGC Medicina Física y Rehabilitación, Hospital de Neurotraumatología y Rehabilitación, Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Carolina Fernández-Lao
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain.
| | - Alba María Ruíz-Martínez
- Department of Radiation Oncology, Hospital Universitario Vírgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Mario Lozano-Lozano
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Lucía Ortiz-Comino
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty (Melilla), University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Noelia Galiano-Castillo
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Sport and Health Research Center (IMUDs), Instituto de Investigación Biosanitaria Ibs, Granada, Spain
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Lutsey PL, Zineldin I, Misialek JR, Full KM, Lakshminarayan K, Ishigami J, Cowan LT, Matsushita K, Demmer RT. OSA and Subsequent Risk of Hospitalization With Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study. Chest 2023; 163:942-952. [PMID: 36442663 PMCID: PMC10268811 DOI: 10.1016/j.chest.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND OSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function. RESEARCH QUESTION Is OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections? STUDY DESIGN AND METHODS Prospective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N = 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS ARIC participants were on average 62.7 (SD = 5.5) years of age, and 52.8% were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years' follow-up. Participants with severe OSA were at 1.87 times (95% CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively). INTERPRETATION Severe OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Islam Zineldin
- M Health Fairview, University of Minnesota, Minneapolis, MN
| | - Jeffrey R Misialek
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kelsie M Full
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Junichi Ishigami
- Division of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Logan T Cowan
- Department of Biostatistics, Epidemiology, and Environmental Health Sciences, Georgia Southern University, Statesboro, GA
| | - Kunihiro Matsushita
- Division of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan T Demmer
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Borges TGV, Muniz CR, Ferreira FR, Brendim MP, Muxfeldt ES. Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2023; 280:443-453. [PMID: 36098863 PMCID: PMC9469056 DOI: 10.1007/s00405-022-07612-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate (i) the outcome of swallowing therapy program on the rehabilitation of oropharyngeal dysphagia in resistant hypertensive patients with obstructive sleep apnea (OSA) and (ii) the association between the clinical and anthropometric characteristics of these individuals and this outcome. METHODS This was a prospective interventional study in which resistant hypertensives diagnosed with OSA by polysomnography and dysphagia by fiberoptic endoscopic evaluation of swallowing (FESS) participated. All participants underwent a FEES and assessment of the risk of dysphagia (Eating Assessment Tool, EAT-10) and swallowing-related quality of life (Swal-QoL) before and after the intervention. The therapeutic program was performed daily by the participants, with weekly speech-therapist supervision for eight weeks, including the following strategies: Masako, chin tuck against resistance, and expiratory muscle training. RESULTS A total of 26 (78.8%) of the participants exhibited improvement in the degree of dysphagia in the intervention outcome. After the intervention, there was a statistically significant improvement in the level of penetration-aspiration (p = 0.007), the degree of pharyngeal residue (p = 0.001), the site of onset of the pharyngeal phase (p = 0.001), and the severity of dysphagia (p = 0.001) compared to before intervention. The EAT-10 score was 2 (0-6) before and 0 (0-3) after intervention (p = 0.023). Swal-QoL had a score on the symptom frequency domain of 92.8 (75-100) before and 98.2 (87.5-100) after intervention (p = 0.002). CONCLUSIONS Resistant hypertensive patients with OSA showed improved swallowing performance after swallowing therapy program.
