Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure. Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex. Swallowing evaluation after surgery for obstructive sleep apnea syndrome: uvulopalatopharyngoplasty vs. expansion pharyngoplasty Geniotubercle advancement with a uvulopalatal flap and its effect on swallow function in obstructive sleep apnea. Validity and Reliability of the Eating Assessment Tool (EAT-10) Swallowing dysfunction related to snoring: a videoradiographic study. Non-invasive Assessment of Swallowing and Respiration Coordination for the OSA Patient Relationship Between Swallowing Function and Gas Exchange During Day and Night in Patients with Obstructive Sleep Apnea Syndrome Swallowing and pharyngo-esophageal manometry in obstructive sleep apnea. Laryngopharyngeal Sensory Deficits in Patients with Laryngopharyngeal Reflux and Dysphagia
BACKGROUND Nocturnal gastroesophageal reflux ( nGER ) is common in patients with obstructive sleep apnea ( OSA ) . Small , short-term studies have shown that treatment with nasal continuous positive airway pressure ( CPAP ) decreases esophageal acid exposure . OBJECTIVE To examine the relationship between OSA and nGER , and the effect of CPAP on nGER , in a long-term follow-up study of a large cohort of patients with OSA and nGER . METHODS We prospect ively studied 331 patients diagnosed as having OSA between October 1 , 1993 , and November 30 , 2000 . At baseline , patients grade d their frequency of nGER symptoms on a scale of 1 ( never ) to 5 ( always ) . All patients were prescribed CPAP for their OSA . At follow-up , the frequency of nGER symptoms was obtained by telephone interview . RESULTS Of the 331 patients with OSA , nGER was present in 204 ( 62 % ) before treatment with CPAP . Follow-up was obtained in 181 patients ( 89 % ) . Of these 181 patients , 165 ( 91 % ) were still using CPAP and 16 ( 9 % ) were not , forming the treatment and control groups , respectively . The patients compliant with CPAP had a significant improvement in nGER score , from a mean of 3.38 before CPAP treatment to 1.75 after treatment ( 48 % improvement ; P<.001 ) , while patients not using CPAP ( control subjects ) showed no improvement ( mean , 3.56 to 3.44 ; P = .55 ) . There was a strong correlation between CPAP pressure and improvement in nGER score ( correlation , r = 0.70 ; P<.001 ) , with patients with higher CPAP pressures demonstrating a greater improvement in nGER score . CONCLUSIONS Nocturnal GER is common in patients with OSA . Treatment with nasal CPAP decreases the frequency of nGER symptoms by 48 % . Higher nasal CPAP pressures are associated with greater improvement in nGER UNLABELLED Obstructive sleep apnea ( OSA ) has high prevalence and may cause serious comorbidities . The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospect i ve multivariate assessment s of predictor variables for OSA . METHOD We evaluate gag reflex and palatal reflex , of fifty-five adult patients , and their subsequent overnight polysomnography . RESULTS Forty-one participants presented obstructive sleep apnea . The most relevant findings in our study were : [ 1 ] absence of gag reflex on patients with severe obstructive apnea ( p=0.001 ) ; [ 2 ] absence of palatal reflex on moderate obstructive apnea patients ( p=0.02 ) . CONCLUSION Gag reflex and palatal reflex , a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and /or obstructive sleep apnea syndrome Purpose To evaluate the effect of pharyngeal surgery on swallowing pattern in patients with obstructive sleep apnea syndrome ( OSAS ) , and to compare two surgical techniques : uvulopalatopharyngoplasty ( UPPP ) and expansion pharyngoplasty ( EP ) , through videofluoroscopy . Methods Longitudinal prospect i ve cohort , in a tertiary referral center . 17 adult patients were enrolled this study , divided into two groups : patients who underwent UPPP ( n = 10 ) or EP ( n = 7 ) .  Swallowing videofluoroscopy  ( for both liquid and pasty consistences ) was assessed at three different periods : before surgery , and at 14 and 28 days following surgery . Comparisons were performed between pre- and post-operative ( PO ) swallowing conditions in the same patient , and between surgical techniques . Results Asymptomatic OSAS patients already presented altered swallowing pattern before surgery . Both surgical procedures led to an increased hyoid movement time and an increased frequency of laryngeal penetration in early PO during liquid ingestion . For pasty consistency , both techniques reduced velum movement time and increased pharyngeal transit time and the rate of stasis in hypopharynx . All these parameters reached or tended to reach the pre-operative indices at day PO 28 . Conclusions OSAS patients show sub- clinical changes in swallowing pattern before surgery . Both surgical techniques are related to transitory changes in swallowing biomechanics . Complete or partial reversal to pre-operative swallowing parameters occurs 1 month after both surgery techniques OBJECTIVES /HYPOTHESIS Evaluate swallowing characteristics before and after geniotubercle advancement ( GTA ) with a uvulopalatal flap ( UPF ) . STUDY DESIGN Prospect i ve case control series in an academic military practice . METHODS Fourteen patients with apnea-hypopnea index ( AHI ) > 10 scheduled for GTA were enrolled consecutively , eight of whom completed all aspects of the study for evaluation .  Video fluoroscopic swallow study was performed preoperatively and 4 months postoperatively . National Institute of Health freeware ImageJ64 software was used to measure hyolaryngeal elevation and displacement .  