Breathing and swallowing dynamics across the adult lifespan
Breathing and swallowing dynamics across the adult lifespan
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DOI：
10.1001/archotol.131.9.762
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发表时间：
2005-09-01
影响因子：
--
通讯作者：
Heffner, J
中科院分区：
文献类型：
--
作者：
Martin-Harris, B;Brodsky, MB;Heffner, J
背景：正常口咽吞咽的生理成分的异常与吸入事件和吸入性肺炎的易感性有关，吸入性肺炎是老年人的一种常见的致命疾病。研究表明，呼吸和吞咽过程中参与呼吸道保护的主要生理吞咽成分之间存在时间和生理上的联系。我们利用伴随的视频透视图像和鼻腔呼吸气流记录建立了完整的呼吸和吞咽模式的标准化模型。目的：建立成人在整个衰老过程中呼吸和吞咽的标准化时间和呼吸时相模式关系；将这些模式中的任何改变与吞咽异常、吞咽过程中的吸入事件和吸入性肺炎的易感性联系起来；并开发临床实用的评估方法来识别呼吸和吞咽不协调。欢迎所有符合条件的健康志愿者，并对年龄、种族和性别进行筛选，以确保每个人的分布均等。干预：研究了11例预定吞咽事件和相关呼吸活动的呼吸相模式和发作和持续时间。所有受试者的单液钡吞咽检查通过同步视频透视和呼吸记录进行研究。主要观察指标：数字化记录和分析11个预定呼吸和吞咽事件中的每个事件的发作。确定吞咽前和吞咽后的呼吸时相。记录呼吸道穿透的存在、深度和反应，并与呼吸模式相关。结果：确定了四种随年龄增长而改变的呼吸时相模式。对暂时性呼吸和吞咽事件的相关分析显示，正常模式下有4个明显可区分的功能单位。结论：这项研究为呼吸和吞咽事件的明确区分模式和功能分组提供了证据，这是确定吞咽困难患者异常呼吸和吞咽模式是否与健康结局相关的必要的第一步。
Background: Aberrations in the physiologic components of normal oropharyngeal swallowing have been linked to aspiration events and to predisposition to aspiration pneumonia, a common, deadly disease in elderly persons. Studies have demonstrated a temporal, physiologic link between breathing and the principal physiologic swallowing components involved in airway protection during swallowing. We developed a normative model of integrated breathing and swallowing patterns using concomitant videofluoroscopic images and nasal respiratory airflow recordings.Objectives: To establish normative temporal and respiratory-phase pattern relationships between breathing and swallowing in adult human beings across the aging continuum; to relate any alterations in these patterns to swallowing abnormality, an aspiration event during swallowing, and predisposition to aspiration pneumonia; and to develop clinically practical evaluation methods for identifying breathing and swallowing discoordination.Setting: Fluoroscopy suite in an acute care hospital.Participants: Eighty-two healthy adult volunteers gave informed consent. All eligible healthy volunteers were welcome and were screened for age, race, and sex for equal distribution of each.Intervention: Respiratory-phase patterns and the onset And duration of 11 predetermined swallowing events and associated respiratory activities were studied. All participants' single-liquid barium swallow examinations were studied with simultaneous videofluoroscopy and respiratory recordings.Main Outcome Measures: Onset of each of the 11 predetermined breathing and swallowing events was digitally recorded and analyzed. The phases of breathing before and after swallowing were identified. The presence, depth, and response to airway penetration were recorded and related to respiratory pattern.Results: Four respiratory-phase patterns were identified that changed with advanced age. The correlation analyses of the temporal breathing and swallowing events revealed a normal pattern of 4 clearly distinguishable functional units. Differences in apnea duration and apnea offset occurred with advanced age.Conclusion: This research provides evidence for clearly distinguishable patterns and functional groupings of breathing and swallowing events, a necessary first step toward determining whether abnormal breathing and swallowing patterns in patients with dysphagia are associated with health outcome.