Nasal Constant Positive Airway Pressure Inhibits the Swallowing Reflex

Nishino, Takashi; Sugimori, Kunio; Kohchi, Akira; Hiraga, Kenji

doi:10.1164/ajrccm/140.5.1290

Cited by 48 publications

(34 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concerning this possibility, it has been shown that nasal continuous positive airway pressure (CPAP) or negative extrathoracic pressure applied in normal adult humans decreases the frequency of repeated swallows [6,7]. Furthermore, our recent study showed that hyperpnea decreased and breath-holding increased the frequency of repeated swallows [8].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning the first possibility, there are several reports [5][6][7][8] to support the idea that the vagally mediated reflexes such as lung/pulmonary reflexes and upper airway reflexes play an important role in the control of the swallowing reflex. On the other hand, no substantial evidence to support possibility (2) above has been reported.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of withdrawal of phasic lung inflation during normocapnia and hypercapnia on the swallowing reflex in humans

Sai

Isono

Nishino

2004

Journal of Anesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of withdrawal of phasic lung inflation during normocapnia and hypercapnia on the swallowing reflex in humans

Sai

Isono

Nishino

2004

Journal of Anesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

“…Nasal CPAP has been previously shown to inhibit waterinduced swallowing in conscious adult humans (12) and spontaneous NNS in newborn lambs during QS (19). However, the precise reflex mechanism(s) by which swallowing is inhibited by nasal CPAP remains unclear.…”

Section: Effect Of Positive Airway Pressure On Nns Frequencymentioning

confidence: 99%

“…We recently reported that a nasal CPAP of 6 cmH 2 O inhibits spontaneous NNS in newborn lambs during quiet sleep (QS) (19). Although such effects were previously reported for waterinduced swallowing in conscious adult humans (12), the precise mechanism by which swallowing is inhibited by nasal CPAP remains unclear. Recent findings suggest it may be mediated by mechanoreceptors in the upper airways or by bronchopulmonary slowly adapting stretch receptors (SARs).…”

mentioning

confidence: 96%

Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

Samson¹,

Roy²,

Ouimet³

et al. 2008

Journal of Applied Physiology

View full text Add to dashboard Cite

The present study investigated the mechanism by which continuous positive airway pressure (CPAP) suppresses nonnutritive swallowing (NNS) during quiet sleep (QS) in newborn lambs. Eighteen full-term lambs were chronically instrumented and evenly distributed into three separate groups to determine the extent to which modulation of NNS may be attributed to stimulation of upper airway and/or bronchopulmonary mechanoreceptors. Six lambs were tracheotomized, six other lambs underwent a two-step bilateral intrathoracic vagotomy, and the remaining six lambs underwent chronic laryngotracheal separation (isolated upper airway group). Forty-eight hours after surgery, each nonsedated lamb underwent polysomnographic recordings on three consecutive days. States of alertness, NNS and respiratory movements were recorded. Results demonstrate that a CPAP of 6 cmH2O inhibited NNS during QS while administered directly on the lower airways and that bivagotomy prevented this inhibition. However, application of CPAP on the upper airways only also inhibited NNS during QS. Finally, the application of a CPAP of 6 cmH2O had no systematic effect on NNS-breathing coordination (assessed by the respiratory phase preceding and following NNS). In conclusion, our results suggest that bronchopulmonary receptors are implicated in the inhibiting effects of nasal CPAP of 6 cmH2O on NNS in all our experimental conditions, whereas upper airway receptors are only implicated in certain conditions.nasal and tracheal continuous positive airway pressure; vagotomy; laryngotracheal separation; bronchopulmonary receptors NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) has been used in newborns for a number of years for treating respiratory distress syndrome and apneas of prematurity and as a bridge between endotracheal tube ventilation and spontaneous ventilation (4, 6, 10). However, laryngeal functions, such as nonnutritive swallowing (NNS), which fulfils the important task of clearing upper airways from secretions and liquids refluxed from the stomach, have not been specifically assessed in newborns during nasal CPAP, aside from one study wherein nasal CPAP was shown to increase laryngeal opening (5). We recently reported that a nasal CPAP of 6 cmH 2 O inhibits spontaneous NNS in newborn lambs during quiet sleep (QS) (19). Although such effects were previously reported for waterinduced swallowing in conscious adult humans (12), the precise mechanism by which swallowing is inhibited by nasal CPAP remains unclear. Recent findings suggest it may be mediated by mechanoreceptors in the upper airways or by bronchopulmonary slowly adapting stretch receptors (SARs). Indeed, a recent study showed that application of CPAP on isolated larynx enhances laryngeal constrictor muscle (thyroarytenoid) activity in piglets (22). Alternatively, continuous lung inflation induced by negative extrathoracic pressure in awake adult humans also inhibits water-triggered swallows (7), suggesting that SARs can modulate swallowing. According to the authors, the latter hypothesis was f...

show abstract

“…However, while there are few reports of adverse events in the literature, they relate to barotrauma [75] and loss of airway protection [76]. The use of CPAP in hypercapnia and/or hypoventilation may be inappropriate as tidal volume and minute ventilation are uncontrolled [74].…”

Section: Precautions With Continuous Positive Airway Pressure Treatmentmentioning

confidence: 99%

The use of positive pressure devices by physiotherapists

Denehy

Berney²

2001

Eur Respir J

View full text Add to dashboard Cite

The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

show abstract

Nasal Constant Positive Airway Pressure Inhibits the Swallowing Reflex

Cited by 48 publications

References 3 publications

Effects of withdrawal of phasic lung inflation during normocapnia and hypercapnia on the swallowing reflex in humans

Effects of withdrawal of phasic lung inflation during normocapnia and hypercapnia on the swallowing reflex in humans

Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

The use of positive pressure devices by physiotherapists

Contact Info

Product

Resources

About