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The interaction between breathing and swallowing in amyotrophic lateral sclerosis

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Abstract

The aim of the study is to determine the association between respiratory swallow patterns in amyotrophic lateral sclerosis (ALS) patients. Furthermore, it aims to clarify the role of the dysphagia limit in defining the relationship between swallowing disorders and respiratory disorders. Functional rating scales were used to describe swallowing and respiratory function. Swallowing was observed using the dysphagia limit. Dysphagia limit is the volume at which a second or more swallows are required to swallow the whole bolus. Laryngeal and chest movement sensors, pulmonary function tests, submental, and diaphragm electromyography activity were used to evaluate the relationship between swallowing and respiratory phase. Of the 27 patients included in the study, 14 were dysphagic and 13 were non-dysphagic. Tests showed normal respiratory function in 11 of the non-dysphagic patients and 3 of the dysphagic patients. There was a high correlation between the dysphagia limit and Amyotrophic Lateral Sclerosis Functional Rating Scale swallowing parameters. Non-dysphagic patients were able to swallow during inspiration but only six patients in the dysphagic group were able to swallow during inspiration. The occurrence of dysphagia in ALS is related to piecemeal deglutition and respiration consistency during swallowing. Detecting the timing of disturbances in the relationship between swallowing and respiration may be a way of identifying dysphagia. Dysphagia limit may be a useful, complementary test for assessing swallowing disturbances in amyotrophic lateral sclerosis.

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Acknowledgments

We wish to thank Mrs.Barbara Kılıç who reviewed the English for text. This study was supported by the Akdeniz University Scientific Research Grant (grant number: 2011.04.0101.037). Some parts of this study were presented as a poster at the World Neurology Congress 2013 and Joint Congress of European Neurology 2014. The abstract is entitled “Swallowing and Respiration Relationship in Amyotrophic Lateral Sclerosis.” in the Journal of Neurological Sciences 2013, 333, e427–428.

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Authors and Affiliations

  1. Department of Neurology, Akdeniz University Faculty of Medicine, 07070, Antalya, Turkey

    Nazan Simsek Erdem, Ali Ünal, Ferah Kızılay & Hilmi Uysal

  2. Department of Radiology, Akdeniz University Faculty of Medicine, 07070, Antalya, Turkey

    Kamil Karaali

  3. Department of Pulmonary Diseases, Akdeniz University Faculty of Medicine, 07070, Antalya, Turkey

    Candan Öğüş

  4. Department of Clinical Neurophysiology, Akdeniz University Faculty of Medicine, B Blok Level 2, 07070, Antalya, Turkey

    Hilmi Uysal

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  1. Nazan Simsek Erdem
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  2. Kamil Karaali
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  3. Ali Ünal
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  4. Ferah Kızılay
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  5. Candan Öğüş
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  6. Hilmi Uysal
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Correspondence to Hilmi Uysal.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical standards

The methods were approved by Clinical Research Ethics Committee of Akdeniz University Faculty of Medicine (B.30.2.AKD.0.20.05.05).

Informed consent

The methods were approved by the local ethics committee. All patients were asked to sign a written informed consent form.

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Erdem, N.S., Karaali, K., Ünal, A. et al. The interaction between breathing and swallowing in amyotrophic lateral sclerosis. Acta Neurol Belg 116, 549–556 (2016). https://doi.org/10.1007/s13760-016-0643-0

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  • DOI: https://doi.org/10.1007/s13760-016-0643-0

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