Dysphagie und obstruktive Schlafapnoe (OSA) – Was ist die pathophysiologische Brücke?

Zusammenfassung

Patienten mit obstruktiver Schlafapnoe (OSA) und Schnarchen haben eine erhöhte Prävalenz an Schluckstörungen. Schlucken ist ein komplexer Vorgang, der einer exakten neuromuskulären Koordination bedarf. Sowohl bei der Atmung als auch beim Schluckvorgang wird der Pharynx gemeinsam genutzt. Der Schluckprozess kann in eine orale, pharyngeale und ösophageale Phase unterteilt werden. Mit dem Schluckreflex geht ein Anheben von Hyoid und Larynx einher, die Glottis verschließt den Eingang zum Larynx. Während der Schluckapnoe, die eine Atempause von 0,5–1,0 Sekunden umfasst, passiert der Bolus den pharyngealen Atemweg. Dysphagien sind mit schweren Komplikationen wie Aspiration und Pneumonie assoziiert. Obwohl die Pathophysiologie der Dysphagie bei OSA-Patienten unklar ist, gehen wir davon aus, dass sie auch ein Resultat der durch Vibration (Schnarchen) induzierten Störung der Sensomotorik des Oropharynx ist.

Abstract

There is a high prevalence of dysphagia among patients with obstructive sleep apnea (OSA) and snoring. Swallowing is a complex process requiring fine-tuned neuromuscular coordination. Breathing and swallowing share a common passage in the pharynx. Swallowing process can be divided into an oral, pharyngeal and esophageal phase. When the swallowing reflex starts, hyoid and larynx are pulled up and the glottis covers the entrance to larynx. During swallowing apnea, which is a respiration pause for about 0.5–1.0 seconds, the bolus passes pharyngeal airway. Dysphagia is associated with severe complications such as aspiration and pneumonia. Although the pathophysiology of dysphagia in OSA-patients is not clearly understood, we assume that dysphagia is also a result of sensory and motor changes in the oropharynx caused by snoring vibrations.

Schlüsselwörter

obstruktive Schlafapnoe - Schnarchen - Schlucken - Dysphagie - Aspiration

Keywords

obstructive sleep apnea - snoring - swallowing - dysphagia - aspiration

Publikationsverlauf

Eingereicht: 07. Februar 2025

Angenommen: 13. März 2025

Artikel online veröffentlicht:
01. April 2025

• Literatur

• 1 Bhutada AM, Broughton WA, Garand KL. Obstructive sleep apnea syndrome (OSAS) and swallowing function – a systematic review. Sleep and Breathing 2020; 24: 791-799
• 2 Koehler U, Hildebrandt O, Degerli M. et al. From vibration trauma to pharyngeal muscle instability: A self-sustaining pathophysiological process (circulus vitiosus) in obstructive sleep apnea. Pneumologie 2024;
• 3 Warnecke T, Dziewas R. Neurogene Dyspagien – Diagnostik und Therapie. Stuttgart: Verlag W. Kohlhammer; 2013
• 4 Kohno A, Kohno M, Ohkoshi S. Swallowing and aspiration during sleep in patients with obstructive sleep apnea versus control individuals. SleepJ 2022; 45: 1-11
• 5 Sato K, Chitose S, Sato K. et al. Recurrent aspiration pneumonia precipitated by obstructive sleep apnea. Auris Nasus Larynx 2021; 48: 659-665
• 6 Su VY, Liu CJ, Wang HK. et al. Sleep apnea and risk of pneumonia: a nationwide population-based study. Can Med Assoc J 2014; 186: 415-421
• 7 Hensen HA, Carberry JC, Krishnan AV. et al. Impaired pharyngeal reflex responses to negative pressure: a novel cause of sleep apnea in multiple sclerosis. J Appl Physiol 2022; 132: 815-823
• 8 Mu L, Chen J, Jing Li. et al. Mechanisms of Swallowing, Speech and Voice Disorders in Parkinsonʼs Disease: Literature Review with Our First Evidence for the Peripheral Nervous System Involvement. Dysphagia 2024; 39: 1001-1012
• 9 Bartolome G. Neurorehabilitation des Schluckens. NeuroGeriatrie 2014; 11: 79-90
• 10 Yoshida Y, Tanaka Y, Hirano M. et al. Sensory Innervation of the Pharynx and Larynx. Am J Med 2000; 108: 51-61
• 11 Cole CL, Mus M, Yu VX. et al. Healthy Human Laryngopharyngeal Sensory Innervation Density Correlates with Age. Laryngoscope 2023; 133: 773-784
• 12 Foote AG, Thibeault SL. Sensory Innervation oft he Larynx and the Search for Mucosal Mechanoreceptors. J Speech, Language and Hearing Res 2021; 64: 371-391
• 13 Valle ME, Cobo T, Vega JA. Mechanosensory Neurons, Cutaneous Mechanoreceptors, and Putative Mechanoproteins. Microsc Res Tech 2012; 75: 1033-1043
• 14 Lear CS, Flanagan JB. The frequency of deglutition in man. Arch Oral Biol 1965; 10: 83-99
• 15 Sato K, Nakashima T. Human adult deglutition during sleep. Ann Otol Rhinol Laryngol 2006; 115: 334-339
• 16 Pitts T, Iceman KE. Deglutition and the Regulation of the Swallow Motor Pattern. Physiology 2023; 38: 10-24
• 17 Lefton-Greif MA, McGrath-Morrow SA. Deglutition and respiration: development, coordination, and practical implications. Semin Speech Lang 2007; 28: 166-179
• 18 Shah F, Stal P. Myopathy of the upper airway in snoring and obstructive sleep apnea. Laryngoscope Investigative Otolaryngology 2022; 7: 636-645
• 19 Patel JA, Ray BJ, Fernandez-Salvador C. et al. Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review. Am J Otolaryngol 2018; 39: 327-337
• 20 Friberg D. Heavy Snorer’s Disease: a Progressive Local Neuropathy. Acta Otolaryngol 1999; 19: 925-933
• 21 Friberg D, Ansved T, Borg K. et al. Histological Indications of a Progressive Snorers Disease in an Upper Airway Muscle. Am J Respir Crit Care Med 1998; 157: 586-593
• 22 Pizzorni N, Radovanovic D, Pecis M. et al. Dysphagia symptoms in obstructive sleep apnea: prevalence and clinical correlates. Respir Res 2021; 22: 117
• 23 Kato T, Abe K, Mikami A. et al. Subjective oropharyngeal symptoms for abnormal swallowing in Japanese patients with obstructive sleep apnea syndrome: a descriptive questionnaire study. Cranio 2016; 34: 35-39
• 24 Marra L, Cavallaro G, DiLecce V. et al. The association between dysphagia and OSA. Acta Otorhinolaryngologica Italica 2022; 42: 82-88
• 25 Valarelli LP, Corradi AM, Grechi TH. et al. Cephalometric, muscular and swallowing changes in patients with OSA. J Oral Rehabil 2018; 45: 692-701
• 26 Valbuza JS, De Oliveira MM, Zancanella E. et al. Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study. Sleep Breath 2011; 15: 209-213
• 27 Levring Jäghagen E, Franklin KA, Isberg A. Snoring, sleep apnoea and swallowing dysfunction: a videoradiographic study. Dentomaxillofacial Radiology 2003; 32: 311-316