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Affiliation(s)
- Thalyta Georgia Vieira Borges
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Carla Rocha Muniz
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Flavia Rodrigues Ferreira
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Mariana Pinheiro Brendim
- Speech-Language Pathology Department, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 4º andar - Speech-Language Pathology Clinic, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha do Fundão, Rio de Janeiro, 21941-590 Brazil
| | - Elizabeth Silaid Muxfeldt
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
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Schindler A, de Fátima Lago Alvite M, Robles-Rodriguez WG, Barcons N, Clavé P. History and Science behind the Eating Assessment Tool-10 (Eat-10): Lessons Learned. J Nutr Health Aging 2023; 27:597-606. [PMID: 37702330 DOI: 10.1007/s12603-023-1950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is an underdiagnosed medical condition with a high prevalence in populations such as patients with frailty, neurological disease, or head and neck pathology. Potential barriers to its diagnosis include lack of (or low) awareness of the existence and severity of the condition, the hidden nature of the condition within the 'normal ageing' process, clinical limitations, and socioeconomic reasons. Consequently, an effective treatment is not systematically offered in a timely manner, and complications, such as dehydration and respiratory infections or aspiration pneumonia, can arise. To overcome this issue, the early use of screening questionnaires to identify people at risk of swallowing disorders represents the cornerstone of preventive medicine. Several screening tools have been created but few are widely used in clinical practice. The Eating Assessment Tool-10 (EAT-10) was developed as a quick, easy-to-understand, and self-administered screening tool for OD. METHODS A literature review was conducted in five databases with no restrictions on the language, date of publication, or design of the study to identify aspects of the validation, applicability, and usefulness of EAT-10. RESULTS AND CONCLUSIONS Transcultural adaptation and translation studies, as well as studies involving various types of patients with dysphagia in different settings have shown the validity and reliability of EAT-10 in relation to the gold standard and other validation tools. The use of this standardised screening tool could be used as a primary screening instrument of dysphagia in routine clinical practice across a wide range of diseases and settings and thereby increase the likelihood of early diagnosis and management of a condition that lead to serious complications and impaired quality of life.
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Affiliation(s)
- A Schindler
- William Gildardo Robles-Rodriguez FUCS: Fundacion Universitaria de Ciencias de la Salud, Colombia,
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10
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Verbraecken J. More than sleepiness: prevalence and relevance of nonclassical symptoms of obstructive sleep apnea. Curr Opin Pulm Med 2022; 28:552-558. [PMID: 36101923 PMCID: PMC9553267 DOI: 10.1097/mcp.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the nonclassical symptoms and manifestations occurring in patients with obstructive sleep apnea (OSA), both from a standpoint of prevalence and in terms of clinical relevance. Particular emphasis will be given to nightmares, comorbid insomnia, restless legs syndrome and periodic limb movement disorder, bruxism, morning headache, nocturia, acid reflux, chronic cough and dysphagia. RECENT FINDINGS A review of the recent literature suggests that nonclassical symptoms have a high prevalence, are underestimated, and can interact with quality of life. Although these disturbances may occur together by mere coincidence, they may interact reciprocally. However, the degree of symptoms is not always correlated with OSA severity. SUMMARY OSA is a heterogeneous disease with variable clinical manifestations. This review highlights the need for detailed evaluation of patients with OSA to diagnose other important sleep disorders and clinical manifestations, given their frequent association.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Stomatognathic System Changes in Obese Patients Undergoing Bariatric Surgery: A Systematic Review. J Pers Med 2022; 12:jpm12101541. [PMID: 36294680 PMCID: PMC9605559 DOI: 10.3390/jpm12101541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Obesity is a multifactorial chronic disease involving multiple organs, devices, and systems involving important changes in the stomatognathic system, such as in the orofacial muscles, temporomandibular joint, cheeks, nose, jaw, maxilla, oral cavity, lips, teeth, tongue, hard/soft palate, larynx, and pharynx. Patients with obesity indicated for bariatric surgery reportedly presented with abnormalities in the structures and function of the stomatognathic apparatus. This occurs through the accumulation of adipose tissue in the oral cavity and pharyngeal and laryngeal regions. Therefore, this systematic review aimed to elucidate the changes occurring in the stomatognathic system of patients with obesity after undergoing bariatric surgery. Method: Information was searched based on the equations developed with the descriptors obtained in DECS and MESH using the PRISMA methodology. Studies published between 2010 and October 2021 in databases including PubMed, ProQuest, Scielo, Dialnet, EBSCO, and Springer Link were considered. Results: Eighty articles met the inclusion criteria after evaluating the articles, thereby allowing for the determination of the morphophysiological correlation of the stomatognathic system with the population studied. At the morphological or structural level, changes were observed in the face, nose, cheeks, maxilla, jaw, lips, oral cavity, teeth, tongue, palate, temporomandibular joint, neck, muscles, head, shoulders, larynx, and pharynx. At the morphological level, the main changes occurred in, and the most information was obtained from, the labial structures, teeth, muscles, pharynx, and larynx. Physiological changes were in breathing, phonation, chewing, and swallowing, thereby revealing the imbalance in basic and vital functions. Conclusions: Analyzing the changes and structures of obese patients and candidates for bariatric surgery revealed that, in the preoperative period, the evidence is clear owing to the presence of a wide range of information. However, the information is more limited regarding the postoperative period; thus, further research focusing on characterization of the system postoperatively is warranted.
