Safety and feasibility of evaluating airway-protective reflexes during sleep: new technique and preliminary results. Gastrointest Endosc 2007 Mar;65(3):483-6
Date
02/27/2007Pubmed ID
17321251DOI
10.1016/j.gie.2006.10.019Scopus ID
2-s2.0-33847061288 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: The airway is vulnerable to aspiration during sleep. The integrity of aerodigestive-protective reflexes during sleep has not been studied previously because of a lack of adequate techniques.
OBJECTIVE: To determine the safety and the feasibility of a new technique to elicit pharyngoglottal closure reflex (PGCR), pharyngo-upper-esophageal sphincter (UES) pressure contractile reflex (PUCR), and reflexive pharyngeal swallow (RPS) during sleep.
SETTING: Outpatient sleep laboratory.
DESIGN AND INTERVENTION: PGCR, PUCR, and RPS were elicited in 3 subjects by injecting colored water into the pharynx through a specially designed UES manometry catheter to which a thin videoendoscope was taped. This assembly was passed transnasally and positioned to obtain UES-pressure recordings and adequate endoscopic glottic views. Sleep was monitored by polysomnography, and all modalities were synchronized by using a timer. Subjects were evaluated while awake and during stage I sleep.
RESULTS: All subjects were monitored for 3 hours of natural sleep, during which several periods of stage I sleep were observed. While awake, PGCR, PUCR, and RPS were elicited in all subjects. During sleep, PGCR was present in all, PUCR in 2, and RPS in 2 (1 after arousal) subjects. Threshold volumes for reflex elicitation were not significantly different between the awake state and stage I sleep. None of the subjects exhibited laryngeal penetration or aspiration.
LIMITATIONS: Small numbers of subjects were studied only in stage I sleep.
CONCLUSIONS: When using the above technique, it is safe and feasible to study aerodigestive reflexes during sleep. Preliminary data suggest that PGCR, PUCR, and RPS can be elicited during sleep.
Author List
Dua KS, Bajaj JS, Rittmann T, Hofmann C, Shaker RAuthors
Kulwinder S. Dua MD Professor in the Medicine department at Medical College of WisconsinReza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultDeglutition
Electromyography
Endoscopy, Gastrointestinal
Esophageal Sphincter, Upper
Feasibility Studies
Gagging
Humans
Male
Manometry
Polysomnography
Pressure
Reference Values
Reproducibility of Results
Respiratory Aspiration
Sleep
