Sato Kiminori, Chitose Shun-Ichi, Sato Kiminobu, Sato Fumihiko, Ono Takeharu, Umeno Hirohito
Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Auris Nasus Larynx. 2021 Aug;48(4):659-665. doi: 10.1016/j.anl.2020.11.021. Epub 2020 Dec 6.
The clearance of the pharynx by deglutition and the respiratory phase patterns associated with deglutition are important in protecting airways and lungs against aspiration. The deglutition and respiratory phase patterns during sleep in patients (without swallowing disorders while awake) with obstructive sleep apnea (OSA) precipitating recurrent intractable aspiration pneumonia were investigated.
After videoendoscopic and videofluorographic examinations of swallowing showed subjects had no swallowing disorders while awake, two adults with recurrent intractable aspiration pneumonia precipitated by severe OSA were examined via time-matched digital recordings of polysomnography and surface electromyography of the muscles (thyrohyoid and suprahyoid muscles) related to swallowing and compared with the same patients before and under CPAP therapy.
CPAP therapy cured recurrent intractable aspiration pneumonia. Swallows following and/or followed by inspiration (uncoordinated deglutition with respiration), which were frequently observed before CPAP therapy, were markedly reduced under CPAP therapy. On the other hand, swallows following and/or followed by expiration (coordinated deglutition with respiration) markedly increased under CPAP therapy. Deglutition was related to the sleep stage. The deeper the sleep stage, the lower the deglutition frequency. Before and under CPAP therapy, swallowing was infrequent and absent for long periods. However, respiratory phase patterns associated with sleep-related deglutition in patients with OSA under CPAP therapy markedly improved.
In patients (without swallowing disorders while awake) with OSA precipitating recurrent intractable aspiration pneumonia, the high rate of uncoordinated deglutition with respiration (swallows following and/or followed by inspiration) during sleep were markedly reduced and the rate of coordinated deglutition with respiration (swallows following and/or followed by expiration) was markedly increased under CPAP therapy. Sleep-related deglutition and respiratory phase patterns are likely to adversely influence aspiration pneumonia in patients with OSA. CPAP therapy improved not only apnea-hypopnea during sleep and sleep quality but also sleep-related deglutition, especially respiratory phase patterns associated with deglutition in patients with OSA. CPAP therapy may decrease the risk of aspiration and greatly improve aspiration-related diseases such as aspiration pneumonia.
吞咽时咽部的清理以及与吞咽相关的呼吸阶段模式对于保护气道和肺部免受误吸至关重要。本研究对患有阻塞性睡眠呼吸暂停（OSA）并引发复发性难治性吸入性肺炎的患者（清醒时无吞咽障碍）睡眠期间的吞咽和呼吸阶段模式进行了调查。
在视频内镜和视频荧光吞咽检查显示受试者清醒时无吞咽障碍后，对两名因严重OSA引发复发性难治性吸入性肺炎的成年人进行了多导睡眠图和与吞咽相关肌肉（甲状舌骨肌和舌骨上肌）表面肌电图的时间匹配数字记录，并与同一患者在CPAP治疗前及治疗期间进行比较。
CPAP治疗治愈了复发性难治性吸入性肺炎。在CPAP治疗前经常观察到的吸气后和/或吸气前吞咽（吞咽与呼吸不协调）在CPAP治疗期间明显减少。另一方面，呼气后和/或呼气前吞咽（吞咽与呼吸协调）在CPAP治疗期间明显增加。吞咽与睡眠阶段有关。睡眠阶段越深，吞咽频率越低。在CPAP治疗前及治疗期间，吞咽很少且长时间不存在。然而，CPAP治疗下OSA患者与睡眠相关吞咽的呼吸阶段模式明显改善。
在患有OSA并引发复发性难治性吸入性肺炎的患者（清醒时无吞咽障碍）中，睡眠期间吞咽与呼吸不协调（吸气后和/或吸气前吞咽）的高发生率在CPAP治疗期间明显降低，而吞咽与呼吸协调（呼气后和/或呼气前吞咽）的发生率明显增加。与睡眠相关的吞咽和呼吸阶段模式可能会对OSA患者的吸入性肺炎产生不利影响。CPAP治疗不仅改善了睡眠期间的呼吸暂停低通气和睡眠质量，还改善了与睡眠相关的吞咽，特别是OSA患者与吞咽相关的呼吸阶段模式。CPAP治疗可能会降低误吸风险，并大大改善诸如吸入性肺炎等与误吸相关的疾病。
