中重度阻塞性睡眠呼吸暂停患者的吞咽生物力学改变。
Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea.
机构信息
Department of Speech Pathology & Audiology, Flinders Medical Centre, Adelaide, South Australia, Australia.
Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.
出版信息
J Clin Sleep Med. 2021 Sep 1;17(9):1793-1803. doi: 10.5664/jcsm.9286.
STUDY OBJECTIVES
Dysphagia is a common but under-recognized complication of obstructive sleep apnea (OSA). However, the mechanisms remain poorly described. Accordingly, the aim of this study was to assess swallowing symptoms and use high-resolution pharyngeal manometry to quantify swallowing biomechanics in patients with moderate-severe OSA.
METHODS
Nineteen adults (4 female; mean (range) age, 46 ± 26-68 years) with moderate-severe OSA underwent high-resolution pharyngeal manometry testing with 5-, 10-, and 20-mL volumes of thin and extremely thick liquids. Data were compared with 19 age- and sex-matched healthy controls (mean (range) age, 46 ± 27-68 years). Symptomatic dysphagia was assessed using the Sydney Swallow Questionnaire. Swallow metrics were analyzed using the online application swallowgateway.com. General linear mixed model analysis was performed to investigate potential differences between people with moderate-severe OSA and controls. Data presented are means [95% confidence intervals].
RESULTS
Twenty-six percent (5 of 19) of the OSA group but none of the controls reported symptomatic dysphagia (Sydney Swallow Questionnaire > 234). Compared with healthy controls, the OSA group had increased upper esophageal sphincter relaxation pressure (-2 [-1] vs 2 [1] mm Hg, = 32.1, < .0001), reduced upper esophageal sphincter opening (6 vs 5 mS, = 23.6, < .0001), and increased hypopharyngeal intrabolus pressure (2 [1] vs 7 [1] mm Hg, = 19.0, < .05). Additionally, upper pharyngeal pressures were higher, particularly at the velopharynx (88 [12] vs 144 [12] mm Hg⋅cm⋅s, = 69.6, < .0001).
CONCLUSIONS
High-resolution pharyngeal manometry identified altered swallowing biomechanics in people with moderate-severe OSA, which is consistent with a subclinical presentation. Potential contributing mechanisms include upper esophageal sphincter dysfunction with associated upstream changes of increased hypopharyngeal distension pressure and velopharyngeal contractility.
CITATION
Schar MS, Omari TI, Woods CM, et al. Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea. . 2021;17(9):1793-1803.
研究目的
吞咽困难是阻塞性睡眠呼吸暂停（OSA）的常见但未被充分认识的并发症。然而，其机制仍描述不佳。因此，本研究的目的是评估中重度 OSA 患者的吞咽症状，并使用高分辨率咽测压法来定量吞咽生物力学。
方法
19 名成年患者（4 名女性；平均（范围）年龄，46±26-68 岁）接受高分辨率咽测压检查，分别使用 5、10 和 20ml 容量的稀薄和极浓稠液体。将数据与 19 名年龄和性别匹配的健康对照者（平均（范围）年龄，46±27-68 岁）进行比较。使用悉尼吞咽问卷评估有症状的吞咽困难。使用在线应用程序 swallowgateway.com 分析吞咽指标。采用一般线性混合模型分析来研究中重度 OSA 患者与对照组之间的潜在差异。数据以平均值[95%置信区间]表示。
结果
26%（19 例中的 5 例）的 OSA 组但没有对照组报告有症状的吞咽困难（悉尼吞咽问卷>234）。与健康对照组相比，OSA 组的食管上括约肌松弛压力增加（-2[-1]与 2[1]mmHg， = 32.1，<0.0001），食管上括约肌开口减小（6 与 5mS， = 23.6，<0.0001），咽内食团压升高（2[1]与 7[1]mmHg， = 19.0，<0.05）。此外，上咽部压力更高，尤其是在会厌咽部（88[12]与 144[12]mmHg·cm·s， = 69.6，<0.0001）。
结论
高分辨率咽测压法发现中重度 OSA 患者的吞咽生物力学发生改变，这与亚临床表现一致。潜在的致病机制包括食管上括约肌功能障碍，伴有咽扩张压升高和会厌收缩力增强等上游变化。
引文
Schar MS, Omari TI, Woods CM, et al. Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea.. 2021;17(9):1793-1803.
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