Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy.
Division of Respiratory Diseases, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy.
Respir Res. 2021 Apr 21;22(1):117. doi: 10.1186/s12931-021-01702-2.
Epidemiology of dysphagia and its drivers in obstructive sleep apnea (OSA) are poorly understood. The study aims to investigate the prevalence of dysphagia symptoms and their association with demographic and clinical factors in patients with OSA.
Patients with OSA referring to an Academic Sleep Outpatient Clinic were enrolled in a prospective study. Demographic, clinical characteristics, and OSA symptoms were collected. All patients underwent home sleep cardiorespiratory polygraphy and the Eating-Assessment Tool questionnaire (EAT-10) to investigate dysphagia symptoms. Patients with a positive EAT-10 were offered to undergo a fiberoptic endoscopic evaluation of swallowing (FEES) to confirm the presence of dysphagia. FEES findings were compared with a healthy control group. Univariate and multivariate analyses were performed to assess predictors of dysphagia.
951 patients with OSA (70% males, age 62 IQR51-71) completed the EAT-10, and 141 (15%) reported symptoms of dysphagia. Female gender (OR = 2.31), excessive daily sleepiness (OR = 2.24), number of OSA symptoms (OR = 1.25), anxiety/depression (OR = 1.89), and symptoms of gastroesophageal reflux (OR = 2.75) were significantly (p < 0.05) associated with dysphagia symptoms. Dysphagia was confirmed in 34 out of 35 symptomatic patients that accepted to undergo FEES. Patients with OSA exhibited lower bolus location at swallow onset, greater pharyngeal residue, and higher frequency and severity of penetration and aspiration events than healthy subjects (p < 0.05).
A consistent number of patients with OSA show symptoms of dysphagia, which are increased in females and patients with a greater OSA symptomatology, anxiety and depression, and gastroesophageal reflux. The EAT-10 appears a useful tool to guide the selection of patients at high risk of dysphagia. In clinical practice, the integration of screening for dysphagia in patients with OSA appears advisable.
阻塞性睡眠呼吸暂停（OSA）患者的吞咽困难及其驱动因素的流行病学情况了解甚少。本研究旨在调查 OSA 患者吞咽困难症状的患病率及其与人口统计学和临床因素的相关性。
患有 OSA 的患者被招募到一家学术睡眠门诊进行前瞻性研究。收集人口统计学、临床特征和 OSA 症状。所有患者均接受家庭睡眠心肺多导图和饮食评估工具问卷（EAT-10）检查吞咽困难症状。EAT-10 阳性的患者被建议进行纤维内镜吞咽评估（FEES）以确认是否存在吞咽困难。FEES 结果与健康对照组进行比较。采用单变量和多变量分析评估吞咽困难的预测因素。
951 例 OSA 患者（70%为男性，年龄 62[IQR51-71]岁）完成了 EAT-10 调查，141 例（15%）报告有吞咽困难症状。女性（OR=2.31）、日间嗜睡过多（OR=2.24）、OSA 症状数量（OR=1.25）、焦虑/抑郁（OR=1.89）和胃食管反流症状（OR=2.75）与吞咽困难症状显著相关（p<0.05）。35 例有症状且接受 FEES 检查的患者中，有 34 例被证实存在吞咽困难。与健康受试者相比，OSA 患者在吞咽起始时的食团位置更低，咽部残留物更多，且渗透和吸入事件的频率和严重程度更高（p<0.05）。
相当数量的 OSA 患者出现吞咽困难症状，女性和 OSA 症状更严重、焦虑和抑郁以及胃食管反流的患者症状增加。EAT-10 似乎是一种有用的工具，可以指导选择吞咽困难风险较高的患者。在临床实践中，对 OSA 患者进行吞咽困难筛查似乎是合理的。
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