|
1
|
Yanagida R, Yamaguchi K, Nakagawa K, Yoshimi K, Hino T, Kisara A, Tohara H. Sleep apnea and dysphagia in patients after a stroke recovering in convalescence rehabilitation. J Prosthet Dent 2024:S0022-3913(24)00638-3. [PMID: 39516148 DOI: 10.1016/j.prosdent.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 11/16/2024]
Abstract
STATEMENT OF PROBLEM Sleep apnea is prevalent among patients after a stroke and can complicate recovery, particularly in those with dysphagia. While studies have investigated sleep apnea in patients after a stroke in acute-care settings, its prevalence and impact of those in convalescent rehabilitation remain largely unknown. PURPOSE The purpose of this clinical study was to investigate the prevalence and severity of sleep apnea among patients after a stroke in convalescent rehabilitation and to explore the relationship between the severity of sleep apnea and dysphagia. MATERIAL AND METHODS In total, 196 patients after a stroke hospitalized in a rehabilitation hospital in Chiba Prefecture, Japan were enrolled in this study. The participants had suffered a stroke and had been admitted for post-stroke rehabilitation after being discharged from acute-care hospitals. An overnight sleep test was administered with WatchPAT, which measured the apnea-hypopnea index (AHI), minimum SpO2 (MinSpO2), and 3% oxygen desaturation index (ODI3%). Functional oral intake level was assessed with the Functional Oral Intake Scale (FOIS). Statistical analyses were conducted by using multiple regression followed by the 2-sample t test, Kruskal-Wallis tests, and the chi-squared test (α=.05). RESULTS Among the initial 196 participants enrolled, 140 participants (78 men and 62 women; mean age, 73.3 ±12.4 years) underwent a sleep test, with only 91 completing it. Out of the 91 participants, 85 (93.4%) had sleep apnea, and the prevalence increased to 95.7% specifically among participants with dysphagia. Significant differences in Japan Coma Scale scores (P<.001) and modified Rankin Scale scores (P<.001) were observed between the tube-dependent (FOIS 1 to 3) and total oral diet (FOIS 4 to 7) groups. Multiple regression analysis revealed a significant association between AHI and BMI (P=.020), and AHI and FOIS (P=.007), adjusted for age, sex, and confounding factors. CONCLUSIONS This study revealed a high prevalence of sleep apnea among patients after a stroke in convalescent rehabilitation, as well as a significant correlation between the severity of sleep apnea and dysphagia. Clinicians should consider sleep apnea management as a critical component of post-stroke rehabilitation, given its potential for improving swallowing function.
Collapse
Affiliation(s)
- Ryosuke Yanagida
- Clinical Resident, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Senior Assistant Professor, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Kazuharu Nakagawa
- Associate Professor, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Assistant Professor, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takami Hino
- Dental Hygienist, Dysphagia Rehabilitation, Dental Clinic, Shin-Yachiyo Hospital, Chiba, Japan
| | - Ayumi Kisara
- Dental Hygienist, Dysphagia Rehabilitation, Dental Clinic, Shin-Yachiyo Hospital, Chiba, Japan
| | - Haruka Tohara
- Professor and Chair, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| |
Collapse
|
|
2
|
Saito N, Ogawa T, Shiraishi N, Koide R, Komine H, Yokoyama M, Hanawa S, Sasaki K. Difference in the Electromyographic Behavior of the Masticatory and Swallowing Muscles During Cued Versus Spontaneous Swallowing. Dysphagia 2024; 39:398-406. [PMID: 37752277 PMCID: PMC11127863 DOI: 10.1007/s00455-023-10621-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
The risk of dysphagia and/or aspiration is determined using screening tests, such as the repeated saliva swallowing test and modified water swallowing test, which evaluate cued swallowing. However, humans masticate and swallow foods with various consistencies, forms, and amounts, without conscious awareness. Therefore, this study aimed to examine the difference in the behavior of masticatory and swallowing muscles during spontaneous versus cued swallowing through a series of mastication and swallowing processes by evaluating surface electromyogram (sEMG) signals. The effect of the consistency and amount of food on the behavior of these muscles was also investigated. The sEMG recordings of the masseter muscles and anterior belly of the digastric muscle for 12 subjects, and genioglossus muscle for 5 subjects were obtained. The genioglossus activity was recorded using custom-made ball electrodes. The test foods were cookies and tofu, in amounts of 2 g and 4 g. The normalized muscle activity (integrated EMG), duration of the muscle activity, initial activation timepoint of each muscle, and total duration of swallowing were compared among four conditions. The activity of each muscle was significantly higher during the swallowing of cookies than tofu, for 4 g vs 2 g, and for cued versus spontaneous swallowing. The duration of each muscle activity, initial activation timepoint, and total duration of swallowing were significantly longer for cookies versus tofu, for 4 g vs 2 g, and for spontaneous versus cued swallowing. These results suggest that the behavior of the masticatory and swallowing muscles is affected by cued swallowing and by the consistency and amount of food.
Collapse
Affiliation(s)
- Naoya Saito
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Toru Ogawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Naru Shiraishi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Rie Koide
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hideya Komine
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masayoshi Yokoyama
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Soshi Hanawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| |
Collapse
|
|
3
|
Maghsoudipour M, Nokes B, Bosompra NO, Jen R, Li Y, Moore S, DeYoung PN, Fine J, Edwards BA, Gilbertson D, Owens R, Morgan T, Malhotra A. A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes. J Clin Med 2021; 10:jcm10194554. [PMID: 34640575 PMCID: PMC8509668 DOI: 10.3390/jcm10194554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.
Collapse
Affiliation(s)
- Maryam Maghsoudipour
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Brandon Nokes
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Naa-Oye Bosompra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Rachel Jen
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Yanru Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;
| | - Stacie Moore
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Pamela N. DeYoung
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Janelle Fine
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Bradley A. Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC 3800, Australia;
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
| | - Dillon Gilbertson
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Robert Owens
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Todd Morgan
- Department of Dentistry, Scripps Encinitas Hospital, Encinitas, CA 92024, USA;
| | - Atul Malhotra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
- Correspondence:
| |
Collapse
|