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Sleep Apr 2022There are only a few reports on voluntary swallowing during sleep; therefore, this study aimed to propose a method for observing voluntary swallowing during sleep using... (Observational Study)
Observational Study
STUDY OBJECTIVES
There are only a few reports on voluntary swallowing during sleep; therefore, this study aimed to propose a method for observing voluntary swallowing during sleep using polysomnography. The frequency of voluntary swallowing during sleep and the factors related to swallowing and aspiration during sleep were investigated.
METHODS
Polysomnography records of 20 control subjects and 60 patients with obstructive sleep apnea (OSA) (mild, moderate, and severe groups; n = 20 each) were collected. Simultaneous increases in the electromyographic potentials of the submental and masseter muscles, termed coactivation, and declining oronasal airflow (SA) were extracted as "swallowing." The cough reflex that occurred during sleep was extracted as "aspiration." The frequency of swallowing events was compared among the different OSA severity groups. Subsequently, a multivariate regression analysis was performed.
RESULTS
The average frequency of coactivation with SA in control subjects was 4.1 events/h and that without SA was 1.7 events/h. These frequencies increased with the severity of OSA during non-REM sleep. The distance of the hyoid to the Frankfurt plane was associated with the frequency of coactivation with (β = 0.298, p = 0.017) as well as without SA (β = 0.271, p = 0.038). The frequency of coactivation without SA was associated with aspiration (B = 0.192, p = 0.042).
CONCLUSIONS
Our data provide new insights into the relationship between swallowing and aspiration during sleep. We found that the longer the distance from the hyoid bone to the Frankfurt plane, the higher the coactivation without SA, which could lead to aspiration during sleep.
CLINICAL TRIALS
Retrospective observational study of swallowing during sleep in obstructive sleep apnea patients using polysomnography, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050460, UMIN000044187.
Topics: Deglutition; Humans; Hyoid Bone; Polysomnography; Sleep; Sleep Apnea, Obstructive
PubMed: 35167701
DOI: 10.1093/sleep/zsac036 -
Turkish Journal of Emergency Medicine Sep 2015Foreign body aspiration is seen frequently in pediatric and geriatric patients, but it can also be seen in adults. Needle aspiration is a common problem in our country....
Foreign body aspiration is seen frequently in pediatric and geriatric patients, but it can also be seen in adults. Needle aspiration is a common problem in our country. Foreign body aspiration can lead to complete airway obstruction, asphyxia and death but sometimes symptoms may not be evident during the early period of aspiration and patients may present with complications afterwards. Early diagnosis is important in foreign body aspiration for prevention of mortality and complications. Suspicion aroused by patient history is the first step towards a diagnosis. Plain radiography and tomography may be used for imaging. Bronchoscopy is performed for diagnosis if there is uncertainty after imaging and may also be used for the treatment of diagnosed cases. In this article, we present a foreign body aspiration case that presented with difficulty and pain while swallowing, subsequently found to be the result of a needle that was stuck between the oropharynx and epiglottis.
PubMed: 27239613
DOI: 10.1016/j.tjem.2015.11.010 -
The Laryngoscope Jul 2018Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by...
OBJECTIVE
Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by the primary disease process. The relationship between expiratory function, cough, and aspiration is less clear in head and neck cancer (HNC) survivors for whom the disease process does not directly impact the lower respiratory system. Our objective was to compare mechanisms of airway clearance (expiratory force and cough) with aspiration status in postradiated HNC survivors.
STUDY DESIGN
Cross-sectional study.
METHODS
One hundred and three disease-free HNC survivors ≥ 3-months postradiotherapy referred for modified barium swallow studies were prospectively enrolled regardless of dysphagia status. Maximum expiratory pressures (MEPs) and peak cough flow (PCF) measures were taken at enrollment and examined as a function of aspiration status using generalized linear regression methods.
RESULTS
Thirty-four (33%) patients aspirated. Maximum expiratory pressure and PCF demonstrated a moderate positive correlation (Pearson's r = 0.35). Adjusting for sex and age, MEPs were on average 19.2% lower (21.1 cm H O, 95% confidence interval [CI] 5.3, 36.8) among aspirators. Peak cough flow was also 14.9% lower (59.6 L/minute, 95% CI 15.8, 103.3) among aspirators after adjusting for age and sex.
CONCLUSION
Expiratory functions were depressed in postradiated HNC aspirators relative to nonaspirators, suggesting that airway protection impairments may extend beyond disrupted laryngopharyngeal mechanisms in the local treatment field. Exercises to strengthen subglottic expiratory force-generating capacity may offer an adjunctive therapeutic target to improve airway protection in chronic aspirators after head and neck radiotherapy.
LEVEL OF EVIDENCE
2b. Laryngoscope, 128:1615-1621, 2018.