Video recordings assessed vallecular pooling , aspiration , and bolus movement . Studies were review ed by a speech pathologist and an otolaryngologist . RESULTS Preoperatively , the mean AHI was 48.3 ± 48.45 events per hour , with a median of 48.5 ( range , 12.4 - 76 ) . Postoperatively the mean AHI was 11.6 ± 10.7 events per hour , with a median of 10.75 ( range , 3.8 - 29 ) ( P = .003 ) . There was no reported pre- or postoperative dysphagia or aspiration . No radiographic evidence of silent aspiration was seen . Hyolaryngeal movements were measured as a percentage of C2-C4 reference distance . The superior elevations were pre- and postoperatively 40 % and 37 % ( P = .85 ) , anterior displacement changes 18.9 % and 18.8 % ( P = .23 ) , and total motion 49 % and 42 % ( P = .26 ) , respectively . CONCLUSIONS GTA with UPF surgery did not significantly affect the hyolaryngeal function of patients Objectives : The Eating Assessment Tool is a self-administered , symptom-specific outcome instrument for dysphagia . The purpose of this study was to assess the validity and reliability of the  10-item Eating Assessment Tool ( EAT-10 ) . Methods : The investigation consisted of 4 phases : 1 ) line-item generation , 2 ) line-item reduction and reliability , 3 ) normative data generation , and 4 ) validity analysis . All data were collected prospect ively . Internal consistency was assessed with the Cronbach alpha . Test-retest reliability was evaluated with the Pearson product moment correlation coefficient . Normative data were obtained by administering the instrument to a community cohort of healthy volunteers .  Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses . Results : A total of 629 surveys were administered to 482 patients . The internal consistency ( Cronbach alpha ) of the final instrument was 0.960 . The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91 . The mean ( ±SD ) EAT-10 score of the normal cohort was 0.40 ± 1.01 . The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia , 23.10 ± 12.22 for those with oropharyngeal dysphagia , 9.19 ± 12.60 for those with voice disorders , 22.42 ± 14.06 for those with head and neck cancer , and 11.71 ± 9.61 for those with reflux . The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders ( p < 0.001 ) . The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment ( p < 0.001 ) . Conclusions : The EAT-10 has displayed excellent internal consistency , test-retest reproducibility , and criterion-based validity . The normative data suggest that an EAT-10 score of 3 or higher is abnormal . The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders Biopsy studies of the soft palatal and oropharyngeal tissues in habitual snorers and patients suffering from obstructive sleep apnoea have shown signs of neurogenic lesions . These lesions might affect the pharyngeal swallowing function , which is dependent on adequate sensitivity . The objective of the present study was to test the hypothesis that snoring is associated with aberrant pharyngeal swallowing function . Forty-one consecutive patients without dysphagia , seeking medical attention because of heavy snoring and various degrees of daytime sleepiness , were prospect ively selected . Fifteen non-snoring volunteers without dysphagia served as controls . Patients and volunteers were videoradiographically examined in lateral and posteroanterior views during the oral and pharyngeal phases of swallowing . The hypothesis was verified . Snoring patients demonstrated deviant pharyngeal swallowing function seven times more frequently than did the non-snoring volunteers . Deviant pharyngeal swallowing function was observed in 22 ( 54 % ) of the snorers compared with 1 ( 7 % ) of the non-snoring volunteers . Impaired bolus control with premature leakage of bolus into the pharynx and a delayed evocation of the swallowing reflex was the most common finding , followed by bolus residual in the pharynx and laryngeal penetration . The conclusion was that snoring is associated with sub clinical pharyngeal swallowing dysfunction Abstract The objectives of this study are to investigate swallowing and its coordination with respiration in patients with obstructive sleep apnea ( OSA ) . This is a prospect i ve cohort study conducted in a tertiary referred Medical Center . A non-invasive method of assessing swallowing was used to detect the oropharyngeal swallowing parameters and the coordination with respiration during swallowing . The system used to assess swallowing detected : ( 1 ) movement of the larynx using a force-sensing resistor ; ( 2 ) submental muscle activity using surface electromyography ; and ( 3 ) coordination with respiration by measuring nasal airflow . Five sizes of water boluses ( maximum 20 mL ) were swallowed three times , and the data recorded and analyzed for each participant . Thirty-nine normal controls and 35 patients with OSA who fulfilled the inclusion criteria were recruited . The oropharyngeal swallowing parameters of the patients differed from the controls , including longer total excursion duration and shorter duration of submental muscles contraction . A longer swallowing respiratory pause ( SRP ) , temporary coordination with respiration during swallowing , was demonstrated in the patients compared with the controls . The frequency of non-expiratory/expiratory pre- and postswallowing respiratory phase patterns of the patients was similar with the controls . There was significantly more piecemeal deglutition in OSA patients when clumping 10- and 20-mL water boluses swallowing together ( p = 0.048 ) . Oropharyngeal swallowing and coordination with respiration affected patients with OSA , and it could be detected using a non-invasive method . The results of this study may serve as a baseline for further research and help advance research methods in obstructive sleep apnea swallowing studies Patients with obstructive sleep apnea syndrome ( OSAS ) are likely to exhibit an impaired swallowing reflex . However , mechanisms of disturbed swallowing reflex have not been determined . Because the upper-airway function is inhibited by hypoxia and hypercapnia , we examined the relationship between the swallowing function and gas exchange during day and night in patients with OSAS . Twenty-four patients with OSAS and 24 age-matched controls were studied . OSAS was diagnosed from overnight polysomnography .  