Yagi Naomi, Oku Yoshitaka, Nagami Shinsuke, Yamagata Yoshie, Kayashita Jun, Ishikawa Akira, Domen Kazuhisa, Takahashi Ryosuke
Department of Swallowing Physiology, Hyogo College of MedicineNishinomiya, Japan.
Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan.
Front Physiol. 2017 Sep 22;8:676. doi: 10.3389/fphys.2017.00676. eCollection 2017.
Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing-swallowing discoordination occurs are not well-understood. : We hypothesized that breathing-swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system. The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow), pause duration (duration of respiratory pause for swallowing), and the breathing-swallowing coordination pattern. We classified swallows that closely follow inspiration (I) as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing-swallows discoordination. We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing-swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.
吸气时吞咽以及吞咽后紧接着吸气会增加误吸的几率，并可能导致病情加重。然而，这种呼吸 - 吞咽失调发生的机制尚未完全明确。我们假设当吞咽在呼吸周期中的时机不恰当时，会发生呼吸 - 吞咽失调。为了验证这一假设，我们使用非侵入性吞咽监测系统，对健康受试者和吞咽困难患者的呼吸和吞咽活动进行了监测。测量的参数包括吞咽在呼吸周期中的时机、吞咽潜伏期（呼吸暂停开始到吞咽开始之间的间隔）、暂停持续时间（吞咽时呼吸暂停的持续时间）以及呼吸 - 吞咽协调模式。我们将紧跟吸气（I）的吞咽分类为I - SW，而将在吸气之前的吞咽分类为SW - I模式。吞咽困难患者的吞咽潜伏期和暂停持续时间延长，并且倾向于出现反映呼吸 - 吞咽失调的I - SW或SW - I模式。我们得出结论，在呼吸周期中不恰当的时机进行吞咽会导致呼吸 - 吞咽失调，并且吞咽潜伏期的延长会导致吞咽时机延迟，从而使吞咽困难患者的SW - I模式增加。
