Fiberoptic endoscopic evaluation of swallowing and the Brazilian version of the Eating Assessment Tool-10 in resistant hypertensive patients with obstructive sleep apnea

Brendim, Mariana Pinheiro; Muniz, Carla Rocha; Borges, Thalýta Georgia Vieira; Ferreira, Flávia Rodrigues; Muxfeldt, Elizabeth Silaid

doi:10.1016/j.bjorl.2022.01.006

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Brazilian Journal of Otorhinolaryngology

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Brasil

Español English

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Sumário

ORIGINAL ARTICLE • Braz. j. otorhinolaryngol. 88 (suppl 5) • Nov-Dec 2022 • https://doi.org/10.1016/j.bjorl.2022.01.006 copy

Fiberoptic endoscopic evaluation of swallowing and the Brazilian version of the Eating Assessment Tool-10 in resistant hypertensive patients with obstructive sleep apnea

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The aim of this study was to describe the prevalence and characteristics of OD through Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and the Eating Assessment Tool-10 (EAT-10) in hypertensive patients with OSA, as well as to describe the sensitivity of EAT-10 for the detection of OD in this population.

Methods:

This study included a convenience sample in which 85 resistant hypertensive patients diagnosed with OSA in an university hospital participated. Participants were subjected to the EAT-10 (index test) and FEES (reference standard).

Results:

The median EAT-10 score was 2 (0–5.5). According to the FEES, 27 participants did not have dysphagia, 42 had mild dysphagia and 16 had mild to moderate dysphagia. The sensitivity of the EAT-10 was 70.7% (95% CI: 57.3–81.9) at a cutoff score ≤1, with a discriminatory power of 67.4% (p = 0.005). The most prevalent symptom in this population was “food stuck in the throat”, while the most prevalent signs were delayed initiation of the pharyngeal phase of swallowing, premature bolus spillage and pharyngeal residue.

Conclusion:

In our study, the cutoff score for the EAT-10 for screening for OD in this population was ≥ 1. In conclusion, this population presented a high prevalence of dysphagia detected in FEES and its severity is associated with higher EAT-10 scores.

KEYWORDS
Sleep apnea; Obstructive; Deglutition disorders; Fiberoptic endoscopic evaluation of swallowing; ROC curve; Screening

HIGHLIGHTS

Resistant hypertensive with OSA have a high prevalence of deglutition disorders.

Changes in the oral phase of swallowing are inferred by FEES in these subjects.

Changes in the pharyngeal phase of swallowing are found by FEES in these subjects.

The greater severity of dysphagia is associated with higher EAT-10 scores.

The cutoff score for EAT-10 for screening of dysphagia is ≥1 in these subjects.

Characteristics	Total	Oropharyngeal dysphagia		p-Value
	n = 85	No (n = 27)	Yes (n = 58)
Sex, females, n (%)	63 (74.1)	18 (66.7)	45 (77.6)	0.285^a a Pearson’s Chi-Square test.
Age (years), median (IQR)	60 (55–63)	58 (54–62)	61 (55.75–63.25)	0.080^b b Mann-Whitney test.
Smoking, n (%)	9 (10.6)	4 (14.8)	5 (8.6)	0.305^c c Fisher’s exact test.
Weight (kg), median (IQR)	84 (75.5–103.5)	81 (77–109)	86 (73–103.25)	0.959^b b Mann-Whitney test.
Height (m), mean±SD	1.62 ± 0.01	1.63 ±0.1	1.61 ±0.1	0.447^d d Independent samples t-test.
BMI (kg/m²), median (IQR)	33.7 (28.7–37)	32.2 (28.7–36.2)	34.2 (28.7–37.2)	0.549^b b Mann-Whitney test.
NC (cm), mean±SD	41.4±4.6	42.3 ±3.99	41 ±4.83	0.204^d d Independent samples t-test.
AHI, median (IQR)	22 (10–38)	22 (8–38)	23 (12–36.25)	0.558^b b Mann-Whitney test.
CPAP, n (%)	19 (22.4)	5 (18.5)	14 (24.1)	0.563^a a Pearson’s Chi-Square test.
Severity of OSA, n (%)
Mild	30 (35.3)	12 (44.4)	18 (31)	0.366^a a Pearson’s Chi-Square test.
Moderate	23 (27.1)	5 (18.5)	18 (31)
Severe	32 (37.6)	10 (37)	22 (37.9)

Signs		Item 2	Item 4	Item 5	Item 7	Item 8	Item 9	EAT-10
Premature spillage	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–1)	0 (0–2)	1 (0–6.75)
Premature spillage	Yes	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)^a a p < 0.05.	1 (0–2)	0 (0–0)	2 (0–4)
Delayed onset of the PR	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–2)	0 (0–1)	0 (0–4)
Delayed onset of the PR	Yes	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–2)	0 (0–1.75)	2 (0–6)
Piecemeal deglutition	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–2)	0 (0–1)	1 (0–3.5)
Piecemeal deglutition	Yes	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–2)	0 (0–1.75)	2 (0–6)
Delayed posterior leakage	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–1)	0 (0–1)	1 (0–3)
Delayed posterior leakage	Yes	0 (0–0)	0 (0–0)	0 (0–0)^a a p < 0.05.	0 (0–0)	1 (0–3)^a a p < 0.05.	0 (0–2)	3 (0–6)^a a p < 0.05.
Penetrationaspiration	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–2)	0 (0–0)	1 (0–3)
Penetrationaspiration	Yes	0 (0–0)^a a p < 0.05.	0 (0-1)	0 (0–0)	0 (0–0)	1 (0–2.5)	0 (0–3)^a a p < 0.05.	2 (0–9)
Pharyngeal residue	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–1)	0 (0–2)	0 (0–4.5)
Pharyngeal residue	Yes	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	1 (0–2)^a a p < 0.05.	0 (0–1)	2 (0–5.75)
Oropharyngeal dysphagia	No	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–3)
Oropharyngeal dysphagia	Yes	0 (0–0)	0 (0–0)	0 (0–0)	0 (0–0)	1 (0–2)^b b p < 0.01.	0 (0–2)	2 (0–6)^b b p < 0.01.

EAT-10	Cutoff score: ≥1	Cutoff score: ≥2	Cutoff score: ≥3
Sensitivity (95% CI)	70.69% (57.3–81.9)	62.07% (48.4–74.5)	46.55% (33.3–60.1)
Specificity (95% CI)	62.96% (42.4–80.6)	70.37% (49.8–86.2)	74.07% (53.7–88.9)
Accuracy	68.24%	64.71%	55.29%
Predictive value +	80.4% (70.9–87.3)	81.8% (70.9–89.3)	79.4% (65.8–88.5)
Predictive value −	50.0% (37.9–62.1)	46.3% (36.4–56.6)	39.2% (31.7–47.2)
LR+ (95% CI)	1.91 (1.1–3.2)	2.09 (1.1–3.9)	1.80 (0.9–3.6)
LR— (95% CI)	0.47 (0.3–0.8)	0.54 (0.4–0.8)	0.72 (0.5–1.0)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author. E-mail:marianabrendim@gmail.com (M.P. Brendim).