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Mira AS, Goldsberry LJ, Previtera MJ, Simmons AK, McKenna VS. A Scoping Review on the Intersection Between Voice and Swallowing Measures in Healthy and Disordered Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-18. [PMID: 39196816 DOI: 10.1044/2024_ajslp-24-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE Voice and swallowing are distinct functions that share anatomical and physiological properties; however, research investigating their intersection is limited. The purpose of this scoping review was to explore the literature surrounding the relationship between voice and swallowing measures in healthy adults and those with non-degenerative disorders. Specifically, we aimed to elucidate whether objective voice measures could be used as correlates of swallowing function. METHOD We systematically searched four databases (Embase, PubMed, CINAHL, and Web of Science) for relevant literature using a combination of key words and controlled vocabulary generated from the Yale Mesh Analyzer. The inclusion criteria consisted of peer-reviewed studies in the English language that reported on healthy adults and/or patients with non-degenerative neurological disorders and pulmonary diseases and contained instrumental and/or objective voice and swallowing measures. Two raters completed the abstract screening process followed by independent full-text reviews. Case studies, review studies, gray literature, or abstract-only studies were excluded. RESULTS Among 5,485 screened studies, 182 were fully reviewed, with only 11 studies meeting the inclusion criteria. Eight studies found an association between voice and swallowing objective measures, whereas the other three did not. Significant voice measures that were related to swallowing safety and/or physiology included maximum fundamental frequency (F0), F0 range, maximum phonation time, biomechanics of effortful pitch glides, and voice onset time. CONCLUSIONS Although there was heterogeneity in the measures used, specific objective voice measures showed promise in clinical practice as a screening tool for dysphagia. Further investigations are needed to validate the clinical utility of these measures across diverse patient populations.
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Affiliation(s)
- Amna S Mira
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Lindsey J Goldsberry
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | | | - Amanda K Simmons
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Victoria S McKenna
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
- Department of Biomedical Engineering, University of Cincinnati, OH
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, OH
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Vasconcellos P, Mafort TT, Ribeiro-Alves M, Costa CHD. Association between swallowing dynamics, tongue pressure and pulmonary function in patients with idiopathic pulmonary fibrosis. BMC Pulm Med 2024; 24:315. [PMID: 38965496 PMCID: PMC11223328 DOI: 10.1186/s12890-024-03117-3] [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: 11/22/2023] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Swallowing is a complex process that requires the coordination of muscles in the mouth, pharynx, larynx, and esophagus. Dysphagia occurs when a person has difficulty swallowing. In the case of subjects with respiratory diseases, the presence of oropharyngeal dysphagia potentially increases lung disease exacerbations, which can lead to a rapid decline in lung function. This study aimed to analyze the swallowing of patients with idiopathic pulmonary fibrosis (IPF). METHODS Patients with IPF were evaluated using the Eating Assessment Tool (EAT-10), tongue pressure, the Timed Water Swallow Test (TWST), and the Test of Mastication and Swallowing Solids (TOMASS). The findings were related to dyspnea severity assessed by the modified Medical Research Counsil (mMRC) score; the nutritional status screened with Mini Nutritional Assessment (MNA) tool; and pulmonary function tests, specifically spirometry and measurement of the diffusing capacity for carbon monoxide (DLCO), the maximal inspiratory pressure (PImax), and the maximal expiratory pressure (PEmax). RESULTS The sample consisted of 34 individuals with IPF. Those who exhibited swallowing modifications scored lower on the MNA than those who did not (9.6 ± 0.76 vs. 11.64 ± 0.41 points; mean difference 1.98 ± 0.81 points; p = 0.02). They also showed poorer lung function when considering the predicted force vital capacity (FVC; 81.5% ± 4.61% vs. 61.87% ± 8.48%; mean difference 19.63% ± 9.02%; p = 0.03). The speed of liquid swallowing was altered in 31of 34 of the evaluated subjects (91.1%). The number of liquid swallows correlated significantly with the forced expiratory volume in 1 s (FEV1)/FVC ratio (r = 0.3; p = 0.02). Solid eating and swallowing assessed with the TOMASS score correlated with lung function. The number of chewing cycles correlated negatively with PImax% predicted (r = -0.4; p = 0.0008) and PEmax% predicted (r = -0.3; p = 0.02). FVC% predicted correlated with increased solid swallowing time (r = -0.3; p = 0.02; power = 0.6). Swallowing solids was also impacted by dyspnea. CONCLUSION Patients with mild-to-moderate IPF can present feeding adaptations, which can be related to the nutritional status, lung function, and the severity of dyspnea.
