Bhutada Ankita M, Carnaby Giselle D, Broughton William A, Beverly Brenda L, Garand Kendrea L
Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
Department of Communication Sciences and Disorders, School of Health Professions, University of Texas Health, San Antonio, TX, USA.
Dysphagia. 2024 Sep 19. doi: 10.1007/s00455-024-10760-9.
Despite the high estimated prevalence of dysphagia in OSA, there is a paucity of evidence supporting behavioral interventions for treatment. The purpose of this study was to assess the impact of expiratory muscle strength training (EMST) on validated, standardized metrics of swallow and airway clearance capacity functions in moderate-to-severe OSA. 10 participants with OSA (mean age = 65.2 years) completed four weeks of EMST training employing a prospective single-arm, double-baseline interventional design. The Modified Barium Swallow Impairment Profile (MBSImP) Component and Composite (Oral Total [OT] and Pharyngeal Total [PT]) scores measured swallow physiology. Airway clearance capacity measures included maximum expiratory pressure (MEP) and peak cough flow (PCF). A historical normative database was used for OSA patient comparison of swallowing metrics. A total of 234 swallows were analyzed. At baseline, impairments in lingual control, oral residue and esophageal clearance were observed. However, no significant differences in the MBSImP Composite (OT/PT) scores were observed between the OSA and healthy referent group. After EMST intervention, there were no significant differences in pre- to post-intervention Composite (OT/PT) scores. However, large effect size was observed for MEP (p < 0.001, d = 3.0), and non-significant, but moderate effect size was observed in PCF (p = 0.19, d = 0.44). Study findings further quantify swallowing in moderate-to-severe OSA and provide preliminary evidence supporting the impact of EMST on airway clearance capacity.
尽管阻塞性睡眠呼吸暂停（OSA）患者吞咽困难的估计患病率很高，但支持行为干预治疗的证据却很少。本研究的目的是评估呼气肌力量训练（EMST）对中重度OSA患者吞咽及气道清除功能的有效标准化指标的影响。10名OSA患者（平均年龄=65.2岁）采用前瞻性单臂双基线干预设计完成了为期四周的EMST训练。改良钡剂吞咽障碍量表（MBSImP）的组成部分和综合评分（口腔总分[OT]和咽部总分[PT]）用于测量吞咽生理功能。气道清除能力指标包括最大呼气压力（MEP）和峰值咳嗽流量（PCF）。使用历史规范数据库对OSA患者的吞咽指标进行比较。共分析了234次吞咽情况。在基线时，观察到舌控制、口腔残留和食管清除方面存在障碍。然而，OSA组和健康对照组之间在MBSImP综合评分（OT/PT）上没有显著差异。EMST干预后，干预前后的综合评分（OT/PT）没有显著差异。然而，观察到MEP有较大的效应量（p<0.001，d=3.0），PCF有非显著但中等的效应量（p=0.19，d=0.44）。研究结果进一步量化了中重度OSA患者的吞咽情况，并为EMST对气道清除能力的影响提供了初步证据。
