Dysphagia symptoms in obstructive sleep apnea: prevalence and clinical correlates

Nicole Pizzorni,Federica Annoni,Marica Pecis,Rosaria Lorusso,Pierachille Santus,Maurizio Rizzi,Alice Bartorelli,Dejan Radovanovic,Antonio Schindler

doi:10.1186/s12931-021-01702-2

Nicole Pizzorni, Federica Annoni + Show 7 more

Open Access

https://doi.org/10.1186/s12931-021-01702-2

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Abstract

BackgroundEpidemiology of dysphagia and its drivers in obstructive sleep apnea (OSA) are poorly understood. The study aims to investigate the prevalence of dysphagia symptoms and their association with demographic and clinical factors in patients with OSA.MethodsPatients with OSA referring to an Academic Sleep Outpatient Clinic were enrolled in a prospective study. Demographic, clinical characteristics, and OSA symptoms were collected. All patients underwent home sleep cardiorespiratory polygraphy and the Eating-Assessment Tool questionnaire (EAT-10) to investigate dysphagia symptoms. Patients with a positive EAT-10 were offered to undergo a fiberoptic endoscopic evaluation of swallowing (FEES) to confirm the presence of dysphagia. FEES findings were compared with a healthy control group. Univariate and multivariate analyses were performed to assess predictors of dysphagia.Results951 patients with OSA (70% males, age 62 IQR51-71) completed the EAT-10, and 141 (15%) reported symptoms of dysphagia. Female gender (OR = 2.31), excessive daily sleepiness (OR = 2.24), number of OSA symptoms (OR = 1.25), anxiety/depression (OR = 1.89), and symptoms of gastroesophageal reflux (OR = 2.75) were significantly (p < 0.05) associated with dysphagia symptoms. Dysphagia was confirmed in 34 out of 35 symptomatic patients that accepted to undergo FEES. Patients with OSA exhibited lower bolus location at swallow onset, greater pharyngeal residue, and higher frequency and severity of penetration and aspiration events than healthy subjects (p < 0.05).ConclusionA consistent number of patients with OSA show symptoms of dysphagia, which are increased in females and patients with a greater OSA symptomatology, anxiety and depression, and gastroesophageal reflux. The EAT-10 appears a useful tool to guide the selection of patients at high risk of dysphagia. In clinical practice, the integration of screening for dysphagia in patients with OSA appears advisable.

Highlights

Epidemiology of dysphagia and its drivers in obstructive sleep apnea (OSA) are poorly understood
No data exists on dysphagia characteristics in OSA patients who complain of dysphagia
Dysphagia symptoms: prevalence and associations Based on the Eating-Assessment Tool (EAT-10), 141 (15%) patients reported symptoms of dysphagia

Summary

Introduction

Epidemiology of dysphagia and its drivers in obstructive sleep apnea (OSA) are poorly understood. The study aims to investigate the prevalence of dysphagia symptoms and their association with demographic and clinical factors in patients with OSA. Swallowing is a highly complex sensorimotor process requiring adequate neuromuscular coordination, strength, precision, timing, speed, and motor planning [1]. Any alteration to these components may lead to Dysphagia may occur in patients with obstructive sleep apnea (OSA). Based on a recent systematic review, studies instrumentally assessing dysphagia in patients with OSA reported a prevalence of 20–77%. One study from Japan analyzed dysphagia symptoms in a large sample of 507 patients with OSA and found a prevalence of 16% [7]. Knowledge of risk factors for dysphagia in OSA would assist clinicians in the identification of patients requiring a comprehensive swallowing assessment

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