by Cyndee Williams Bowen, SLP
This is my third post regarding the use of oropharyngeal exercises as an alternative or conjunctive treatment for mild-to-moderate obstructive sleep apnea syndrome (OSAS). I have often told colleagues that I see oropharyngeal weakness and subclinical signs and symptoms of dysphagia in the individuals assessed under my obstructive sleep apnea protocol. The photos in my June 2014 #ResearchTuesday blog illustrate weakness that would lead to a reasonable expectation of disordered swallowing, but the client reported no known problems. This not an uncommon occurrence and is the topic of the study I selected for review this month.
Schindler A., Mozzanica F., Sonzini G., Plebani D., Urbani E., Pecis M., Montano N. Oropharyngeal dysphagia in patients with obstructive sleep apnea syndrome. Dysphagia 2014;29:44-51.
Schindler et al. assessed multiple bolus textures and volumes using Fiberoptic Endoscopic Evaluation of Swallowing (FEES), quantitative measures, and perceptual rating scales. A total of 72 patients diagnosed with moderate or severe OSAS and aymptomatic for dysphagia were assigned to two groups according to OSAS severity – 30 moderate; 42 severe. FEES was administered to evaluate each patient’s deglutition of 5, 10, and 20 ml liquid, semisolid, and solid boluses. Assessment parameters included spillage, penetration, aspiration, retention, and piecemeal swallow functions. Quantitative analysis was conducted via the Penetration-Aspiration Scale, Pooling Score, and Dysphagia Outcome and Severity Scale. Perceptual measures were conducted for each patient via the SWAL-QOL questionnaire.
Results: Approximately 50% of patients diagnosed with OSAS of any severity level were found to present with subclinical swallowing dysfunction. Of the parameters assessed, premature spillage was experienced by 64% of subjects followed by retention (44%), penetration (36%), and piecemeal deglutition (28%). Of special note is the finding that although patients presented with no overt signs, symptoms, or complaints of dysphagia, they confirmed symptoms of swallowing changes when questioned directly.
The authors acknowledge limitations to this study and recommend that their findings be considered preliminary. Based upon the results of this and previous studies, they recommend that consultations with OSAS patients include specific questions regarding swallow function, followed by referral for dysphagia assessment if indicated. They also suggest that low-frequency vibration trauma caused by frequent snoring be explored as a possible etiology for this dysfunction.
This study confirms my observations that people with OSAS present with subclinical signs and symptoms of oropharyngeal dysphagia. I believe Speech-Language Pathologists can add proactive value to sleep apnea assessment and treatment teams. These findings add weight to that point-of-view.
Cyndee Williams Bowen owns Bowen Speech-Language Therapy, LLC in Clearwater, Florida. She is committed to collaboration with expertise and creativity for empowered communication, swallowing, and vocal quality. Visit the Obstructive Sleep Apnea page of the Bowen Speech Website for more information on the topic of this blog entry.