Topics: Aged; Cancer Survivors; Cough; Cross-Sectional Studies; Deglutition Disorders; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Muscle Strength; Radiotherapy; Respiratory Aspiration; Respiratory Muscles
PubMed: 29114887
DOI: 10.1002/lary.26986 -
The Laryngoscope Dec 2017The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations,...
OBJECTIVES/HYPOTHESIS
The natural clinical progression of aspiration to eventual pulmonary compromise is not well understood. We hypothesized that dietary modification recommendations, Penetration-Aspiration Scale (PAS) score, and dysphagia etiology would be associated with changes in time to first pulmonary event and overall survival for patients with documented aspiration on radiologic testing. This study identified a cohort of patients with detectable unsensed penetration or aspiration on videofluoroscopic swallowing study (VFSS), and followed this cohort over time for development of pulmonary events and death. We then evaluated the association of aspiration severity and dietary modification recommendations on incidence of these endpoints.
STUDY DESIGN
Retrospective chart review.
METHODS
A total of 2,616 VFSS exam reports were reviewed from our institution performed between January 1, 2009 and December 31, 2010. Aspiration or unsensed penetration (PAS of 5 or greater) was detected in 564 (21.5%) of these patients, who were then included in the study cohort. Medical records were reviewed retrospectively for development of pulmonary events (pneumonia, pneumonitis, or other life-threatening pulmonary illness) and all-cause mortality for up to 54 months after initial VFSS. Univariate Kaplan-Meier analysis and multivariate Cox regression were performed for time to first pulmonary event and survival predicted by recommended diet, PAS score, and dysphagia etiology.
RESULTS
Dysphagia etiology was highly associated with increased development of pulmonary events for some patients, especially those with generalized nonspecific dysphagia due to deconditioning or frailty (hazard ratio [HZ] vs. stroke 2.95, 95% confidence interval [CI]: 1.53-5.69, P = .001) and esophageal dysphagia (HZ: 2.66, 95% CI: 1.17-6.02, P = .019). Dysphagia etiology was also associated with increased mortality for patients with generalized nonspecific dysphagia due to deconditioning or frailty (HZ: 3.32, 95% CI: 2.0-5.52, P < .001), postsurgical patients (HZ: 1.73, 95% CI: 1.05-2.86, P = .032), and chronic neurologic disease (HZ: 1.87, 95% CI: 1.12-3.13, P = .017). Dietary modification recommendations at the time of VFSS (prohibition of oral intake or modification of food consistency) had no significant impact on time to first pulmonary event (P = .37) or survival (P = .17), whereas PAS score was associated with decreased time to first pulmonary event on univariate but not multivariate analysis (HZ for 1-point increase: 1.6, 95% CI: 0.99-1.36, P = .067). Kaplan-Meier estimate of overall 3-year mortality for this patient cohort was 39%.
CONCLUSIONS
Etiology of dysphagia is associated with a higher mortality rate and development of pulmonary events in patients with unsensed penetration or aspiration on VFSS, especially for those patients with generalized deconditioning and frailty or esophageal dysphagia. Severity of aspiration as defined by PAS was not associated with altered overall survival. Recommendations for dietary modification to a nothing by mouth status or modified food consistency had no statistically significant association with development of pulmonary events or survival in patients with detectable unsensed penetration or aspiration on VFSS compared to full-diet recommendation.
LEVEL OF EVIDENCE
4. Laryngoscope, 127:S1-S10, 2017.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Deglutition; Deglutition Disorders; Diet Therapy; Female; Fluoroscopy; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Pneumonia, Aspiration; Proportional Hazards Models; Regression Analysis; Respiratory Aspiration; Respiratory Insufficiency; Retrospective Studies; Severity of Illness Index; Video Recording; Young Adult
PubMed: 28884823
DOI: 10.1002/lary.26854 -
Anaesthesia Oct 2018
Topics: Anesthesia, General; Gastrointestinal Contents; Humans; Preoperative Care; Respiratory Aspiration; Stomach; Terminology as Topic; Ultrasonography
PubMed: 30047982
DOI: 10.1111/anae.14362 -
Revista Latino-americana de Enfermagem 2015to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.
OBJECTIVE
to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.
METHOD
cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration.
RESULTS
risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration.
CONCLUSION
dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.
Topics: Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Nursing Diagnosis; Prognosis; Respiratory Aspiration; Risk Assessment; Risk Factors; Stroke
PubMed: 26039291
DOI: 10.1590/0104-1169.0197.2545 -
Ear, Nose, & Throat Journal Sep 2021Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and... (Review)
Review
INTRODUCTION
Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and mortality can result if dentures are swallowed or aspirated. This 10-year review investigated the development of complications following denture aspiration or ingestion, and identified key learning points.
METHODS
The Medline database was searched for cases of denture ingestion or aspiration from October 1, 2009, to October 31, 2019. Search terms included "dental prosthesis, denture, dental plate, bridge and false teeth" and "swallow, ingest, eat, aspirate and inhale." Potential factors influencing the development of complications were assessed (hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage, and airway obstruction). Statistical analysis was performed using χ and Pearson correlation tests in R Studio. No ethical approval was required.
