Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex

Valbuza, Juliana Spelta; Oliveira, Márcio Moysés de; Conti, Cristiane Fiquene; Prado, Lucila Bizari Fernandes do; Carvalho, Luciane Bizari Coin de; Prado, Gilmar Fernandes do

doi:10.1590/s0004-282x2011000600015

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…Specifically, the investigators found evidence of a relationship between lower axonal density in soft palatal nerve fascicles and degree of swallowing dysfunction [32]. Similarly, Valbuza and colleagues [46] reported impaired palatal and gag reflexes in patients with moderate-severe OSAS. Collectively, the evidence suggests that palatal-pharyngeal injury may be due to repeated trauma and tissue stretching resulting from lowfrequency snoring vibrations.…”

Section: Discussionmentioning

confidence: 94%

Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review

2020

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Objectives The purpose of this systematic review was to summarize and qualitatively analyze published evidence elucidating the prevalence of dysphagia and detail alterations in swallowing function in patients with OSAS. Methods Computerized literature searches were performed from four search engines. The studies were selected based on the inclusion and exclusion criteria. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2009). A total 2645 studies were initially retrieved, of which a total of 17 studies met inclusion criteria. Two reviewers, blinded to each other, evaluated level and strength of evidence using the Oxford Centre for Evidence-based Medicine Levels of Evidence and QualSyst, respectively. Results Dysphagia prevalence ranged from 16 to 78% among the eligible studies. Studies varied in operational definitions defining swallowing dysfunction (dysphagia) and method used to assess swallowing function. Approximately 70% of eligible studies demonstrated strong methodological quality. The majority of studies (n = 11; 65%) reported pharyngeal swallowing impairments in patients with OSAS, including delayed initiation of pharyngeal swallow and penetration/aspiration. Conclusion This systematic review describes swallowing function in patients with OSAS. However, due to the variability in defining OSAS and dysphagia, in the assessment method used to determine dysphagia, and heterogeneity of study designs, true prevalence is difficult to determine. Clinicians involved in the management of OSAS patients should employ validated assessment measures to determine if swallow dysfunction is present.

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Section: Discussionmentioning

confidence: 94%

Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review

2020

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“…Many studies on swallowing in patients with OSA have reported that patients with OSA have impaired sensory and motor function of the pharyngeal structure, due to the low-frequency vibrations of habitual snoring and presence of abnormal signs of swallowing [ 23–37 , 39–42 ]. These factors are thought to be involved in the delay of the onset of swallowing [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Swallowing and aspiration during sleep in patients with obstructive sleep apnea versus control individuals

Kohno

Ohkoshi

2022

Sleep

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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 co-activation, 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 co-activation 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 co-activation with (β=0.298, P=0.017) as well as without SA (β=0.271, P=0.038). The frequency of co-activation 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 co-activation without SA, which could lead to aspiration during sleep.

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“…CPAP may improve subclinical swallowing dysfunction in OSA (Okada et al, 2000). Palatal reflexes to tactile stimuli such as the gag reflex are diminished, particularly in severe OSA (Valbuza et al, 2011a). The extent to which these changes are caused by sensory impairments or efferent changes and whether or not they influence OSA severity remains unknown.…”

Section: Functionmentioning

confidence: 99%

Functional Role of Neural Injury in Obstructive Sleep Apnea

Saboisky¹,

Butler²,

Gandevia³

et al. 2012

Front. Neur.

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The causes of obstructive sleep apnea (OSA) are multifactorial. Neural injury affecting the upper airway muscles due to repetitive exposure to intermittent hypoxia and/or mechanical strain resulting from snoring and recurrent upper airway closure have been proposed to contribute to OSA disease progression. Multiple studies have demonstrated altered sensory and motor function in patients with OSA using a variety of neurophysiological and histological approaches. However, the extent to which the alterations contribute to impairments in upper airway muscle function, and thus OSA disease progression, remains uncertain. This brief review, primarily focused on data in humans, summarizes: (1) the evidence for upper airway sensorimotor injury in OSA and (2) current understanding of how these changes affect upper airway function and their potential to change OSA progression. Some unresolved questions including possible treatment targets are noted.

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Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex

Cited by 6 publications

References 23 publications

Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review

Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review

Swallowing and aspiration during sleep in patients with obstructive sleep apnea versus control individuals

Functional Role of Neural Injury in Obstructive Sleep Apnea

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