The Relationships among Objective Measures of Tongue Strength and Risk of Aspiration

Objective: The objective measures of tongue strength can predict the risk of aspiration. Isometric tongue pressure and endurance have been reported to be lower in patients who have premature spillage, penetration and/or aspiration on endoscopic evaluation. We aimed to study the relationships between the objective measures of tongue strength and risk of aspiration in our population. Methods: Seventy-five participants were enrolled to the study. The mean age of the participants was 58.3 ±13.6 years old. They were divided into three groups (25 participants in each group). The first group was normal participants who have had no history of swallowing problem with normal flexible endoscopic evaluation of swallowing (FEES). The second group was symptomatic patients who have had history of dysphagia and/or aspiration but normal FEES. The third group was patients who have had history of dysphagia and/or aspiration with evidence of premature spillage or laryngeal penetration or aspiration by FEES. All participants underwent objective measurements of the tongue strength including maximal isometric pressure (MIP) and endurance by Iowa Oral Performance Instrument (IOPI). The quantitative data between groups were compared using ANOVA and chi-square test was used for qualitative data. The optimal cut-off points were determined by Receiver Operating Characteristic (ROC) curve. Results: MIP and endurance were significantly lower in patients who have had premature spillage, penetration and/or aspiration on endoscopic evaluation. The appropriate cut-off points for high risk group are 35 and 25 kPa for the anterior and posterior tongue pressure respectively. Conclusion: The tongue pressure can be used to screen patients who are at risk of aspiration, which will lead to early investigation and intervention for the management of these patients

Characteristics and Clinical Presentations of Patients at the Siriraj Snoring Clinic

Objective: To describe characteristics and clinical presentations of patients in Siriraj snoring clinic and to analyze their relationships with obstructive sleep apnea (OSA) severity. Methods: Three hundred and seventy-three patients’self-administered questionnaires regarding sleep problems recorded between January 2012 and December 2013 and 275 polysomnographic reports were reviewed. Results: Among 373 respondents, there were 247 males (66.2%) and 126 females (33.8%), with an average age of 48 years and body mass index of 28.2 kg/m2.  Their most common complaints and comorbidities were snoring ≥3 nights/week (87.9%), worrying about complications from apnea (72.4%), dyslipidemia (36.7%), hypertension (34.3%), and diabetes mellitus (12.1%), respectively. Using apnea-hypopnea index (AHI) of ≥5 and ≥30 events/hour, there were 76.7% and 38.5% of patients diagnosed as OSA and severe OSA, respectively. While using respiratory disturbance index (RDI) with similar cut-off, almost everyone (98.8%) and 60.2% of patients will be diagnosed as OSA and severe OSA, respectively.  Characteristics significantly associated with AHI ≥15 events/hour were snoring ≥3 nights/week, witnessed apneas, and nocturia (p < 0.05). The comorbidities which significantly associated with OSA group were hypertension, diabetes, and dyslipidemia.  There were only weak significant relationships between AHI (and RDI) with ESS and quality of life. Conclusion: The most common complaints in our clinic were loud snoring and worrying about OSA consequences, not excessive daytime sleepiness. Based on RDI criteria, almost everyone were diagnosed as OSA; however, it had poor relationship with patients’symptoms, comorbidities and quality of life.  Thus, for better OSA evaluation, we should use data from several aspects, not only AHI nor RDI for proper patient management