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Affiliation(s)
- Paula Vasconcellos
- Pedro Ernesto University Hospital, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio De Janeiro, Brazil.
| | - Thiago Thomaz Mafort
- Pulmonology Discipline, Pedro Ernesto University Hospital, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, Brazil
| | - Marcelo Ribeiro-Alves
- Laboratório de Pesquisa Clínica em DST-AIDS, Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz - FIOCRUZ - Rua Leopoldo Bulhões, Manguinhos, Rio de Janeiro, 1480, Brazil
| | - Cláudia Henrique da Costa
- Pulmonology Discipline, Pedro Ernesto University Hospital, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, Brazil
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Fan Y, Shi Y, Wu Y, Yang F, Zhang C, Gu M, Hu P, Duan W, Wang H, Zhou Y. A nomogram-based prediction model for dysphagia in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Clin Nurs 2024. [PMID: 38764243 DOI: 10.1111/jocn.17208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/21/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024]
Abstract
AIM AND OBJECTIVES To investigate the prevalence of dysphagia in patients with COPD, identify the risk factors for dysphagia, develop a visual clinical prediction model and quantitatively predict the probability of developing dysphagia. BACKGROUND Patients with COPD are at high risk of dysphagia, which is strongly linked to the acute exacerbation of their condition. The use of effective tools to predict its risk may contribute to the early identification and treatment of dysphagia in patients with COPD. DESIGN A cross-sectional design. METHODS From July 2021 to April 2023, we enrolled 405 patients with COPD for this study. The clinical prediction model was constructed according to the results of a univariate analysis and a logistic regression analysis, evaluated by discrimination, calibration and decision curve analysis and visualized by a nomogram. This study was reported using the TRIPOD checklist. RESULTS In total, 405 patients with COPD experienced dysphagia with a prevalence of 59.01%. A visual prediction model was constructed based on age, whether combined with cerebrovascular disease, chronic pulmonary heart disease, acute exacerbation of COPD, home noninvasive positive pressure ventilation, dyspnoea level and xerostomia level. The model exhibited excellent discrimination at an AUC of .879. Calibration curve analysis indicated a good agreement between experimental and predicted values, and the decision curve analysis showed a high clinical utility. CONCLUSION The model we devised may be used in clinical settings to predict the occurrence of dysphagia in patients with COPD at an early stage. RELEVANCE TO CLINICAL PRACTICE The model can help nursing staff to calculate the risk probability of dysphagia in patients with COPD, formulate personalized preventive care measures for high-risk groups as soon as possible to achieve early prevention or delay of dysphagia and its related complications and improve the prognosis. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ying Fan
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yuxin Shi
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng, China
| | - Yunyun Wu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fang Yang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Chao Zhang
- Xiangyang Hospital affiliated to of Hubei University of Chinese Medicine, Xiangyang, China
| | - Mengjun Gu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Pengchao Hu
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | | | - Hongli Wang
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yumei Zhou
- Xiangyang No 1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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Westergren A, Smithard D, Westergaard M, Norup A, Riis J, Krarup A, Hansen LEM, Emborg C, Melgaard D. Convergent and discriminant validity of the Minimal Eating Observation Form - version II: a cross-sectional study. BMC Geriatr 2024; 24:27. [PMID: 38182980 PMCID: PMC10770885 DOI: 10.1186/s12877-023-04639-x] [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: 10/31/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The Minimal Eating Observation Form - Version II (MEOF-II) is a brief and easy to use screening tool for eating difficulties, that is psychometrically robust. The aim of this study was to explore convergent (measuring similar constructs) and discriminant (measuring somewhat different constructs) validity of the MEOF-II to other validated dysphagia specific, activity and participation related instruments. METHODS In this cross-sectional