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Huff A, Karlen-Amarante M, Pitts T, Ramirez JM. Optogenetic stimulation of pre-Bötzinger complex reveals novel circuit interactions in swallowing-breathing coordination. Proc Natl Acad Sci U S A 2022; 119:e2121095119. [PMID: 35858334 PMCID: PMC9304034 DOI: 10.1073/pnas.2121095119] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/31/2022] [Indexed: 02/02/2023] Open
Abstract
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.
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Affiliation(s)
- Alyssa Huff
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101
| | - Teresa Pitts
- Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY 40202
| | - Jan Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101
- Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, WA 98108
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Lu PW, Chen CC, Wu JF, Lee HC, Lee YC, Wang HP, Wu MS, Tseng PH. Clinical Characteristics and Associated Psychosocial Dysfunction in Patients With Functional Dysphagia: A Study Based on High-Resolution Impedance Manometry and Rome IV Criteria. Clin Transl Gastroenterol 2022; 13:e00511. [PMID: 35905413 PMCID: PMC10476845 DOI: 10.14309/ctg.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The pathophysiology of functional dysphagia as defined by the updated Rome IV criteria is complex and remains largely unknown. We aimed to investigate its clinical characteristics and its association with psychosocial comorbidities. METHODS Consecutive patients referred to our motility laboratory for evaluation of esophageal dysphagia were identified. All patients were assessed with upper endoscopy, high-resolution impedance manometry, and validated symptom questionnaires. Data from those who were diagnosed with functional dysphagia (n = 96) based on the Rome IV criteria were analyzed. Age- and sex-adjusted healthy volunteers were also enrolled for comparison. Psychiatric comorbidity and poor sleep quality were defined as total score of 5-item Brief Symptom Rating Scale ≥6 and Pittsburgh Sleep Quality Index ≥6, respectively. RESULTS The age peak of patients with functional dysphagia was at 40-60 years (47.9%) with females predominant (67%). Forty-four patients (45.8%) had psychiatric comorbidities, whereas 80 (83.3%) experienced poor sleep quality. Female patients were more likely to have trouble falling asleep, shorter sleep duration, and severe bloating. Compared with the healthy volunteers, patients with functional dysphagia had higher 5-item Brief Symptom Rating Scale and Pittsburgh Sleep Quality Index scores (5.34 ± 3.91 vs 1.84 ± 2.61, 9.64 ± 4.13 vs 4.77 ± 3.60, both P < 0.001) but similar results on high-resolution impedance manometry. Those with ineffective esophageal motility (16.7%) had less sleep efficiency than those with normal motility. DISCUSSION Patients with functional dysphagia were mainly middle-aged women and had a high prevalence of psychiatric comorbidities and sleep disturbances, especially in female patients. Patients with functional dysphagia displayed similar esophageal motility as the healthy volunteers did.
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Affiliation(s)
- Po-Wen Lu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taiwan, ROC
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taiwan, ROC
| | - Chien-Chuan Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Chuan Lee
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Kohno A, Kohno M, Ohkoshi S. Swallowing and aspiration during sleep in patients with obstructive sleep apnea versus control individuals. Sleep 2022; 45:6528989. [PMID: 35167701 PMCID: PMC8996030 DOI: 10.1093/sleep/zsac036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/07/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Study Objectives
There are only a few reports on voluntary swallowing during sleep; therefore, this study aimed to propose a method for observing voluntary swallowing during sleep using polysomnography. The frequency of voluntary swallowing during sleep and the factors related to swallowing and aspiration during sleep were investigated.
