Abstract
PurposeRespiratory–swallow coordination is vital for airway protection, preventing aspiration, or penetration of foreign material into the airway. With the implementation of the International Dysphagia Diet Standardization Initiative definitions for different liquid consistencies used in dysphagia management, it is important to establish whether respiratory–swallow coordination patterns differ across these consistencies. This study aimed to evaluate respiratory behaviors during swallowing across the spectrum from thin to extremely thick liquids in healthy adults less than 60 years of age.MethodThirty healthy adults, aged 21–55 years, each consumed 54 naturally sized cup sips or spoonfuls of liquid stimuli prepared in thin, slightly thick, mildly thick, moderately thick, and extremely thick consistencies. Half of the stimuli were prepared using barium and half with a lemon-flavored water. Concurrent respiratory and swallowing pressure signals were collected to evaluate the respiratory phase pattern and pause duration associated with the swallow.ResultsAn expiration–swallow–expiration pattern was the dominant respiratory phase pattern, observed in 92.7% of the trials, with no significant effect of consistency. Respiratory pause duration was found to be significantly shorter with barium stimuli (0.73 s) compared to nonbarium stimuli (0.78 s) (p < .001, Cohen's d = .2), with no notable effects based on the factors of sex or liquid consistency.ConclusionsIn a convenience sample of healthy adults under the age of 60 years, consistent respiratory–swallow phasing and stable timing across the spectrum from thin to extremely thick liquids was observed. The data from this study can serve as preliminary reference data to which assessment information for individuals with dysphagia or respiratory challenges can be compared.
Highlights
C entral pattern generators, located in the brainstem, coordinate the respiratory and swallowing systems
A significant main effect of barium was found, F(1, 1384.14) = 12.243, p < .001, with shorter respiratory pause durations for the barium stimuli compared to the nonbarium stimuli (Cohen’s d = 0.2, i.e., small)
We hypothesized that the healthy adults in our sample would demonstrate respiratory phase pattern stability across the different International Dysphagia Diet Standardization Initiative (IDDSI) levels of liquid consistency, with possible differences in respiratory pause duration between barium and nonbarium liquids
Summary
C entral pattern generators, located in the brainstem, coordinate the respiratory and swallowing systems Coordinated behaviors between these two systems work to prevent the aspiration of foreign material into the airway through the precisely timed activation of the muscles and structures responsible for laryngeal vestibule closure, and the cessation of airflow through the oropharyngeal tract during swallowing (referred to as a respiratory pause or swallow apnea). Swallows in which the respiratory pause is followed by inspiratory airflow, as opposed to expiratory, are thought to involve a greater risk of postswallow aspiration of pharyngeal residue (Brodsky et al, 2010; Hadjikoutis et al, 2000; Martin-Harris et al, 2008; Nishino & Hiraga, 1991; Preiksaitis & Mills, 1996)
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