study, participants (n = 100, mean age 72, n = 42 women), diagnosed with either chronic pulmonary disease, Parkinson´s disease, Multiple Sclerosis, or stroke were recruited from rehabilitation centres. Patient-reported outcomes and clinical-rated assessments, capturing eating ability in general and swallowing in specific, included: The Dysphagia Handicap Index (DHI), the 4-question test (4QT), the Minimal Eating Observation Form - II, the Volume - Viscosity Swallow Test (V-VST), Flexible Endoscopic Evaluation of Swallowing (FEES) documented according to the Penetration-Aspiration Scale (PAS). Type of oral intake was documented using the Functional Oral Intake Scale (FOIS). Activities in daily living was assessed with Barthel index (BI). Spearman's correlation coefficient was used to analyze associations. The MEOF-II total score was hypothesised to have moderate correlations (r ≥ 0.3) with the other assessments, besides with PAS and FOIS (weak correlations, r < 0.3). RESULTS In total 78 participants had any type of eating difficulties (MEOF-II), 69 reported dysphagia (4QT), 62 had dysphagia according to V-VST, 29 showed evidence of penetration/aspiration (PAS), and 31 participants had decreased oral intake ability (FOIS). The MEOF-II total score had moderate correlations with DHI, BI, 4QT, V-VST volume, and weak correlations with V-VST dysphagia and viscosity, PAS, and FOIS. Comparing a prior hypothesised correlation strengths against empirical findings showed that 83% of the hypothesised correlations were correct. CONCLUSIONS The MEOF-II is a holistic and objective screening tool that can indicate the need for further assessment and corresponds well with the persons' subjective experiences. MEOF-II does not specifically assess the risk for penetration/aspiration.
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Affiliation(s)
- Albert Westergren
- The PRO-CARE Group and the Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, SE-291 88, Kristianstad, Sweden.
| | - David Smithard
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, GB, UK
- Centre for Exercise Activity and Rehabilitation (CEAR), School of Human Sciences, University of Greenwich, London, GB, UK
| | - Mark Westergaard
- Department of Physiotherapy and Occupational Therapy, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Anne Norup
- Department of Physiotherapy and Occupational Therapy, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Krarup
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Elise Møller Hansen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Dorte Melgaard
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Mancopes R, Steele CM. Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging. Codas 2023; 36:e20220260. [PMID: 37878956 PMCID: PMC10727231 DOI: 10.1590/2317-1782/20232022260] [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: 11/11/2022] [Accepted: 02/17/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Swallowing impairment is a serious extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies suggest that individuals with stable COPD show atypical values for several videofluoroscopy measures of swallowing, compared to healthy adults under age 60. However, it is unclear to what degree these changes are attributable to healthy aging. In this study, we aimed to clarify how swallowing in people with stable COPD differs from age-matched healthy controls. METHODS We performed a retrospective analysis of videofluoroscopy data from two previously-collected datasets: a) a sample of 28 adults with stable COPD (18 male); b) a sample of 76 healthy adults, from which 28 adults were selected, matched for sex and age to participants in the COPD cohort. In both prior studies, participants swallowed 20% w/v liquid barium prepared in different consistencies (thin; mildly, moderately, and extremely thick). Blinded duplicate ratings were performed according to a standard procedure, yielding measures of laryngeal vestibule closure (LVC) integrity and timing, swallow timing, upper esophageal sphincter (UES) opening, pharyngeal constriction and pharyngeal residue. Mann-Whitney U tests and odds ratios were performed to determine significant group differences (p<.05). RESULTS Across the consistencies tested, participants with COPD showed significantly shorter durations of LVC, earlier onsets and shorter durations of UES opening, and reduced pharyngeal constriction. No significant differences were seen in other measures. CONCLUSION These results point to features of swallowing in people with stable COPD that differ from changes seen with healthy aging, and which represent risks for potential aspiration.
