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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several types of neurologic diseases can contribute to disturbed respiration during sleep. Abnormal function of respiratory and upper airway muscles can occur with neuromuscular diseases and lead to upper airway obstruction and alveolar hypoventilation during sleep. Central nervous system disorders that cause dysarthria and dysphagia can also lead to obstructive and central sleep apnea, even in the absence of the usual anatomic deformities associated with OSA. Appropriate treatment requires an understanding of the effect of the underlying disease process on upper airway and respiratory function.
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PMID:Neurologic aspects of sleep apnea and related respiratory disturbances. 219 7

A 30-year-old nonatopic woman had experienced a 9-year history of persistent symptoms of supraglottic edema. She had previously undergone epiglottectomy and excision of redundant left arytenoid tissue to improve her breathing and dysphagia. Uvular tissue was removed surgically at our clinic for histopathological examination of the excised tissues. This revealed diffuse infiltration by mast cells, many of which appeared degranulated. Uvular tissue from control patients undergoing uvulopalatopharyngoplasty for obstructive sleep apnea contained significantly fewer mast cells per high power field. To our knowledge such a degree of mast cell infiltration into supraglottic tissues has not been reported previously or associated with clinical symptoms.
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PMID:Mast cell pharyngitis as a cause of supraglottic edema. 339 76

Obstructive sleep apnea in children is most often secondary to severe adenotonsillar hypertrophy. A 5 1/2-year-old boy presented with loud snoring, increasing dysphagia, nocturnal choking, and apnea. Extensive papillomatosis of the uvula, soft palate, and nasopharynx was found to be causing the obstruction. Although multiple papillomas of the larynx and tracheobronchial tree are well known, the occurrence of extensive papillomas of the oral cavity is rare. The unusual clinical presentation and pathologic significance are discussed.
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PMID:Massive oropharyngeal papillomatosis causing obstructive sleep apnea in a child. 362 Jan 53

Uvulopalatopharyngoplasty (UPPP) is a commonly performed procedure for obstructive sleep apnea (OSA). However, results are inconsistent. Patients in whom the UPPP procedure has failed have a smaller change in airway size as compared to responders, and also many demonstrate continued obstruction at the palate. We present a modification, transpalatal advancement pharyngoplasty, that increases upper oropharyngeal and retropalatal airway size by advancing the soft palate. Eleven patients with severe OSA and multiple sites of airway narrowing were corrected by this method. Three patients had prior UPPP and 5 patients had concomitant tongue-base procedures. Overall results demonstrate clinical enlargement of the retropalatal space. In the 6 patients who had transpalatal advancement pharyngoplasty alone, 4 (67%) were successful responders as defined by a respiratory disturbance index (RDI) of less than 20 events per hour. RDI decreased from 52.8 +/- 12.2 to 12.3 +/- 2.8 events per hour. For the entire group, RDI decreased from 73.3 +/- 29.4 to 25.1 +/- 28.2 events per hour (P < .001). There were four complications, including a transient oronasal fistula(1), transient dysphagia(2), and serous otitis media(1). Transpalatal advancement pharyngoplasty potentially may offer an alternative to increasingly aggressive resection with UPPP in an effort to increase the upper oropharyngeal and retropalatal airway and may be appropriate in careful selected patients as part of the surgical treatment of OSA.
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PMID:Transpalatal advancement pharyngoplasty for obstructive sleep apnea. 844 14

Solitary extramedullary plasmacytomas are uncommon neoplasms. They occur most frequently in the upper aerodigestive tract and account for 4% of the nonepithelial tumors in this site. The evolution of a plasmacytoma is unsteady and symptoms at presentation have included dystonia, dysphagia, oral pain, cough, and dyspnea on exertion. Plasmacytoma of the upper aerodigestive tract has not been previously reported as a cause of obstructive sleep apnea.
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PMID:Plasmacytoma as a cause of obstructive sleep apnea. 876 30

The patency of the upper airways during inspiration is maintained by reflexogenic muscular dilation, mediated by afferent nerves. Our hypothesis is that a local disturbance in these nerves might explain the increased tendency of upper airways to collapse in patients with obstructive sleep apnea. The vascular reaction in the mucosal microcirculation is regulated by afferent nerves. To investigate this, we developed the laser Doppler perfusion monitoring method and electrical nerve stimulation for investigations of the soft palatal mucosa in non-snoring subjects. A 12 cm probe with integrated bipolar electrodes and a special probe-holder were designed. The bandwidths 12 and 24 kHz were compared and the latter was better able to detect a high blood-flow. A dose response relation was found between the voltage stimulation level and percentage increase in blood-flow. Three series of stimuli (40 V) in 10 subjects caused reproducible vascular reactions. In conclusion, this method seems to be safe, tolerable and valuable for investigations of patients with obstructive sleep apnea or other pharyngeal disorders, e.g. dysphagia, in the search for local nerve lesions.
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PMID:Evaluation of the vascular reaction in pharyngeal mucosa. 965 19