RESULTS
Eighty-five patients were identified from 77 case reports. Fourteen articles were excluded due to insufficient information. Complications were documented in 37.6% (n = 32) of patients with 2 cases resulting in death. Duration of symptoms over 1 day ( = .005) and delayed removal beyond 4 days post-ingestion ( = .017) was significantly associated with increased rates of complications. There was no significant association between complication rate and patient age, denture type, level of impaction, or radiolucency.
CONCLUSION
Denture aspiration or ingestion can have serious consequences. Factors impacting complication rate revolve around early recognition and treatment. Clinician awareness of the potential risks of dentures is paramount to early diagnosis. We recommend early intervention to reduce the morbidity associated with this unassuming device.
Topics: Dentures; Foreign Bodies; Humans; Respiratory Aspiration; United Kingdom
PubMed: 32293908
DOI: 10.1177/0145561320917529 -
Frontiers in Psychology 2022Grounding on Holland's RIASEC model of vocational interests and the respective assumptions on person-environment fit (congruence), this paper focuses on how congruence...
Grounding on Holland's RIASEC model of vocational interests and the respective assumptions on person-environment fit (congruence), this paper focuses on how congruence is related to study outcomes, especially students' persistence, performance, and satisfaction. The paper distinguishes the measure of congruence with respect to social congruence (SOC) (interest fit with the study mates) and aspirational congruence (ASP) (interest fit with the occupation aspired) and also distinguishes the effects of congruence for gender and six different study areas including Science, Technology, Engineering, Mathematics (STEM), medicine, economics, education, and languages. The paper analyses 10,226 university freshmen of the German National Educational Panel Study (NEPS) and follows them longitudinally with respect to their study outcomes. The results show that students' persistence was more related to SOC than to ASP, especially for male students. Furthermore, SOC was particularly important for students in STEM areas. Regarding performance, however, ASP was more important. Here, we notably found correlations for STEM subjects with a balanced proportion of female students. Regarding satisfaction, mainly marginal correlations could be found. The results indicate conceptual differences between social and aspirational congruence as well as specific effects for gender and study area. While research might take this into account by specifically developing their models for different study areas, career counseling may reflect on the different significance of the interest-based person-environment fit for different study areas. Initiatives for raising young people's participation in STEM should therefore specifically focus on students that have high chances to develop interest profiles that are congruent to STEM rather than students who show profiles which already indicate a low congruence.
PubMed: 35310220
DOI: 10.3389/fpsyg.2022.816620 -
Expert Review of Gastroenterology &... Jun 2020Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can...
INTRODUCTION
Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia.
AREAS COVERED
This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD.
EXPERT OPINION
A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options.
Topics: Deglutition; Deglutition Disorders; Disease Progression; Humans; Parkinson Disease; Pneumonia, Aspiration; Respiratory Aspiration; Risk Factors; Self Report
PubMed: 32657208
DOI: 10.1080/17474124.2020.1769475 -
Health Expectations : An International... Oct 2023The risk of aspiration is high in stroke patients due to dysphagia/loss of swallowing. This problem can cause problems affecting the nutrition of patients. Due to the...
BACKGROUND
The risk of aspiration is high in stroke patients due to dysphagia/loss of swallowing. This problem can cause problems affecting the nutrition of patients. Due to the possible risk of aspiration during feeding, patient relatives are hesitant to feed their patients. Because of this fear, malnutrition and hospital readmissions may increase. It is important to evaluate the fear of aspiration risk of relatives of patients hospitalized in the neurology service. The aim of this study is to determine the views of the relatives of patients treated in the neurology service about the risk of aspiration through metaphors.
METHOD
This article analyzed metaphors of patients' relatives' about the risk of aspiration. The analysis uses metaphor identification and analysis. The research sample consisted of 31 patients. First of all, in the study, evaluation of the data was conducted by performing content analysis, as a result of which it was divided into metaphors and conceptual categories, and the relevant field was associated with the text (event, thought, feelings, related in speech or writing). In the reporting of research, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used.
RESULTS
It was seen that the patients' relatives produced 31 different metaphors in response to the statement 'Aspiration risk is like …, because it is …' The patients' relatives mostly compared the concept of 'fear of aspiration' to the concept of 'fear' (n: 24).
CONCLUSIONS
In this study, relatives mostly described the concept of fear related to the risk of aspiration. According to this result, patients' relatives have a great fear of aspiration increasing the risk of readmission to hospital and of malnutrition. This result shows that informing patients' relatives will increase awareness and will allow them to provide informed care.
PATIENT AND PUBLIC CONTRIBUTION
Collaborated with patients and their relatives regarding the risk of aspiration and contributed to the planning of care for the risk of aspiration.
PubMed: 37784255
DOI: 10.1111/hex.13883