Methods
Polysomnography records of 20 control subjects and 60 patients with obstructive sleep apnea (OSA) (mild, moderate, and severe groups; n = 20 each) were collected. Simultaneous increases in the electromyographic potentials of the submental and masseter muscles, termed coactivation, and declining oronasal airflow (SA) were extracted as “swallowing.” The cough reflex that occurred during sleep was extracted as “aspiration.” The frequency of swallowing events was compared among the different OSA severity groups. Subsequently, a multivariate regression analysis was performed.
Results
The average frequency of coactivation with SA in control subjects was 4.1 events/h and that without SA was 1.7 events/h. These frequencies increased with the severity of OSA during non-REM sleep. The distance of the hyoid to the Frankfurt plane was associated with the frequency of coactivation with (β = 0.298, p = 0.017) as well as without SA (β = 0.271, p = 0.038). The frequency of coactivation without SA was associated with aspiration (B = 0.192, p = 0.042).
Conclusions
Our data provide new insights into the relationship between swallowing and aspiration during sleep. We found that the longer the distance from the hyoid bone to the Frankfurt plane, the higher the coactivation without SA, which could lead to aspiration during sleep.
Clinical Trials
Retrospective observational study of swallowing during sleep in obstructive sleep apnea patients using polysomnography, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050460, UMIN000044187.
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Affiliation(s)
- Akane Kohno
- Department of Internal Medicine, Graduate School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
- Center for Dental Sleep Medicine, Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Masaki Kohno
- Center for Dental Sleep Medicine, Nippon Dental University Niigata Hospital, Niigata, Japan
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Shogo Ohkoshi
- Department of Internal Medicine, Graduate School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
- Department of Internal Medicine, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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Yeung J, Burke PGR, Knapman FL, Patti J, Brown EC, Gandevia SC, Eckert DJ, Butler JE, Bilston LE. Task-dependent neural control of regions within human genioglossus. J Appl Physiol (1985) 2022; 132:527-540. [PMID: 34989652 DOI: 10.1152/japplphysiol.00478.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Anatomical and imaging evidence suggests neural control of oblique and horizontal compartments of the genioglossus differs. However, neurophysiological evidence for differential control remains elusive. This study aimed to determine whether there are differences in neural drive to the oblique and horizontal regions of the genioglossus during swallowing and tongue protrusion. Adult participants (N=63; 48M) were recruited from a sleep clinic; 41 had Obstructive Sleep Apnoea (OSA: 34M, 8F). Electromyographic (EMG) was recorded at rest (awake, supine) using 4 intramuscular fine-wire electrodes inserted percutaneously into the anterior oblique, posterior oblique, anterior horizontal and posterior horizontal genioglossus. Epiglottic pressure and nasal airflow were also measured. During swallowing, two distinct EMG patterns were observed- a monophasic response (single EMG peak) and a biphasic response (two bursts of EMG). Peak EMG and timing of the peak relative to epiglottic pressure were significantly different between patterns (linear mixed models, p<0.001). Monophasic activation was more likely in the horizontal than oblique region during swallowing (OR=6.83, CI=3.46-13.53, p<0.001). In contrast, during tongue protrusion, activation patterns and EMG magnitude were not different between regions. There were no systematic differences in EMG patterns during swallowing or tongue protrusion between OSA and non-OSA groups. These findings provide evidence for functional differences in the motoneuronal output to the oblique and horizontal compartments, enabling differential task-specific drive. Given this, it is important to identify the compartment from which EMG is acquired. We propose that the EMG patterns during swallowing may be used to identify the compartment where a recording electrode is located.
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Affiliation(s)
- Jade Yeung
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | | | - Fiona L Knapman
- grid.250407.4Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jessica Patti
- grid.250407.4Neuroscience Research Australia, Randwick, Australia
| | - Elizabeth C Brown
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Simon C Gandevia
- grid.250407.4Neuroscience Research Australia, Randwick, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health (AISH)/ Flinders Health and Medical Research Institute Sleep Health, grid.1014.4Flinders University, Bedford Park, SA, Australia
| | - Jane E Butler
- grid.250407.4Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, grid.1005.4Neuroscience Research Australia, Randwick, Australia
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