The inclusion of a query concerning the presence of snoring in a questionnaires used by the Allergy Service of Childrens Hospital Los Angeles (CHLA) uncovered a significant number of patients who were experiencing prolonged and discomforting symptoms owing to previously undiagnosed obstructive sleep apnea (OSA) caused by adenotonsillar hypertrophy. Of 352 patients who were discharged with a diagnosis of OSA and tonsillectomy and/or adenoidectomy at CHLA in 1996-1997, a retrospective study of the first 45 randomly selected patients who agreed to participate in a telephone interview was performed. Analysis revealed that all patients experienced severe and discomforting symptoms with all describing severe or moderate snoring. Other symptoms included chronic mouth breathing (84%), frequent otitis media (64%), sinusitis (56%), sore throat (51%), choking (47%), and daytime drowsiness (42%). Other symptoms included poor school performance, enuresis, poor appetite and/or weight gain, dysphagia, and vomiting. Symptoms began at a mean age of approximately 2 years ("birth"-9 years), and the mean period of time between the development of significant symptoms and OSA was 3.3 years (6 months-13 years). Delay between onset of significant symptoms and surgery was > 1 year in 82% of the patients, > 2 years in 51% of the patients, > 4 years in 31% of the patients, and > 6 years in 13% of the patients. Forty percent of patients were self-referred to an otolaryngologist for treatment despite their primary care physician being aware of the symptoms. These results indicate that patient with OSA experienced prolonged morbidity and delays in treatment, which is probably widespread. Physician, parent, and third-party factors were found to have contributed to the delays in treatment.
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PMID:Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. 1069 47

The objective of this study was to investigate the effects on outcomes and morbidity of combining temperature-controlled radiofrequency (TCRF) tongue reduction with uvulopalatopharyngoplasty (UPPP) as an initial site-directed approach to the surgical treatment of obstructive sleep apnea syndrome (OSAS). This investigation was a prospective, nonrandomized, open-enrollment study of 20 consecutive eligible patients with OSAS. Seven patients had a single-level velopharyngeal obstruction (Fujita type I or IIa), and they were assigned to undergo UPPP only (group 1). Thirteen patients had a multilevel velopharyngeal and retroglossal obstruction (Fujita type IIb), and they were assigned to undergo TCRF tongue reduction in addition to UPPP (group 2). Patients who had only a retroglossal obstruction (Fujita type III) were not included in this study. Following their initial operation, nine patients in group 2 underwent two subsequent in-office TCRF tongue treatments under local anesthesia. Three patients in group 2 were lost to followup, and one patient underwent only one TCRF procedure at the initial operation; data on the latter patient are included in some of the outcomes measures reported here where indicated, but no data are reported on the three who were lost to followup. The primary post-treatment outcomes measures were the results of comparative polysomnography and clinician and patient evaluations regarding morbidity and symptom improvement. Analysis of these data showed that there was no difference between the two groups in terms of postoperative pain or dysphagia following the initial operative session. The degree of symptom improvement in the two groups was similar. Overall success rates--as measured by the apnea/hypopnea index (group 1: 57.1% success; group 2: 50.0%) and by the apnea index (group 1: 71.4% success; group 2: 70.0%)--were statistically comparable, given the small size of the sample (figures are based on 10 patients in group 2). The author concludes that combining TCRF tongue reduction with UPPP in patients with multilevel obstruction improves response rates to a degree that is comparable to that seen with UPPP alone in patients with single-level velopharyngeal obstruction. Moreover, the combination treatment does not increase the risk of additional pain, morbidity, and complications compared with UPPP alone.
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PMID:Combined temperature-controlled radiofrequency tongue reduction and UPPP in apnea surgery. 1157 50

Patients with obstructive sleep apnea syndrome (OSAS) are likely to exhibit an impaired swallowing reflex. However, mechanisms of disturbed swallowing reflex have not been determined. Because the upper-airway function is inhibited by hypoxia and hypercapnia, we examined the relationship between the swallowing function and gas exchange during day and night in patients with OSAS. Twenty-four patients with OSAS and 24 age-matched controls were studied. OSAS was diagnosed from overnight polysomnography. The swallowing reflex was judged by the latent time (LT) for swallowing following bolus injection of distilled water at the suprapharynx, the inspiratory suppression time (IST) from swallowing termination to the next onset of inspiration, and the threshold for evoking the swallowing response in terms of a volume of water (TV). Whereas the LT values are positively correlated with PaCO2 but not with PaO2 during the day, the values of IST and TV were not associated with daytime PaCO2 or PaO2. Nocturnal nadir SaO2 was correlated with LT, IST, and TV. These results indicate that oxyhemoglobin desaturation and hypercapnia may be associated with one of the mechanisms of the impaired swallowing function in patients with OSAS.
Dysphagia 2001
PMID:Relationship between swallowing function and gas exchange during day and night in patients with obstructive sleep apnea syndrome. 1172 Apr

Emerging clinical application of electrical stimulation in three systems is reviewed. In the bladder, stimulation of sacral posterior roots reduces reflex incontinence and significantly improves bladder capacity. With the combination of anterior and posterior root stimulation, bladder control can be achieved without the need for rhizotomy. Preliminary research demonstrates that bladder contractions may also be generated by stimulation of the urethral sensory branch of the pudendal nerve, even after acute spinal cord transection, while inhibition of the bladder and control of urge incontinence can be achieved by stimulation of the whole pudendal nerve. Spinal cord stimulation can modulate the activity of the intrinsic cardiac nervous system involved in the regulation of regional cardiac function and significantly reduce the pain associated with angina pectoris. Finally in the area of upper airway disorders, functional electrical stimulation has great potential for increasing life support as well as for quality of life in chronic ailments, particularly obstructive sleep apnea and dysphagia.
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PMID:Emerging clinical applications of electrical stimulation: opportunities for restoration of function. 1176 72


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