Laryngopharyngeal motor dysfunction and obstructive sleep apnea in Parkinson’s disease
- 30 Downloads
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, functional evaluation of the UA by spirometry and a clinical protocol for analysis of laryngopharyngeal muscles and physical examination.
Thirty-one participants (64.6%) fulfilled the criteria for OSA according to the International Classification of Sleep Disorders- third edition (at least respiratory disturbance index of five or higher per hour of sleep plus specific symptoms). 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 those without LMD did (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.
LMD should be considered a factor that is involved in the obstructive phenomenon of UA in patients with OSA and PD.
KeywordsParkinson’s disease Laryngopharyngeal motor dysfunction Upper airway Obstructive sleep apnea Spirometry Mallampati score
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Research involving human participants and/or animals
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the Rio de Janeiro State University Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
The study was approved by the institutional research ethics committee under number 500184.
- 3.Iranzo A, Tolosa E, Gelpi E, Molinuevo JL, Valldeoriola F, Serradell M, Sanchez-Valle R, Vilaseca I, Lomeña F, Vilas D, Lladó A, Gaig C, Santamaria J (2013) Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol 12:443–453. https://doi.org/10.1016/S1474-4422(13)70056-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Mu L, Sobotka S, Chen J, Su H, Sanders I, Adler CH, Shill HA, Caviness JN, Samanta JE, Beach TG, Arizona Parkinson’s Disease Consortium (2013) Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol 72:119–129. https://doi.org/10.1097/NEN.0b013e3182801cde CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Brazilian Institute of Geography and Statistics (2011). Ethno-racial characteristics of the population – a study of the 2008 classification categories of color or race. Resource https://biblioteca.ibge.gov.br/visualizacao/livros/liv49891.pdf. Accessed 20 May 2018
- 23.Berry RB, Brooks R, Gramaldo CE, et al For the American Academy of Sleep Medicine (2017) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.4 American Academy of Sleep Medicine, Darien, IllinoisGoogle Scholar
- 24.American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien, IllinoisGoogle Scholar
- 25.Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force (2005) Standardisation of spirometry. Eur Respir J 26:319–338. https://doi.org/10.1183/09031936.05.00034805 CrossRefPubMedGoogle Scholar
- 32.Saletu M, Anderer P, Saletu B, Hauer C, Mandl M, Oberndorfer S, Zoghlami A, Saletu-Zyhlarz G (2000) Sleep laboratory studies in restless legs syndrome patients as compared with normals and acute effects of ropinirole. 2. Findings on periodic leg movements, arousals and respiratory variables. Neuropsychobiology 41:190–199. https://doi.org/10.1159/000026659 CrossRefPubMedGoogle Scholar