Neuro-Sono, São Paulo Hospital Sleep Laboratory, Universidade Federal de São Paulo, Rua Claudio Rossi 394, CEP 01547-000, São Paulo, SP, Brazil.
Sleep Breath. 2011 May;15(2):209-13. doi: 10.1007/s11325-010-0474-9. Epub 2011 Jan 13.
Patients with obstructive sleep apnea (OSA) may have subclinical swallowing abnormalities due to progressive mechanical trauma of the pharyngeal tissues caused by snoring. There are few trials on swallowing among OSA patients, and most of them used videoradiography. The aim of this trial was to show swallowing function in OSA patients by nasal fibroscopy.
Eleven patients with OSA diagnosed by polysomnography, with a mean age of 48 ± 14 years, without spontaneous complaints of swallowing, and 14 non-snoring volunteers, with a mean age of 47 ± 12 years, without spontaneous complaints of swallowing, participated in the study. The participants were evaluated using nasal fibroscopy. Each participant was offered diet boluses (5 and 10 ml) such as thin liquids, purée, and solids, and their swallowing function was determined according to the following criteria: (1) premature oral leakage to the pharynx; (2) laryngeal penetration; (3) tracheal aspiration; and (4) pharyngeal stasis.
Sixty-four percent of the OSA patients presented premature oral leakage, 55% presented pharyngeal stasis of the bolus after swallowing, and we did not observe laryngeal penetration or tracheal aspiration. There were no subclinical manifestations in the control group.
OSA patients presented subclinical manifestations of abnormal swallowing, when analyzed using nasal fibroscopy, possibly associated with neuromuscular injury caused by snoring.
由于打鼾引起的咽组织渐进性机械性创伤,阻塞性睡眠呼吸暂停(OSA)患者可能存在亚临床吞咽异常。针对 OSA 患者吞咽功能的研究较少,且大多数研究采用视频放射成像。本试验旨在通过鼻纤维镜检查显示 OSA 患者的吞咽功能。
11 名经多导睡眠图诊断为 OSA 的患者(平均年龄 48±14 岁)、无自发性吞咽困难主诉,以及 14 名非打鼾志愿者(平均年龄 47±12 岁)、无自发性吞咽困难主诉,参与了本研究。参与者接受鼻纤维镜检查。每位参与者均被提供 5 毫升和 10 毫升的饮食丸(稀薄液体、泥状食物和固体食物),并根据以下标准确定其吞咽功能:(1)过早向咽腔漏出;(2)吞咽后食团滞留在咽部;(3)喉咽腔吸入;(4)咽部滞留。
64%的 OSA 患者出现过早口腔漏液,55%的患者在吞咽后出现食团滞留在咽部,未观察到喉咽腔穿透或气管吸入。对照组无亚临床表现。
通过鼻纤维镜检查,OSA 患者表现出异常吞咽的亚临床表现,可能与打鼾引起的神经肌肉损伤有关。