Coordination between respiration and swallowing (Xu et al., 2024)

<b>Purpose: </b>The purpose of the present study was to characterize the differences between respiration and swallowing in patients with dysphagia after cervical spinal cord injury (CSCI) and to explore the underlying physiological changes.<b>Method:</b> A total of 95 participants were recruited for bedside swallowing evaluation followed by a flexible endoscopic evaluation of swallowing and surface electromyography with a thermocouple nasal airflow sensor examination: 32 with dysphagia, 33 without dysphagia, and 30 healthy controls. The differences in respiratory patterns, swallowing apnea duration (SAD), inspiratory–expiratory ratio, and swallowing efficiency were observed among healthy adults, CSCI patients with and without dysphagia after CSCI.<b>Results:</b> Compared with those of healthy controls and patients without dysphagia after CSCI, the postswallow respiratory pattern of patients with dysphagia after CSCI was an inspiratory pattern, and the SAD was significantly shorter in patients with dysphagia after CSCI (<i>p</i> &lt; .001). Additionally, the expiratory time in patients with dysphagia was significantly shorter than the inspiratory time, and the swallowing efficiency was reduced, requiring multiple swallows. Moreover, the index of SAD was statistically significant for predicting the development of dysphagia in patients with CSCI (<i>p</i> &lt; .001).<b>Conclusion:</b> Patients with CSCI have an inspiratory pattern after swallowing, and the SAD is significantly reduced; SAD can be used as the predictor of dysphagia in patients after CSCI; the pattern of coordination between respiration and swallowing in patients with dysphagia after CSCI is different from that of healthy controls and patients without dysphagia after CSCI.<b>Supplemental Material S1.</b> Bedside Swallowing Evaluation (BSE).<b>Supplemental Material S2.</b> Patients’ demographic and clinical characteristics and data of parameters related to the coordination between respiration and swallowing.Xu, X., Zhang, Q., Xie, Y., Yang, D., Gao, F., Yuan, Y., Zhang, Y., &amp; Li, J. (2024). Coordination between respiration and swallowing in patients with dysphagia after cervical spinal cord injury: An observational case–control study. <i>American Journal of Speech-Language Pathology</i>, <i>33</i>(5), 2572–2581. https://doi.org/10.1044/2024_AJSLP-24-00135

**研究目的**：本研究旨在明确颈脊髓损伤（cervical spinal cord injury, CSCI）后吞咽困难患者的呼吸与吞咽功能差异，并探究其潜在生理变化机制。**研究方法**：共招募95名受试者，依次接受床旁吞咽评估（Bedside Swallowing Evaluation, BSE）、柔性内镜吞咽检查及表面肌电图联合热电偶鼻气流传感器检测。其中分组为：颈脊髓损伤后伴吞咽困难患者32例，颈脊髓损伤后无吞咽困难患者33例，健康对照30例。本研究对比分析了健康成年人、颈脊髓损伤后伴/不伴吞咽困难患者的呼吸模式、吞咽暂停时长（swallowing apnea duration, SAD）、吸气-呼气比及吞咽效率差异。**研究结果**：与健康对照及颈脊髓损伤后无吞咽困难患者相比，颈脊髓损伤后伴吞咽困难患者的吞咽后呼吸模式呈现吸气型，且其吞咽暂停时长显著缩短（p < 0.001）。此外，伴吞咽困难患者的呼气时长显著短于吸气时长，吞咽效率下降，需多次吞咽方可完成。进一步分析显示，吞咽暂停时长指标可有效预测颈脊髓损伤患者发生吞咽困难的风险（p < 0.001）。**研究结论**：颈脊髓损伤患者吞咽后呈现吸气型呼吸模式，且吞咽暂停时长显著降低；吞咽暂停时长可作为颈脊髓损伤后患者发生吞咽困难的预测指标；颈脊髓损伤后伴吞咽困难患者的呼吸-吞咽协调模式与健康对照及颈脊髓损伤后无吞咽困难患者存在显著差异。**补充材料S1**：床旁吞咽评估（BSE）。**补充材料S2**：受试者人口统计学与临床特征数据，以及呼吸-吞咽协调相关参数数据。Xu, X., Zhang, Q., Xie, Y., Yang, D., Gao, F., Yuan, Y., Zhang, Y., & Li, J. (2024). 颈脊髓损伤后吞咽困难患者的呼吸与吞咽协调：一项观察性病例对照研究. 《美国言语语言病理学期刊》, 33(5), 2572–2581. https://doi.org/10.1044/2024_AJSLP-24-00135