Coordination of respiration and swallowing: functional pattern and relevance of vocal folds closure

Abstract

-Context -Breathing and swallowing coordination, despite the expressive number of study, remain as theme deserving further research. Objectives -To identify a coordination pattern between swallowing and the natural breathing pause that occur in association with it (swallowing apnea) and also the relevance of the vocal folds closure in this process. Methods -Sixty-six adults, male and female, including normal health people, post-laryngectomy individuals and patients with digestive complaints without dysphagia were analyzed. The respiratory air flux interruptions produced by wet requested swallows and dry, requested and spontaneous swallows, were registered using thermo and piezoelectric receptors coupled to synectics medical manometry equipment, using Polygram upper 4.21 software. The results were analyzed with the Chi-square (3×2) and (2×2) nonparametric independency test with P = 0.05. Results -Swallowing apnea is a preventive breathing stop that start just before and stay present during all deglutition pharyngeal phase. It is a well coordinated phenomena that occur as pattern in association with low elastic resistance of the lung, on the expiratory final phase until inspiration initial phase. This breathing stoppage it is usually followed by a short expiraton preceding a new breathing cycle. The swallow apnea and vocal folds closure are both independents mechanisms. Conclusions -It is possible to suppose that in the subconscious condition, swallowing apnea is integrated under coordination of the same control mechanism that also involves the elastic resistance of the lung.

Integrated non‐invasive measurements reveal swallowing and respiration coordination recovery after unilateral stroke

“…Accordingly, there are four pre‐ and postdeglutition respiratory phase patterns, including expiration–expiration (EX/EX), expiration–inspiration (EX/IN), inspiration–expiration (IN/EX), and inspiration–inspiration (IN/IN) . The primary pattern is the EX/EX pattern, which is the only physiologically protective respiratory phase pattern . We then grouped the remaining three minor respiratory phase patterns into one group, the non‐EX/EX pattern group.…”

The variety of dysphagia progression in amyotrophic lateral sclerosis (ALS)

“…Our results suggest a similar trend with dysphagia in the LO group. Given that swallowing and respiratory function are coordinated when swallow takes place (Costa andLemme 2010, Pitts et al 2012), our findings suggest that a decline in respiratory function is associated with the progression of dysphagia in ALS.…”

Otolaryngology head and neck surgery: An integrative view of the larynx

“…50 The respiratory pause certainly occurs in concert with vocal fold closure but seems to be an independent, centrally mediated event, as this apnea persists even in individuals with laryngectomy. 63,64 The swallow apnea will begin often times long before the active laryngeal closure occurs and in normal subjects the apnea can last for 3 seconds or longer. 60,62 In most cases, the swallow occurs during the expiratory phase, in at least healthy adults, 65 and is commonly observed as an inspiration-expiration-swallow-expiration.…”

“…It seems that there is some effort to swallow when there is a condition of low elastic resistance in the lung (final phase of expiration). 64 However, this pattern is not hard-wired and can be modulated volitionally and spontaneously. 37 It is also modified by disease, such as chronic obstructive pulmonary disease 66 and amyotrophic lateral sclerosis.…”