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Laryngopharyngeal motor dysfunction and obstructive sleep apnea in Parkinson's disease
Obstructive sleep apnea (OSA) is a common sleep disorder in Parkinson's disease (PD), but the relationship between these two conditions remains uncertain. Upper airway (UA) dysfunction in PD is well documented in some patients and is believed to be a reflex of the motor involvement of laryngopharyngeal muscles.
The aim of this study is to determine whether UA dysfunction and laryngopharyngeal motor dysfunction (LMD) are involved in the obstructive phenomenon of OSA in PD.
Forty-eight PD patients underwent polysomnography for OSA diagnosis, physical examination, functional evaluation of the UA by spirometry and a clinical protocol for analysis of laryngopharyngeal muscles, where we evaluated de presence of hypophonia, difficulty in protruding at least one third of the tongue, difficulty in coughing voluntarily, difficulty in clearing the throat voluntarily, and difficulty in
elevating the palate during open-mouth inspection and vocalization of the /ah/ phoneme. Participants with at least one of these symptoms were considered to have LMD.
Thirty-one participants (64.6%) fulfilled the criteria for OSA, according to Internacional Classification of Sleep Disorders 3rd edition. UA obstruction was observed in 25% of participants and LMD in 60.4%. Among the clinical indicators of LMD, hypophonia was the most common (58.3%). Participants with LMD had a threefold greater chance of presenting with OSA than did those without LMD (OR = 3.49, 95% CI: 1.01 - 12.1, p = 0.044). Individuals with LMD had more UA dysfunction (37.9 vs 10.5%, p = 0.037), higher scores on UPDRS III (20 vs 15, p = 0.0005) and the Hoehn-Yahr scale (2.5 vs 2.0, p = 0.008), and higher frequencies of postural changes (51.7 vs 21.1%, p = 0.033) and motor phenomena (65.5 vs 31.6%, p = 0.021). Obesity, snoring, neck circumference, and the Mallampati score did not correlate with OSA in PD.
The results of this study indicate that LMD may be a factor involved in the occurrence of UA obstructive phenomena inOSA in patients with PD. LMD can help identify which PD patients should be monitored in regard to the development of OSA as most of the characteristics commonly associated with OSA in the general population do not apply to parkinsonians.
Parkinson`s Disease, Laryngopharyngeal Motor Dysfunction, Upper Airway, Obstructive Sleep Apnea, Spirometry, Mallampati Score
Christianne Martins Correa da Silva Bahia, Agnaldo Jose Lopes, João Santos Pereira, Anamelia Costa Faria