Usefulness of Maximal Expiratory Pressure in Evaluating Dysphagia after Ischemic Stroke

Abstract

Objective: We investigated the usefulness of maximal expiratory pressure (MEP) in evaluating dysphagia subsequent to ischemic stroke. Methods: This study included patients with ischemic stroke who underwent MEP testing and videofluoroscopic swallowing study (VFSS), from October 2016 to February 2020. The VFSS findings were interpreted using the penetrationaspiration scale (PAS) and functional dysphagia scale (FDS). Patients were stratified into the non-aspiration (n=59) and aspiration (n=47) groups. Partial correlation analysis among MEP, PAS, and FDS was performed after adjusting for age. Binary logistic regression using PAS was conducted to investigate the risk factors predisposing patients to inclusion in the aspiration group. Multiple linear regression using FDS was conducted to investigate the risk factors according to dysphagia severity. Receiver operating characteristic (ROC) curve analysis was applied to investigate factors which could be useful for detecting aspiration. Results: Student's t-test revealed a significant difference in MEP between the non-aspiration and aspiration groups. MEP showed a positive correlation with PAS and FDS. MEP was also determined to be a risk factor for inclusion into the aspiration group, and a risk factor according to the severity of dysphagia. In the ROC curve analysis, MEP showed good diagnostic properties to help classify patients with aspiration. Conclusion: Our results indicate that swallowing assessment can predict and help prevent aspiration pneumonia in patients with ischemic stroke. In the present study, MEP showed significant association with aspiration and the severity of dysphagia. Thus, determining the MEP during swallowing assessment in patients with ischemic stroke is potentially a useful parameter to predict dysphagia.