Laryngopharyngeal reflux and dysphagia in patients with obstructive sleep apnea: is there an association?

INTRODUCTION

There is evidence that patients with obstructive sleep apnea (OSA) tend to have a high prevalence of laryngopharyngeal reflux (LPR) and dysphagia. These diseases are known to share the same risk factors and may be interrelated, but there is a lack of studies evaluating their co-occurrence.

OBJECTIVES

To evaluate whether the presence of signs and symptoms suggestive of LPR may be associated with the presence of dysphagia in patients with moderate and severe obstructive sleep apnea (OSA), as well as assess the additional impact of these diseases on quality of life in patients with OSA.

METHODS

Seventy adult patients with moderate or severe OSA were included in the study. The RSI (Reflux Symptom Index) and Swallowing Quality of Life (SWAL-QOL) in dysphagia questionnaires were administered, laryngoscopy was performed to calculate the Reflux Finding Score (RFS), and fiber-optic endoscopic evaluation of swallowing (FEES) was conducted.

RESULTS

The prevalence of LPR was 59.7%, and the prevalence of dysphagia was 27.3%. The association between LPR and dysphagia was present in 17.9% of patients, but with no statistically significant difference. Lower SWAL-QOL scores were observed in several domains in patients with LPR and in only one domain in patients with evidence of dysphagia on FEES.

CONCLUSIONS

Although 17.9% of patients presented with findings suggestive of concomitant LPR and dysphagia, there was no statistically significant association between these two conditions. Patients with LPR had worse scores in several domains of dysphagia-related quality of life, while FEES evidence of dysphagia was associated with worse quality of life in only one domain.

Swallowing disorders after ischemic stroke

OBJECTIVE

To investigate occurrences of swallowing disorders after ischemic stroke.

METHOD

This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days.

RESULTS

50.5% were men and 49.5% women; mean age 65.3 years (SD= ± 11.7) (p ≤ 0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p ≤ 0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p ≤ 0.001).

CONCLUSION

Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

Use of thickened liquids in skilled nursing facilities

OBJECTIVE

Long-term care residents are routinely provided with thickened liquids for the management of dysphagia. The objective of this study was to identify the prevalence of thickened liquid use in skilled nursing facilities.

DESIGN

Facility-wide data were provided by staff at 252 randomly selected skilled nursing facilities owned by 11 multifacility providers. The sample represented 25,470 residents and approximately 20% of all freestanding skilled nursing facilities nationwide.

MAIN OUTCOMES MEASURES

Data regarding prevalence of thickened liquid use and facility characteristics were collected during May 2002. Statistical analysis Descriptive statistics included national and regional averages and national percentile distributions.

RESULTS

A mean of 8.3% (range 0% to 28%) of residents were receiving thickened liquids, with considerable variation between Centers for Medicare and Medicaid Services regions. Of those receiving thickened liquids, on average 60% received "nectar/syrup" thick, 33% received "honey" thick, and 6% received "pudding/spoon" thick, although the frequencies with which each thickness was prescribed varied widely between facilities (range 0% to 100%). Thickened water was provided to residents in 91.6% of facilities. Nationally, registered dietitian staffing levels were lower on average than speech language pathologist staffing levels.

CONCLUSIONS

Thickened liquids are provided to a significant segment of the skilled nursing facility resident population. In the absence of outcomes-based practice standards to guide administrative decisions related to the provision of thickened liquids, dietetics professionals may find regional and national norms helpful for quality assurance processes and to inform resource management decisions in clinical staffing and foodservice.

Clinical Characteristics of Acute Dysphagia in Pediatric Patients Following Traumatic Brain Injury

PRIMARY OBJECTIVE

To document the clinical characteristics of acute dysphagia in a group of pediatric patients after traumatic brain injury (TBI).

RESEARCH DESIGN

Prospective group study.

METHODS

Fourteen subjects (7 males, 7 females), aged 4 years 1 month to 15 years, with moderate or severe TBI (Glasgow Coma Scale [GCS] < 12). Subjects were assessed via clinical bedside examination documenting cognitive status, oromotor function, feeding function, dietary recommendations, and an indication of overall feeding severity.

RESULTS

A pattern of impaired cognition, altered behavior related to feeding, severe tonal and postural deficits, oromotor, respiratory, and laryngeal impairments, and oral sensitivity issues was revealed.

CONCLUSIONS

Swallowing impairment was affected by multilevel deficits, which both individually and in combination had a negative impact on swallowing competence and safety. In light of deficits identified, which could not be observed on videofluoroscopic investigation alone, this study highlighted the importance of the clinical bedside examination in assessing dysphagia in pediatric patients post-TBI for identifying targets for intervention.