Britton Deanna, Hoit Jeannette D, Pullen Elizabeth, Benditt Joshua O, Baylor Carolyn R, Yorkston Kathryn M
Department of Speech and Hearing Sciences, Portland State University, OR.
Northwest Center for Voice and Swallowing, Oregon Health & Sciences University, Portland.
Am J Speech Lang Pathol. 2019 Jul 15;28(2S):784-792. doi: 10.1044/2019_AJSLP-MSC18-18-0101.
Purpose The aim of this study was to describe experiences of speaking with 2 forms of noninvasive positive pressure ventilation (NPPV)-mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP)-in people with neuromuscular disorders who depend on NPPV for survival. Method Twelve participants (ages 22-68 years; 10 men, 2 women) with neuromuscular disorders (9 Duchenne muscular dystrophy, 1 Becker muscular dystrophy, 1 postpolio syndrome, and 1 spinal cord injury) took part in semistructured interviews about their speech. All subjects used M-NPPV during the day, and all but 1 used BPAP at night for their ventilation needs. Interviews were audio-recorded, transcribed, and verified. A qualitative descriptive phenomenological approach was used to code and develop themes. Results Three major themes emerged from the interview data: (a) M-NPPV aids speaking (by increasing loudness, utterance duration, clarity, and speaking endurance), (b) M-NPPV interferes with the flow of speaking (due to the need to pause to take a breath, problems with mouthpiece placement, and difficulty in using speech recognition software), and (c) nasal BPAP interferes with speaking (by causing abnormal nasal resonance, muffled speech, mask discomfort, and difficulty in coordinating speaking with ventilator-delivered inspirations). Conclusion These qualitative data from chronic NPPV users suggest that both M-NPPV and nasal BPAP may interfere with speaking but that speech is usually better and speaking is usually easier with M-NPPV. These findings can be explained primarily by the nature of the 2 ventilator delivery systems and their interfaces.
目的 本研究旨在描述依赖无创正压通气（NPPV）生存的神经肌肉疾病患者使用两种形式的无创正压通气——口含器无创正压通气（M-NPPV）和鼻双水平气道正压通气（BPAP）——时的说话体验。方法 12名年龄在22至68岁之间的神经肌肉疾病患者（10名男性，2名女性）（9例杜氏肌营养不良症、1例贝克肌营养不良症、1例脊髓灰质炎后遗症和1例脊髓损伤）参与了关于其言语的半结构化访谈。所有受试者白天使用M-NPPV，除1人外，所有人晚上使用BPAP以满足通气需求。访谈进行了录音、转录和核实。采用定性描述现象学方法进行编码和提炼主题。结果 访谈数据中出现了三个主要主题：（a）M-NPPV有助于说话（通过提高音量、话语时长、清晰度和说话耐力），（b）M-NPPV干扰说话流畅性（由于需要暂停呼吸、口含器放置问题以及使用语音识别软件困难），（c）鼻BPAP干扰说话（通过导致异常鼻音、语音模糊、面罩不适以及难以将说话与呼吸机输送的吸气协调）。结论 这些来自长期NPPV使用者的定性数据表明，M-NPPV和鼻BPAP都可能干扰说话，但使用M-NPPV时言语通常更好且说话通常更容易。这些发现主要可以通过两种通气输送系统及其接口的性质来解释。
