Abnormal patterns of breathing during swallowing in neurological disorders

Abstract

Swallowing momentarily inhibits breathing, and normally the great majority of apnoeas which accompany a swallow are followed by expiration (xE swallows). This swallowing-breathing interaction is regarded as one of several mechanisms by which the airway is protected from aspiration during swallowing. The purpose of this study was to investigate the interaction of breathing and swallowing in two groups of neurological patients. Twenty-two patients with defined neurological disorders involving various structures or pathways (brain, spinal cord and peripheral nerves) were studied to determine whether particular lesions resulted in breakdown of the normal breathing pattern (22 normal subjects were also assessed and their breathing-swallowing pattern was compared with that of neurological patients). Subsequently, 32 patients with motor neurone disease (MND) were studied to identify factors associated with an abnormal pattern (i.e. swallow apnoeas followed by inspiration) and to clarify whether an abnormal pattern is related to chest infections, episodes of coughing and choking during meals, and prognosis. The swallow apnoea in patients with brain, spinal cord and peripheral neurological diseases was followed by inspiration more frequently than expected [20/22 (91%) patients compared with 2/22 (9%) of normal subjects, P: < 0.001], but this was not associated with a specific site of lesion(s). However, patients with corticobulbar involvement tended to have post-apnoea inspiration more often than those without. MND patients commonly displayed an abnormal pattern during swallowing [14/32 (44%) patients] characterized by inspiration after swallow, prolonged swallow apnoea and multiple swallows per bolus. Over the period of follow-up (12-18 months) this pattern did not predict chest infections, coughing and choking episodes during meals or survival. It seems likely that post-swallowing apnoea inspiration is a non-specific concomitant of disordered swallowing and/or breathing rather than being an important mechanism of aspiration per se or of symptom production.

Effect of a tracheostomy speaking valve on breathing–swallowing interaction

“…There is some evidence that choking may occur only with solids in some neuromuscular patients [28]. However, water rather than jelly was used in most of the previous studies [12,13,27,29], which allowed us to compare our results with earlier data. Furthermore, the use of solids requires chewing, which may cause fatigue, thereby worsening the swallowing impairments.…”

Oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review

“…(2) what are characteristics of oropharyngeal swallowing disorders in patients with COPD? (3) what are the risk factors for developing oropharyngeal swallowing disorders in patients with COPD, and (4) is there any evidence that standard medical treatments for COPD improve oropharyngeal swallowing safety?…”

“…Most investigations that have examined the effects of disordered respiration on swallowing have studied patients with neurologic disease [3][4][5][6][7] . These studies have examined the interaction between disordered breathing and its effect on swallowing in patients with motor neuron disease 3 , spastic cerebral palsy 5 , and Parkinson's disease 6 . Interestingly, only one study sought to compare the breathing and swallowing performance in those with neuromuscular disease and in those with respiratory failure with tracheotomy 4 .…”

Noninvasive Monitoring of Breathing and Swallowing Interaction

“…These findings are consistent with a role for brainstem control (Nishino and Hiraga 1991), especially as both the respiratory center and the swallowing CPG are located in the same area of the brainstem. In contrast, other studies demonstrated that the cortex influences breathing-swallowing interactions in unconscious patients (Hadjikoutis, Pickersgill et al 2000). In the other direction, alterations in breathing patterns and ventilation may influence the coordination of swallowing and breathing.…”

“…Aspiration is another important consequence of impaired swallowing that becomes increasingly common as the disease progresses (Finder, Birnkrant et al 2004). To the best of our knowledge, breathing-swallowing interactions initially received little research attention (Hadjikoutis, Pickersgill et al 2000). Moreover, improvements in the management of chronic respiratory failure translate into differences in breathing conditions across patients and over time, and this variability is likely to complicate the evaluation of breathing-swallowing interactions.…”