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Affiliation(s)
- Renata Mancopes
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
| | - Catriona Margaret Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto - Toronto (ON), Canada.
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6
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Li W, Gao M, Liu J, Zhang F, Yuan R, Su Q, Wang Y, Wang Y. The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2022; 16:567-574. [PMID: 35670185 DOI: 10.1080/17476348.2022.2086123] [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: 02/08/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) in chronic obstructive pulmonary disease (COPD) patients seriously influence the long-term prognosis of COPD patients. The aim of this study was to assess the prevalence and risk factors of OD in patients with COPD through a systematic review and meta-analysis of observational studies. METHODS We identified all observational studies on the prevalence of OD in COPD patients by searching PubMed, Embase, the Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), the China Biomedical Literature Service System (CBM), the Wanfang Database, and the WeiPu (VIP) databases from database establishment to 1 December 2020. RESULTS Results of the meta-analysis showed that the prevalence of OD in COPD patients was 32.7% (95%CI=30.1, 35.4, I2=91.5%). Dyspnea, gastroesophageal reflux disease(GERD), xerostomia, sputum bacteria, poor physical capacity, poor quality of life, and high CRP level are the risk factors for OD in COPD patients. CONCLUSION : The prevalence of OD in COPD patients is high. There were some differences in OD among COPD patients with different sex, ages, continents, evaluation methods, patient source and COPD exacerbation.
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Affiliation(s)
- Wenyan Li
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.,West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingjing Gao
- Department of Anesthesia Surgery, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jin Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Fengwa Zhang
- First Department of Gynecology, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Rongjing Yuan
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Qingling Su
- First Department of Gynecology, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yetong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
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7
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Gonzalez Lindh M, Janson C, Blom Johansson M, Jonsson M, Mälberg E, Allansson E, Holm C, Jennische M, Koyi H. Swallowing dysfunction in patients hospitalised due to a COPD exacerbation. ERJ Open Res 2021; 7:00173-2021. [PMID: 34109239 PMCID: PMC8181655 DOI: 10.1183/23120541.00173-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group. Methods Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction. Results Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p≤0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC ≥2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=−0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=−0.23, p=0.21). Conclusion COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia. Patients hospitalised with #AECOPD experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control grouphttps://bit.ly/32awLkx
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Affiliation(s)
- Margareta Gonzalez Lindh
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Christer Janson
- Dept Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Mimmi Jonsson
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Emma Mälberg
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Holm
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Hirsch Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.,Dept of Respiratory Medicine, Karolinska Institute, Stockholm, Sweden
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Systematic Dysphagia Screening of Elderly Persons in the Emergency Department-A Feasibility Study. Geriatrics (Basel) 2020; 5:geriatrics5040075. [PMID: 33053743 PMCID: PMC7709572 DOI: 10.3390/geriatrics5040075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023] Open
Abstract
Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.
