The Normal Swallow

Shaw, Stephanie M.; Martino, Rosemary

doi:10.1016/j.otc.2013.09.006

Cited by 136 publications

(44 citation statements)

References 67 publications

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“…(13). It is important, however, to note the lack of uniformity in the literature regarding the determination of respiratory phase (12,16,27,28). In the present study, the respiratory phase was determined using pneumotachography, the gold standard method for detection of flow, as well as measurement of pharyngeal pressure, which allows for a precise determination of the timing of swallowing within the respiratory cycle.…”

Section: Discussionmentioning

confidence: 96%

Nocturnal swallowing and arousal threshold in individuals with chronic spinal cord injury

Rizwan

Sankari

Bascom

et al. 2018

Journal of Applied Physiology

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Respiratory complications are potential causes of death in patients with spinal cord injury (SCI). Nocturnal swallowing could be related to transient arousals and could lead to fragmented sleep in SCI patients. However, the impact of nocturnal swallowing on breathing and sleep physiology in SCI is unknown. The objectives of this study were 1) to determine whether nocturnal swallowing is more common in SCI than in able-bodied (AB) subjects, 2) to determine the role of nocturnal swallowing on arousal threshold (ArTh) in SCI individuals with sleep-disordered breathing (SDB), and 3) to determine the effect of continuous positive airway pressure (CPAP) treatment on nocturnal swallowing. A total of 16 SCI and 13 AB subjects with SDB completed in-laboratory polysomnography with a pharyngeal catheter. A swallowing event (SW) was defined as a positive spike in pharyngeal pressure and was used to calculate the swallow index (SI) defined as a number of SW/total sleep time. Each SW was assessed for a relationship to the sleep stages and respiratory cycle phases, and associated arousals and ArTh were calculated. SI was higher in the SCI group compared with AB subjects during wake and different sleep stages ( P < 0.05). SWs were found to be significantly higher in the late expiratory phase in the group with SCI compared with the other respiratory phases and were eliminated by CPAP ( P < 0.05). ArTh for the subjects with SCI was significantly lower ( P < 0.05) compared with the AB subjects. Nocturnal swallowing is more common in SCI than in AB individuals who have SDB, particularly during the expiratory phase. The ArTh is significantly lower in SCI (indicating increased arousal propensity), which may contribute to the mechanism of sleep disturbances in SCI. NEW & NOTEWORTHY Nocturnal swallowing is common in patients with chronic spinal cord injury (SCI) and is associated with frequent arousals from sleep. The lower arousal threshold during sleep in SCI may contribute to the mechanism of sleep disturbances that are commonly found in cervical and high thoracic SCI. Continuous positive airway pressure may play a therapeutic role in alleviating nocturnal swallowing, which may contribute to reduced risk of aspiration.

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Section: Discussionmentioning

confidence: 96%

Nocturnal swallowing and arousal threshold in individuals with chronic spinal cord injury

Rizwan

Sankari

Bascom

et al. 2018

Journal of Applied Physiology

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“…There is a precise and complex control of swallowing by the CNS [ 24 ], which coordinates respiration and deglutition to avoid difficulty in swallowing and respiratory disconfort. During swallows the control of muscle movements is done by cranial and peripheral nerves which are coordinated within the brain stem, mainly medulla oblongata, with sensory nuclei, motor nuclei and interneurons [ 25 ]. Impaired sensory or motor ability at any level impairs the efficiency of swallow physiology [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Timing of Pharyngeal Swallow Events in Chagas’ Disease

Santos

Cassiani

Nascimento

et al. 2014

Gastroenterology Research

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BackgroundEsophageal involvement by Chagas’ disease causes a significative decrease in the number of neurons of the esophageal myenteric plexus, causing an impairment of esophageal motility with the same alterations described in primary esophageal achalasia. There is also a longer duration of pharyngeal transit, which might be consequent of the involvement of the central control of swallowing by the disease, or an adaptation of the pharynx to the difficult bolus transit through the esophagus, which could contribute to the complaint of dysphagia.MethodsWe studied, by videofluoroscopy, the sequence and timings of pharyngeal bolus transit in 16 patients with esophageal involvement by Chagas’ disease and 12 healthy volunteers. Each subject swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses.ResultsThere was no difference between Chagas’ disease patients and normal volunteers in the sequence and timing of events associated with pharyngeal bolus flow, for liquid and paste boluses, and for 5 mL and 10 mL.ConclusionThe timing and sequence of swallow pharyngeal events of patients with Chagas’ disease do not differ from that of control subjects, which suggested that the central control of swallowing is not impaired by the disease.

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“…Pitts, et al. 84 (2012) and Shaw and Martino 94 (2013) provide comprehensive reviews of this material.…”

Section: Efferentsmentioning

confidence: 99%

A framework for understanding shared substrates of airway protection

et al. 2014

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Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough28 (2009) by Hegland, et al.42 (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

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The Normal Swallow

Cited by 136 publications

References 67 publications

Nocturnal swallowing and arousal threshold in individuals with chronic spinal cord injury

Nocturnal swallowing and arousal threshold in individuals with chronic spinal cord injury

Timing of Pharyngeal Swallow Events in Chagas’ Disease

A framework for understanding shared substrates of airway protection

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