Predictors of swallowing disorders in Obstructive Sleep Apnea Syndrome: a case-control and cross-sectional study

Authors

  • Luís André Baptista Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal https://orcid.org/0009-0008-3475-0308
  • Fátima Cruz Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Sara Custódio Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Rui Cabral Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • David Nascimento Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Gonçalo Silva Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Gonçalo Bernardes Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Eva Brycsh Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Joana Guincho Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Carlota Sousa Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal
  • Pedro Escada Unidade Local de Saúde de Lisboa Ocidental, Lisboa, Portugal

DOI:

https://doi.org/10.34631/sporl.3123

Keywords:

Obstructive sleep apnea syndrome, dysphagia, deglutition handicap index

Abstract

Introduction: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep disorder characterized by recurrent upper airway collapse, leading to intermittent hypoxia and sleep fragmentation. While OSAS is associated with multiple systemic comorbidities, its impact on swallowing function remains underrecognized. This study aims to compare swallowing characteristics between OSAS patients and controls and identify risk factors and predictors of swallowing disorders severity.

Methods: A case-control and cross-sectional study was conducted with people with moderate to severe OSAS (PwOSAS) and age- and sex-matched controls. Swallowing function was assessed using the Fiberoptic Endoscopic Evaluation of Swallowing, Dysphagia Outcome and Severity Scale (DOSS), and Dysphagia Handicap Index (DHI). Descriptive statistics, normality tests, group comparisons (t-test, Mann-Whitney U test, Chi-square, Fisher’s exact test) and an ordinal regression were applied, with significance set at p ≤ 0.05.

Results: Fifty individuals (PwOSAS n = 25 and controls n = 25) were included, with a mean age of 50 ± 1.55 years. Swallowing impairments were identified in 60% of PwOSAS compared to 28% of controls (p = 0.023). The most frequent impairments were pharyngeal residue accumulation (52% in PwOSAS vs. 24% in controls; p = 0.041), followed by premature spillage (12% vs. 4%; p = 0.297). PwOSAS had significantly higher DHI scores than controls (p = 0.024). The percentage of recording time with SpO₂ below 90% (T90) is a negative predictor of the severity of swallowing disorders.

Conclusion: Swallowing impairments are common in PwOSAS, with significantly higher pharyngeal residue accumulation and greater impact on daily life compared to controls. These findings highlight the importance of swallowing assessment in this population.

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References

Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014 Feb 22;383(9918):736-47. doi: 10.1016/S0140-6736(13)60734-5.

Malhotra A, White DP. Obstructive sleep apnoea. Lancet. 2002 Jul 20;360(9328):237-45. doi: 10.1016/S0140-6736(02)09464-3.

Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019 Aug;7(8):687-698. doi: 10.1016/S2213-2600(19)30198-5.

Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, Javaheri S. et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017 Feb 21;69(7):841-858. doi: 10.1016/j.jacc.2016.11.069.

Bhutada AM, Broughton WA, Focht Garand KL. Obstructive sleep apnea syndrome (OSAS) and swallowing function—a systematic review. Sleep Breath. 2020 Sep;24(3):791-799. doi: 10.1007/s11325-020-02037-w.

Schindler A, Mozzanica F, Sonzini G, Plebani D, Urbani E, Pecis M. et al. Oropharyngeal dysphagia in patients with obstructive sleep apnea syndrome. Dysphagia. 2014 Feb;29(1):44-51. doi: 10.1007/s00455-013-9474-9.

Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001 Winter;16(1):7-18. doi: 10.1007/pl00021290.

Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018 May;126(5):1763-1768. doi: 10.1213/ANE.0000000000002864.

Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996 Spring;11(2):99-103. doi: 10.1007/BF00417898.

Caparroz FA, de Almeida Torres Campanholo M, Sguillar DA, Haddad L, Park SW, Bittencourt L. et al. A pilot study on the efficacy of continuous positive airway pressure on the manifestations of dysphagia in patients with obstructive sleep apnea. Dysphagia. 2019 Jun;34(3):333-340. doi: 10.1007/s00455-018-9944-1.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8. doi: 10.1007/BF00417897.

Silva-Carvalho I, Martins A, Freitas SV, Teixeira L, Meireles L, Pedroto I. Validation of the European Portuguese Version of the Yale Pharyngeal Severity Rating Scale. Dysphagia. 2025 Apr;40(2):336-342. doi: 10.1007/s00455-024-10731-0.

Speyer R, Cordier R, Bouix C, Gallois Y, Woisard V. Using classical test theory to determine the psychometric properties of the deglutition handicap index. Dysphagia. 2022 Feb;37(1):65-73. doi: 10.1007/s00455-021-10250-2.

Nguyen AT, Jobin V, Payne R, Beauregard J, Naor N, Kimoff RJ. Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep. 2005 May;28(5):585-93. doi: 10.1093/sleep/28.5.585.

Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D. Upper airway sensation in snoring and obstructive sleep apnea. Am J Respir Crit Care Med. 2001 Jul 15;164(2):250-5. doi: 10.1164/ajrccm.164.2.2010012.

Friberg D, Gazelius B, Lindblad LE, Nordlander B. Habitual snorers and sleep apnoics have abnormal vascular reactions of the soft palatal mucosa on afferent nerve stimulation. Laryngoscope. 1998 Mar;108(3):431-6. doi: 10.1097/00005537-199803000-00022.

Dematteis M, Lévy P, Pépin JL. A simple procedure for measuring pharyngeal sensitivity: a contribution to the diagnosis of sleep apnoea. Thorax. 2005 May;60(5):418-26. doi: 10.1136/thx.2003.015032.

Campanholo MAT, Caparroz FA, Stefanini R, Haddad L, Bittencourt LRA, Tufik S. et al. Dysphagia in patients with moderate and severe obstructive sleep apnea. Braz J Otorhinolaryngol. 2021 Jul-Aug;87(4):422-427. doi: 10.1016/j.bjol.2019.10.004.

Valbuza JS, de Oliveira MM, Zancanella E, Conti CF, Prado LB, Carvalho LB. et al. Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study. Sleep Breath. 2011 May;15(2):209-13. doi:10.1007/s11325-010-0474-9.

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Published

2026-03-07

How to Cite

Baptista, L. A., Cruz, F., Custódio, S., Cabral, R., Nascimento, D., Silva, G., … Escada, P. (2026). Predictors of swallowing disorders in Obstructive Sleep Apnea Syndrome: a case-control and cross-sectional study. Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery, 64(1), 27–35. https://doi.org/10.34631/sporl.3123

Issue

Vol. 64 No. 1 (2026): March

Section

Original Article

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Copyright (c) 2026 Luís André Baptista, Fátima Cruz, Sara Custódio, Rui Cabral, David Nascimento, Gonçalo Silva, Gonçalo Bernardes, Eva Brycsh, Joana Guincho, Carlota Sousa, Pedro Escada

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