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Ayuse T, Hisamatsu N, Yamaguchi T, Takahashi Y, Tamada Y, Kurata S, Mishima G, Pinkham M, Tatkov S, Takahata H, Ayuse T. Efficacy of nasal high flow therapy on the coordination between breathing and swallowing of saliva during daytime nap in chronic obstructive pulmonary disease patients: A single center, randomized crossover controlled study. Medicine (Baltimore) 2020; 99:e21778. [PMID: 32846806 PMCID: PMC7447374 DOI: 10.1097/md.0000000000021778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are some clinical reports on dysphagia in patients with chronic obstructive pulmonary disease (COPD); however, its pathophysiology remains largely unknown.Changes in respiratory function occur in patients with COPD causing a decrease in tidal volume and an increase in respiratory rate (tachypnea). In addition, it leads to lack of coordination between respiration and swallowing.A new treatment called nasal high flow (NHF) has been introduced for patients with COPD, replacing the traditional non-invasive ventilation (NIV) procedure. The NHF therapy involves inhalation of high flow of humidified air, which reduces respiratory effort in patients with COPD. Furthermore, NHF therapy facilitates swallowing of saliva even during respiratory management. A recent clinical study reported that high-flow nasal cannula oxygen therapy for 6 weeks improved the health-related quality of life and reduced hypercapnia in patients with stable COPD. Taken together, NHF therapy is gaining attention in the clinical management of patients with COPD.Therefore, in this study, we aim to examine the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during daytime nap in patients with COPD. METHODS/DESIGN This open-label, investigator-initiated, single center study will evaluate the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during the daytime nap in COPD patients with forced expiratory volume in 1 second (FEV1%) of <70% during treatment at the Nagasaki University Hospital Respiratory Rehabilitation Center. Evaluations will be performed during the 90 to 180 minute "daytime nap" in the measurement room of the hospital. The primary endpoint will be the rate of appearance of the expiratory phase after swallowing of saliva and the frequency of swallowing during the measurement period. DISCUSSION The purpose of this study is to obtain evidence regarding the utility of NHF as a potential therapeutic device for COPD patients to prevent aspiration of saliva during the sleep stage of daytime nap. The utility will be assessed by comparing the decrease in incidence rates of the expiratory phase after swallowing of saliva in the NHF device group and the control group, wherein this device was not used.
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Affiliation(s)
| | | | | | | | | | | | | | - Max Pinkham
- Fisher & Paykel Healthcare Ltd., Auckland, New Zealand
| | | | - Hideaki Takahata
- Department of Rehabilitation Medicine, Nagasaki University Hospital
| | - Takao Ayuse
- Department of Special Care Dentistry
- Department of Dental Anesthesiology
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abstract
Due to growing recognition of comorbidities, COPD is no longer considered a disease affecting only the respiratory system. Its management now entails the early diagnosis and treatment of comorbidities. However, although many studies have examined the impact of comorbidities on the evolution of COPD and patients' quality of life, very few have explored the means to systematically identify and manage them. The aims of this article are to summarise the state of current knowledge about comorbidities associated with COPD and to propose a possible screening protocol in the outpatient setting, emphasising the areas needing further research.
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Affiliation(s)
- Delphine Natali
- Respiratory Medicine Dept, Hanoi French Hospital, Hanoi, Vietnam
| | | | | | - Belinda Cochrane
- Dept of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, Australia
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11
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Spronk PE, Spronk LEJ, Lut J, Gnacke E, Mijnes D, van Munster B, Kröner A. Prevalence and characterization of dysphagia in hospitalized patients. Neurogastroenterol Motil 2020; 32:e13763. [PMID: 31742866 DOI: 10.1111/nmo.13763] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/13/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Information on the prevalence of dysphagia in a generalized hospitalized population is lacking. We aimed to gain information on the recognition of dysphagia by nursing staff and the swallow characteristics of patients with and without dysphagia. METHODS The Eating Assessment Tool (EAT-10) and the volume-viscosity water swallow test (VVST) were utilized to assess the prevalence of dysphagia in a generalized hospitalized population in 2 centers (N = 205). Presence of dysphagia was defined as having either an EAT-10 score of 2 or higher or having a positive VVST. Nursing staff recognition of dysphagia was assessed. In addition, the swallow characteristics were assessed both clinically and using submandibular surface electromyographic (SEMG) values of the participants. KEY RESULTS The prevalence of dysphagia in the hospitalized patients was 30.7%. Nursing staff did hardly ever recognize the presence of dysphagia. Concerning the swallow characteristics, patients with dysphagia demonstrated an increase in the SEMG peak levels of the swallowing actions over the course of an exercise from 103 to 110 μV (P = .05), whereas patients without dysphagia did not demonstrate this effect. CONCLUSIONS & INFERENCES Training should be conducted for nursing staff to improve awareness and recognition of dysphagia and thus prevent dysphagia complications. Dysphagia is a large burden on the hospitalized population, and further research should be conducted into the specifics.
