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Findings of the fiberoptic endoscopic evaluation of swallowing in obstructive sleep apnea: case report.
Obstructive sleep apnea (OSA) is characterized by the interruption of respiratory airflow due to the collapse of the upper airways during sleep. Some researchers admit that individuals with OSA may have sensory changes in the oropharynx. Such changes could lead to swallowing dysfunction.
To describe the findings of the fiberoptic endoscopic evaluation of swallowing in a patient with OSA, in order to contribute to the early diagnosis for the treatment of oropharyngeal dysphagia.
Case study, carried out in a male, 54 years old, with resistant arterial hypertension and severe OSA (apnea-hypopnea index: 95/hour). The fiberoptic endoscopic evaluation of swallowing was performed by an otolaryngologist and a speech therapist. The consistencies evaluated were: liquid, nectar, honey and pudding; in volumes of 5 ml, 10 ml and 15 ml, with two swallows of each aliquot of volume/consistency. The exam was evaluated in real time and frame by frame, by two speech therapists independently.
The patient was 105 kg, body mass index equal to 36.33 and neck circumference equal to 49 cm. He was not a smoker and made daily therapeutic use of CPAP during sleep. Spillage, piecemeal swallowing and delayed onset of the pharyngeal phase were observed in all consistencies. The level of the penetration and aspiration scale ranged from 1 to 4, with nectar consistency being the only one that did not show penetration. The degree of pharyngeal residue ranged from absent to moderate. The Kappa agreement index ranged from 0.8 to 1.0.
The individual did not present any complaints or symptoms of swallowing disorders (asymptomatic). However, the fiberoptic endoscopic evaluation of swallowing showed swallow impairment, demonstrating the importance of performing it so that it is possible to diagnose and treat such alterations present in patients with OSA at an early stage. Nectar consistency was the one that presented the least alterations and greater swallowing safety in this study. This can be justified by the fact that it provides greater sensory input compared to thin liquid, while requiring less muscle contraction force of the structures involved in swallowing compared to honey and pudding consistencies.
Obstructive sleep apnea, Fiberoptic endoscopic evaluation of swallowing, Dysphagia
Relato de Caso
Amanda Silva Guimarães Almeida, Mariana da Silva e Silva, Fernanda Dias Guimarães Almeida, Mariana Pinheiro Brendim, Elizabeth Silaid Muxfeldt