The swallowing reflex was judged by the latent time ( LT ) for swallowing following bolus injection of distilled water at the suprapharynx , the inspiratory suppression time ( IST ) from swallowing termination to the next onset of inspiration , and the threshold for evoking the swallowing response in terms of a volume of water ( TV ) . Whereas the LT values are positively correlated with PaCO2 but not with PaO2 during the day , the values of IST and TV were not associated with daytime PaCO2 or PaO2 . Nocturnal nadir SaO2 was correlated with LT , IST , and TV . These results indicate that oxyhemoglobin desaturation and hypercapnia may be associated with one of the mechanisms of the impaired swallowing function in patients with OSAS INTRODUCTION Upper airway nerve and muscle damage associated with obstructive sleep apnea may impair the strength and dynamics of pharyngeal and esophageal contractions during swallowing . OBJECTIVE To evaluate the presence of alterations in pharyngoesophageal manometry in patients with obstructive sleep apnea with and without oropharyngeal dysphagia . METHODS This study prospect ively evaluated 22 patients with obstructive sleep apnea without spontaneous complaints of dysphagia , using a question naire , fiberoptic endoscopic evaluation of swallowing , and pharyngoesophageal manometry , including measurement of the upper and lower esophageal sphincter pressures and mean pharyngeal pressures at three levels during swallowing . RESULTS The dysphagia group consisted of 17 patients ( 77.3 % ) in whom swallowing abnormalities  were detected on fiberoptic endoscopic evaluation of swallowing ( n=15 ; 68.2 % ) and /or in the question naire ( n=7 ; 31.8 % ) . The five remaining cases comprised a control group without oropharyngeal dysphagia . In all cases of abnormalities on fiberoptic endoscopic evaluation of swallowing , there was premature bolus leakage into the pharynx . There was no statistically significant difference between the groups regarding any of the pharyngoesophageal manometry measurements , age , or severity of obstructive sleep apnea . CONCLUSION Pharyngoesophageal manometry detected no statistically significant difference between the groups with and without oropharyngeal dysphagia There are no reliable means of quantifying the edema that results from acid exposure to the posterior larynx in patients with laryngopharyngeal reflux ( LPR ) . However , it is possible to quantify laryngopharyngeal sensitivity in these patients by endoscopic administration of air pulses to the laryngeal mucosa in order to elicit the laryngeal adductor reflex . The purpose of this study was to determine whether patients with LPR have sensory deficits in the laryngopharynx , and whether treatment of these patients with a proton pump inhibitor ( PPI ) results in resolution of sensory deficits . Flexible endoscopic evaluation of swallowing with sensory testing was prospect ively performed in 54 patients with dysphagia without neurologic disease and in 25 healthy controls . The laryngopharyngeal sensory level , posterior laryngeal edema , and LPR were assessed . We defined LPR as passage of food material from the esophageal inlet retro grade into the hypopharynx . Patients with LPR were placed on 3 months of omeprazole or lansoprazole and then retested . Patients without LPR were placed on H2 blockers for 3 months and then retested . In the dysphagia group , 48 of 54 patients ( 89 % ) had edema of the posterior larynx , and 42 of 54 ( 78 % ) had laryngopharyngeal sensory deficits . We noted LPR in 38 of 54 ( 70 % ) . In the control group , 1 of 25 subjects ( 4 % ) had edema , sensory deficits , and LPR . The differences in incidence of edema , sensory deficits , and LPR between the dysphagia group and the control group were significant ( p < .001 , χ2 test ) . Twenty-three patients with LPR placed on a PPI returned for follow-up , with improvement in laryngeal edema in 14 of the 21 ( 67 % ) who had pretreatment edema and resolution of sensory deficits in 15 of the 19 ( 79 % ) who had pretreatment deficits . In the non-LPR , non-PPI group , 11 of 16 patients returned for follow-up , with improvement in laryngeal edema in none of the 11 and improvement in sensory deficits in 1 of the 11 ( 9.1 % ) . The differences in improvement in laryngeal edema and sensory deficits between the LPR , PPI group , and the non-LPR , non-PPI group were significant ( p < .01 , Fisher 's exact test ) . We conclude that patients with dysphagia and edema of the posterior larynx as a result of LPR have sensory deficits in the laryngopharynx . Treatment of these patients with a PPI appears to result in resolution of laryngopharyngeal edema and improvement of sensory deficits , both subjectively and objective ly
The purpose of this systematic review was to summarize and qualitatively analyze published evidence elucidating the prevalence of dysphagia and detail alterations in swallowing function in patients with OSAS .