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Affiliation(s)
- Peter E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.,Expertise Center for Intensive Care Rehabilitation - ExpIRA, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - Laura E J Spronk
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.,Expertise Center for Intensive Care Rehabilitation - ExpIRA, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - Jonneke Lut
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.,Expertise Center for Intensive Care Rehabilitation - ExpIRA, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - Eva Gnacke
- Department of Speech and Language Pathology, Zuyderland School, Heerlen, The Netherlands
| | - Dionne Mijnes
- Department of Speech and Language Pathology, Zuyderland School, Heerlen, The Netherlands
| | - Barbara van Munster
- Department of Geriatrics, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.,Department of Geriatrics, Groningen University, Groningen, The Netherlands
| | - Anke Kröner
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
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Nishida T, Yamabe K, Ide Y, Honda S. Utility of the Eating Assessment Tool-10 (EAT-10) in Evaluating Self-Reported Dysphagia Associated with Oral Frailty in Japanese Community-Dwelling Older People. J Nutr Health Aging 2020; 24:3-8. [PMID: 31886801 DOI: 10.1007/s12603-019-1256-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the present study was to verify the associations between dysphagia as screened by the Eating Assessment Tool-10 (EAT-10) and indicators in the 100-mL water swallowing test (WST) or medical history among community-dwelling older people. STUDY DESIGN A cross-sectional study. SETTING AND PARTICIPANTS The study participants were 202 community-dwelling older Japanese adults aged ≥65 years. MEASUREMENTS We investigated the participants' basic attributes, including age, sex, body mass index, medical history (cerebrovascular disease, respiratory disease: chronic obstructive pulmonary disease [COPD], and history of pneumonia within the previous year), and number of prescribed medications. Dysphagia assessment was performed using the EAT-10 and the 100-mL WST as subjective and objective examinations, respectively. The 100-mL WST used four indicators (SC: swallowing capacity, VS: volume per swallow, TS: time per swallow, and choking signs). Patients with and without dysphagia according to the EAT-10 were divided into two groups according to a cutoff score of 3, and the two groups were then compared in terms of their characteristics including medical history and 100-mL WST indicators. A multiple logistic regression model was used to determine whether the indicators of the 100-mL WST or medical history were independently associated with dysphagia in the EAT-10. RESULTS The multiple logistic regression analysis revealed that dysphagia in the EAT-10 was independently associated with male sex (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 0.98-7.90), COPD (OR = 14.68; 95% CI = 3.14-68.85), and VS and TS in the 100-mL WST (OR = 0.85; 95% CI = 0.80-0.90 and OR = 3.03; 95% CI = 1.78-5.16, respectively). CONCLUSIONS Our results revealed that the EAT-10 was independently associated with the 100-mL WST and respiratory disease. We propose that swallowing rehabilitation incorporating respiratory training could be effective for older people screened using the EAT-10.
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Affiliation(s)
- T Nishida
- Sumihisa Honda, Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8520, Japan, TEL.: +81-95-819-7945, FAX.: +81-95-819-7907, E-mail:
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Satici C, López-Padilla D, Schreiber A, Kharat A, Swingwood E, Pisani L, Patout M, Bos LD, Scala R, Schultz MJ, Heunks L. ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2020; 6:00331-2019. [PMID: 32166088 PMCID: PMC7061203 DOI: 10.1183/23120541.00331-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.
