Respiratory Patterns Associated with Swallowing: Part 1. The Normal Adult Pattern and Changes with Age

Abstract

Simple, non-invasive equipment was designed to record respiratory patterns associated with swallowing food or drink in young and elderly healthy adults, to compare with neurologically impaired patients who complained of dysphagia. The timing of the entry of the test drink from a spoon into the mouth, the swallow event and respiration were recorded electronically and were presented in chart form. The equipment proved to be easy to use and the results were consistent. All 33 subjects showed a well-defined respiratory pattern, with individual minor variations, but different from the pattern of their resting respiration. The direction of respiration during spoon contact was consistent for each individual and the pharyngeal stage of swallowing was almost always followed by a large expiration. Thus the resting respiration is not simply arrested during swallowing, but is substituted by a different, well-controlled pattern.

Effects of Age, Gender, Bolus Volume, and Trial on Swallowing Apnea Duration and Swallow/Respiratory Phase Relationships of Normal Adults

“…The exhale-swallowexhale pattern did not change as a function of age. However, an increase in elderly adult SAD as compared to young adults' [20] is consistent with the findings of this study. Subsequently, an increase in SAD as a function of increased age further supports previous age-related findings of anatomic and physiologic changes in aged swallowing.…”

“…Furthermore, SAD reported was significantly longer in 18 elderly adults when compared to 21 young adults (cf. 1.0 s vs. 0.6 s, p < .05) [20]. Both studies support an age effect on SA but both studies utilized small bolus volumes (i.e., 5 ml and saliva swallows) and small samples consequently limiting data generalization.…”

“…As evidenced, researchers have utilized a variety of respiratory acquisition hardware consisting of respiratory inductive plethysmography [2,7,27,28,29], nose/facemasks [18], nasal cannulas [13,14,20,21], nasal thermistors [2]. Of additional concern is for the normative data established to be clinically useful.…”

Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows

“…Examples include surface electromyography or other physiological tracings (4,5,9,17,21,25,26,31,34). Although the indirect measures of swallowing are generally less invasive and permit the acquisition of greater numbers of swallowing samples, their clinical utility is suspect without simultaneous direct visual confirmation of the swallowing mechanics occurring with respiratory activity.…”

Noninvasive Monitoring of Breathing and Swallowing Interaction

“…This alteration in the breathing pattern may help to clear the airway of secretions and foreign material before the next inspiration, thus contributing to prevent aspiration (Nishino, Yonezawa et al 1985). Breathing-swallowing interactions and the underlying mechanisms have been studied in healthy volunteers by measuring a variety of parameters including the duration of deglutition apnea (Nishino, Yonezawa et al 1985;Selley, Flack et al 1989;Martin, Logemann et al 1994;Klahn and Perlman 1999) and the timing of breathing events relative to swallows (Perlman, Schultz et al 1993;Martin, Logemann et al 1994;Paydarfar, Gilbert et al 1995;Klahn and Perlman 1999). Several factors that influence breathing-swallowing interactions were identified.…”