Abstract
ABSTRACT Purpose: to evaluate the relationship between acoustic analysis of swallowing sounds and the presence of pharyngeal residue and penetration/aspiration detected by fiberoptic endoscopic evaluation of swallowing in resistant hypertensive patients with obstructive sleep apnea. Methods: an observational study in which resistant hypertensive individuals diagnosed with obstructive sleep apnea participated through the all-night polysomnography exam. The participants underwent an acoustic analysis of swallowing sounds, using a Doppler sonar and simultaneously a fiberoptic endoscopic evaluation of swallowing. The acoustic parameters analyzed were initial frequency, initial intensity, first peak frequency, second peak frequency, final intensity and swallowing time. Independent samples of t-test and Mann-Whitney test were used for statistical analysis. The level of statistical significance adopted was 5%. Results: eighty five participants with average age of 58.3±6.3 years were evaluated. There was a statistically significant difference between groups with and without pharyngeal residue, in relation to the following parameters of swallowing acoustic signal: initial frequency and intensity, second peak frequency, final intensity and swallowing time. Only 10 milliliters of pudding consistency showed a statistically significant difference in the second peak frequency of the acoustic signal of swallowing between groups with and without penetration/aspiration. Conclusion: a relationship between measurements of swallowing acoustic signal and pharyngeal residue in this population was found, but not between swallowing sounds and penetration/aspiration.
Highlights
Resistant hypertension is defined as the arterial blood pressure that remains above the target, despite concomitant use of three or more different drug classes, or within target with use of four or more drugs[1]
Purpose: to evaluate the relationship between acoustic analysis of swallowing sounds and the presence of pharyngeal residue and penetration/aspiration detected by fiberoptic endoscopic evaluation of swallowing in resistant hypertensive patients with obstructive sleep apnea
Considering that CPAP is indicated to patients with moderate to severe obstructive sleep apnea (OSA) and with symptoms, it can be assumed the hypothesis of these individuals presenting more important sensory changes, justifying why this study found a higher frequency of penetration/aspiration in individuals using CPAP
Summary
Resistant hypertension is defined as the arterial blood pressure that remains above the target, despite concomitant use of three or more different drug classes, or within target with use of four or more drugs[1] This condition is strongly associated with obstructive sleep apnea (OSA)[2], characterized as a total (apnea) or partial (hypopnea) obstruction of the respiratory flow, due to recurrent collapse of the upper airways during sleep, causing snoring, frequent awakenings and excessive daytime sleepiness[3]. The disadvantages of VFSS consist of radiation exposure, limited time to perform the exam, need to transport the patient and loss of events between bolus presentations due to equipment shutdown; while FEES is related to white-out period during the pharyngeal phase, as well as the time and expense involved with endoscope decontamination[10]. The detection of swallowing sounds for acoustic analysis may be performed by different instruments, such as microphone,[16,17,18,19] accelerometer[20,21,22] and Doppler sonar,[11,12,13,14,15,23,24] having the last an excellent diagnostic accuracy in discriminating swallowing sounds[25]
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