Recurrent aspiration pneumonia precipitated by obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Gastroenterology
• Pulmonology
• Neurology

Background:

• Airway protection relies on pharyngeal clearance via deglutition and coordinated respiratory phases.
• Aspiration pneumonia is a risk in patients with obstructive sleep apnea (OSA) due to impaired airway protection during sleep.
• Patients with OSA may have altered deglutition and respiratory patterns during sleep, even without overt swallowing disorders when awake.

Purpose of the Study:

• To investigate deglutition and respiratory phase patterns during sleep in OSA patients with recurrent aspiration pneumonia.
• To evaluate the impact of Continuous Positive Airway Pressure (CPAP) therapy on these patterns and aspiration pneumonia.

Main Methods:

• Videoendoscopic and videofluorographic swallowing examinations confirmed no awake swallowing disorders.
• Two severe OSA patients with recurrent aspiration pneumonia underwent simultaneous polysomnography and surface electromyography of swallowing muscles.
• Measurements were compared before and during CPAP therapy.

Main Results:

• CPAP therapy successfully resolved recurrent aspiration pneumonia.
• Uncoordinated deglutition (swallowing with inspiration) significantly decreased, while coordinated deglutition (swallowing with expiration) increased under CPAP.
• Deglutition frequency correlated inversely with sleep stage depth; CPAP improved sleep-related deglutition and respiratory patterns.

Conclusions:

• CPAP therapy markedly reduced uncoordinated deglutition and increased coordinated deglutition during sleep in OSA patients with aspiration pneumonia.
• Sleep-related deglutition and respiratory patterns in OSA patients can adversely affect aspiration risk.
• CPAP therapy improves sleep quality, reduces apnea-hypopnea events, and enhances sleep-related deglutition, potentially decreasing aspiration pneumonia risk.