Okuno Kentaro, Nohara Kanji, Takai Etsuko, Sakai Takayoshi, Fleetham John A, Ayas Najib T, Lowe Alan A, Almeida Fernanda R
Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry, 1-8, Yamadaoka, Suita-City, Osaka, 565-0871, Japan.
Dysphagia. 2016 Aug;31(4):579-86. doi: 10.1007/s00455-016-9719-5. Epub 2016 Jun 23.
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.
吞咽是一种保护气道的重要生理反应。尽管睡眠期间误吸可能导致误吸性肺炎，但其相关机制尚未阐明。我们通过在健康年轻成年人的每个睡眠阶段向咽部注入水来评估呼吸与吞咽之间的协调性。七名正常受试者参与了该研究。在多导睡眠图记录期间，为诱发吞咽，我们在清醒状态及每个睡眠阶段通过鼻导管向咽部注入蒸馏水。我们评估了吞咽潜伏期、吞咽呼吸暂停时间、吞咽时的呼吸阶段、吞咽次数和咳嗽情况。共记录到79次吞咽。与清醒状态（4.99秒）相比，在睡眠2期（10.05秒）和睡眠3期（44.17秒）时，吞咽潜伏期的中位数显著更长。睡眠3期的吞咽潜伏期四分位间距非常宽。在两名受试者中，与其他受试者相比，结果主要是延长的。各睡眠阶段之间的吞咽呼吸暂停时间没有显著差异。睡眠期间吞咽后吸气、反复吞咽和吞咽后咳嗽的情况比清醒时更频繁。这项研究表明，睡眠期间作为防止误吸的防御机制的呼吸与吞咽之间的协调性受到了损害。我们的结果从生理上支持了健康成年个体在睡眠期间会误吸咽部分泌物这一事实。