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Affiliation(s)
- Celal Satici
- Respiratory Medicine, Istanbul Gaziosmanpasa Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Daniel López-Padilla
- Respiratory Dept, Gregorio Marañón University Hospital, Spanish Sleep Network, Madrid, Spain
| | - Annia Schreiber
- Interdepartmental Division of Critical Care, University of Toronto, Unity Health Toronto (St Michael's Hospital) and the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Aileen Kharat
- Pulmonology Dept, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Ema Swingwood
- University Hospitals Bristol NHS Foundation Trust, Adult Therapy Services, Bristol Royal Infirmary, Bristol, UK
| | - Luigi Pisani
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Lieuwe D. Bos
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Respiratory Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Marcus J. Schultz
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Leo Heunks
- Intensive Care, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
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Gonzalez Lindh M, Malinovschi A, Brandén E, Janson C, Ställberg B, Bröms K, Blom Johansson M, Lisspers K, Koyi H. Subjective swallowing symptoms and related risk factors in COPD. ERJ Open Res 2019; 5:00081-2019. [PMID: 31579679 PMCID: PMC6759627 DOI: 10.1183/23120541.00081-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/29/2019] [Indexed: 11/05/2022] Open
Abstract
Objectives This study aimed to investigate the prevalence of subjective (i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors. Methods A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test. Results In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28). Conclusion Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Eva Brandén
- Respir. Med. Unit, Dept Med. Solna and CMM, Karolinska Institutet and Karolinska University Hospital Solna, Solna, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Kristina Bröms
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | | | - Karin Lisspers
- Dept of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Hirsh Koyi
- Respir. Med. Unit, Dept Med. Solna and CMM, Karolinska Institutet and Karolinska University Hospital Solna, Solna, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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Amba V, Murphy G, Etemadi A, Wang S, Abnet CC, Hashemian M. Nut and Peanut Butter Consumption and Mortality in the National Institutes of Health-AARP Diet and Health Study. Nutrients 2019; 11:nu11071508. [PMID: 31269682 PMCID: PMC6682967 DOI: 10.3390/nu11071508] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 12/18/2022] Open
Abstract
Although previous studies have shown inverse associations between nut consumption and mortality, the associations between nut consumption and less common causes of mortality have not been investigated. Additionally, about 50% of peanut consumption in the US is through peanut butter but the association between peanut butter consumption and mortality has not been thoroughly evaluated. The National Institutes of Health-AARP (NIH-AARP) Diet and Health Study recruited 566,398 individuals aged 50–71 at baseline in 1995–1996. A food-frequency questionnaire was used to evaluate nut and peanut butter consumption. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for mortality using the non-consumers as reference groups and three categories of consumption. After excluding subjects with chronic diseases at baseline, there were 64,464 deaths with a median follow-up time of 15.5 years. We observed a significant inverse association between nut consumption and overall mortality (HR C4 vs C1 = 0.78, 95% CI = 0.76, 0.81, p ≤ 0.001). Nut consumption was significantly associated with reduced risk of cancer, cardiovascular, respiratory, infectious, renal and liver disease mortality but not with diabetes or Alzheimer’s disease mortality. We observed no significant associations between peanut butter consumption and all-cause (HR C4 vs C1 = 1.00, 95% CI = 0.98, 1.04, p = 0.001) and cause-specific mortality. In a middle-aged US population, nut intake was inversely associated with all-cause mortality and certain types of cause-specific mortality. However, peanut butter consumption was not associated with differential mortality.
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Affiliation(s)
- Vineeth Amba
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
- The College of New Jersey, Ewing, NJ 08628, USA
| | - Gwen Murphy
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, 14117-13135 Tehran, Iran
| | - ShaoMing Wang
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Maryam Hashemian
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA.
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, 14117-13135 Tehran, Iran.
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Caparroz F, Campanholo M, Stefanini R, Vidigal T, Haddad L, Bittencourt LR, Tufik S, Haddad F. Laryngopharyngeal reflux and dysphagia in patients with obstructive sleep apnea: is there an association? Sleep Breath 2019; 23:619-626. [PMID: 31020485 DOI: 10.1007/s11325-019-01844-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Fabio Caparroz
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil.
