Abstract
Swallowing is an important physiological response that protects the airway. Although aspiration during sleep may cause aspiration pneumonia, the mechanisms responsible have not yet been elucidated. We evaluated the coordination between respiration and swallowing by infusing water into the pharynx of healthy young adults during each sleep stage. Seven normal subjects participated in the study. During polysomnography recordings, to elicit a swallow we injected distilled water into the pharynx during the awake state and each sleep stage through a nasal catheter. We assessed swallow latency, swallow apnea time, the respiratory phase during a swallow, the number of swallows, and coughing. A total number of 79 swallows were recorded. The median swallow latency was significantly higher in stage 2 (10.05 s) and stage 3 (44.17 s) when compared to awake state (4.99 s). The swallow latency in stage 3 showed a very wide interquartile range. In two subjects, the result was predominantly prolonged compared to the other subjects. There was no significant difference in the swallow apnea time between sleep stages. The presence of inspiration after swallowing, repetitive swallowing, and coughing after swallowing was more frequent during sleep than when awake. This study suggests that the coordination between respiration and swallowing as a defense mechanism against aspiration was impaired during sleep. Our results supported physiologically the fact that healthy adult individuals aspirate pharyngeal secretions during sleep.
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Abbreviations
- EEG:
-
Electroencephalography
- EMG:
-
Electromyography
- EOG:
-
Electrooculography
- PSG:
-
Polysomnography
- REM:
-
Rapid eye movement
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Acknowledgments
K.O. is the guarantor of the paper and takes responsibility for the integrity for the work as a whole, from inception to published articles. K.N., E.T., and S.T. contributed to conception and design. J.A.F., N.T.A., and A.A.L. contributed to drafting the manuscript for important intellectual content. F.R.A. contributed to analysis, interpretation, and drafting the manuscript. This work was supported by a Scientific Research Grant (C) (25463239) from the Japan Society for the Promotion of Science (JSPS). We thank Mrs. Mary Wong for her assistance in the statistical analysis and Ms. Samantha Song for her editorial assistance.
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Okuno, K., Nohara, K., Takai, E. et al. Sleep Stage Coordination of Respiration and Swallowing: A Preliminary Study. Dysphagia 31, 579–586 (2016). https://doi.org/10.1007/s00455-016-9719-5
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DOI: https://doi.org/10.1007/s00455-016-9719-5