Approximately one-sixth of patients with obstructive sleep apnea (OSA) have demonstrated symptoms of dysphagia. Symptoms of dysphagia are independently associated with female gender, symptoms of OSA, anxiety/depression, gastroesophageal reflux disease (GERD), and excessive daytime sleepiness, according to results of an analysis published in Respiratory Research.
Researchers conducted a prospective, single-center study among outpatients with OSA who were referred to the Sleep Clinic of the Luigi Sacco University Hospital in Milan, Italy. They sought to (1) evaluate the prevalence of dysphagia symptoms among individuals with OSA; (2) examine the association between symptoms of dysphagia and demographic and clinical variables; and (3) describe objective symptoms of dysphagia among symptomatic patients with OSA.
All of the study participants underwent home sleep cardiorespiratory polygraphy and responded to the Eating-Assessment Tool questionnaire (EAT-10) to study their dysphagia symptoms. Individuals with a positive EAT-10 score were offered the opportunity to undergo an endoscopic fiberoptic endoscopic evaluation of swallowing (FEES) to verify the diagnosis of dysphagia.
A total of 951 individuals with OSA completed the EAT-10 and were enrolled in the study. Overall, 70% of the participants were men. The median patient age was 62 years (range, 51-71 years). The median body mass index (BMI) was 28 (range, 25 to 31); the median apnea-hypopnea index was 19 (range, 11-33). Obstructive sleep apnea was mild in 375 individuals, moderate in 297 individuals, and severe in 279 individuals.
Of the 951 individuals who completed the EAT-10 questionnaire, 141 reported symptoms of dysphagia. Female gender (odds ratio [OR], 2.31); excessive daytime sleepiness (OR, 2.24); number of OA symptoms (OR, 1.25); anxiety/depression (OR, 1.89); and symptoms of GERD (OR, 2.75) were all significantly associated with symptoms of dysphagia (all P <.05). Based on an EAT-10 score of 3 or higher, a total of 15% of patients with OSA presented with dysphagia symptoms.
The presence of dysphagia was confirmed in 34 of the 35 symptomatic participants who agreed to undergo FEES. When FEES findings from these 35 participants were compared with those from 27 age-matched, healthy control individuals, regardless of bolus type, individuals with OSA exhibited significantly lower location of the bolus at the onset of swallow (except for solids), greater pharyngeal residue, and higher frequency and severity of penetration and aspiration events (P <.05).
A major limitation of the current study was the fact that the prevalence of dysphagia symptoms was based on objective diagnosis by instrumental assessment. Use of a patient-reported tool might have led to the underestimation of the real prevalence of dysphagia because of poor awareness among patients.
The researchers concluded that the EAT-10 appears to be a sensitive tool for guiding the selection of patients with OSA who are at a potentially high risk for dysphagia. Future studies that include other polysomnographic indices are warranted.
Pizzorni N, Radovanovic D, Pecis M, et al. Dysphagia symptoms in obstructive sleep apnea: prevalence and clinical correlates. Respir Res. 2021;22(1):117. doi:10.1186/s12931-021-01702-2