| | - Milena Campanholo
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Renato Stefanini
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Tatiana Vidigal
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Leonardo Haddad
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Lia Rita Bittencourt
- Department of Psychobiology, Instituto do Sono, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Instituto do Sono, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
| | - Fernanda Haddad
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Sao Paulo, Brazil
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Caparroz FA, de Almeida Torres Campanholo M, Sguillar DA, Haddad L, Park SW, Bittencourt L, Tufik S, Haddad FLM. A Pilot Study on the Efficacy of Continuous Positive Airway Pressure on the Manifestations of Dysphagia in Patients with Obstructive Sleep Apnea. Dysphagia 2018; 34:333-340. [PMID: 30251146 DOI: 10.1007/s00455-018-9944-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
Abstract
There is evidence in the literature demonstrating that patients with obstructive sleep apnea (OSA) may present with dysphagia, but few studies have evaluated whether this complaint can be reversed with treatment of OSA. To assess whether findings of dysphagia in patients with OSA can be reversed with the use of continuous positive airway pressure (CPAP) devices. Seventy adult patients (age 18-70 years) with moderate or severe OSA were included in the study. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) and completed the SWAL-QOL questionnaire on quality of life in dysphagia. Patients with visible abnormalities on FEES were treated with CPAP and reassessed after 3 months. The prevalence of dysphagia was 27.3% (18 patients). Premature spillage was the main finding. On comparison of groups with and without dysphagia, the SWAL-QOL score was significantly worse in the dysphagia group in domain 2 (eating duration and eating desire, p = 0.015), with no impact on overall score (p = 0.107). Of the 18 patients with dysphagia, 12 were started on CPAP; 11 exhibited satisfactory adherence and remained in the study. Abnormal FEES findings resolved in 81% (n = 9/11) of patients who started CPAP (p = 0.004), and dysphagia-specific quality of life also improved significantly (overall SWAL-QOL score, p = 0.028). In this sample of patients with OSA, the overall prevalence of dysphagia (as demonstrated by premature spillage on FEES) was 27.3%. Treatment of OSA with CPAP was able to reverse the endoscopic findings of swallowing dysfunction and to improve quality of life as measured by the SWAL-QOL.
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Affiliation(s)
- Fabio Azevedo Caparroz
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Danilo Anunciatto Sguillar
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung Woo Park
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Vespasiani-Gentilucci U, Pedone C, Muley-Vilamu M, Antonelli-Incalzi R. The pharmacological treatment of chronic comorbidities in COPD: mind the gap! Pulm Pharmacol Ther 2018; 51:48-58. [PMID: 29966745 DOI: 10.1016/j.pupt.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly associated with other chronic diseases, which poses several diagnostic and therapeutic problems. Indeed, important comorbidities frequently remain unrecognized and, then, untreated, whereas respiratory drugs may have non respiratory side effects, and selected non respiratory drugs may variably affect the respiratory function. OBJECTIVE to describe: how COPD affects the presentation and contributes to the diagnostic challenges of its most common comorbidities; how coexisting COPD impacts the therapeutic approach to selected comorbidities and viceversa. METHODS we distinguish comorbidities of COPD depending upon whether they are complications of COPD or share risk factors, mainly smoke, with it or, finally, aggravate COPD. We describe atypical presentations of and diagnostic clues to comorbidities and suggest screening procedures. Finally, the main therapeutic problems, as resulting from the risk of untoward effects of therapies of COPD and its comorbidity, with special attention to drug-drug interactions and possible overdosages, are described. RESULTS selected complications of COPD, such as osteoporosis, sarcopenia and dysphagia, are rarely recognized and treated, likely due to the poor awareness of them. Important comorbidities, such as coronary artery disease, chronic heart failure, obstructive sleep apnoea syndrome and chronic renal failure, also should be systematically searched for because of their commonly variant presentation. Disease-related symptoms should be distinguished from drug effects or drug-drug interaction effects. CONCLUSIONS a truly comprehensive view of the complex COPD patient, hopefully capitalizing on multidimensional geriatric assessment, is needed to dissect the many components of health status impairment and to provide the optimal care. Selected screening procedures are highly desirable to identify frequently missed comorbidities. Pharmacosurveillance is an essential part of the approach to COPD and its comorbidities.
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Affiliation(s)
| | - Claudio Pedone
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
| | - Moises Muley-Vilamu
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
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Jørgensen LW, Søndergaard K, Melgaard D, Warming S. Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients. Clin Nutr ESPEN 2017; 22:85-91. [DOI: 10.1016/j.clnesp.2017.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/10/2017] [Indexed: 12/14/2022]
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A Significant Association of Malnutrition with Dysphagia in Acute Patients. Dysphagia 2017; 33:258-265. [DOI: 10.1007/s00455-017-9855-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023]
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