Breathing and swallowing dynamics across the adult lifespan.
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.


OBJECTIVE
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.


METHODS
Fluoroscopy suite in an acute care hospital.


METHODS
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Martin-Harris
Bonnie
B
Evelyn Trammell Institute for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston 29425, USA. harrisbm@musc.edu
Brodsky
Martin B
MB
Michel
Yvonne
Y
Ford
Carrie L
CL
Walters
Bobby
B
Heffner
John
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology*; D001049:Apnea / Q000503:physiopathology; D003679:Deglutition / Q000502:physiology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007830:Larynx / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010614:Pharynx / Q000502:physiology; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012044:Regression Analysis; D015656:Respiratory Mechanics / Q000502:physiology*; D011795:Surveys and Questionnaires; D014741:Video Recording