脳卒中後の閉塞性睡眠時無呼吸症候群と嚥下障害に対する包括的嚥下指導の効果。無作為化比較試験

Effects of Comprehensive Swallowing Intervention on Obstructive Sleep Apnea and Dysphagia After Stroke: A Randomized Controlled Trial.

抄録

目的:

本研究は、脳卒中患者における閉塞性睡眠時無呼吸症候群（OSA）および嚥下障害に対する包括的嚥下介入の効果を検討することを目的としたものである。

OBJECTIVE: This study aims to explore the effects of comprehensive swallowing intervention on obstructive sleep apnea (OSA) and dysphagia in stroke patients.

方法:

嚥下障害を合併した閉塞性睡眠時無呼吸症候群（OSA）の脳卒中患者を対象に、治療群と対照群に分けてランダム化比較試験を実施した。治療群は包括的な嚥下介入を行い、4週間の嚥下ケアを受け、対照群は嚥下ケアのみを受けた。ベースライン時と4週間の介入後にアウトカム測定を行い、睡眠ポリグラフ（PSG）、ビデオ内視鏡下嚥下検査（VFSS）同期表面筋電図（sEMG）、口腔咽頭磁気共鳴画像（MRI）、嚥下評価尺度により評価しました。

METHODS: We performed a randomized controlled trial in stroke patients with obstructive sleep apnea (OSA) complicated by dysphagia, divided into treatment group and control group. The treatment group underwent comprehensive swallowing intervention and received swallowing care for 4 weeks, while the control group received only swallowing care. Outcome measurements were obtained at baseline and after the 4-week intervention, evaluated by polysomnography (PSG), videoendoscopic swallowing study (VFSS) synchronized surface electromyography (sEMG), oropharyngeal magnetic resonance imaging (MRI) and swallowing assessment scales.

結果:

脳卒中患者60名（治療群30名、対照群30名）が本研究に参加することができた。ベースライン時の両群間にどの評価項目にも有意差はなかった。4週間の介入後，対照群と比較して無呼吸低呼吸指数（AHI）と酸素飽和度指数（ODI）が有意に低下し，平均・最小酸素飽和度（SaO），舌骨上筋群（ASUPMG）および舌骨下筋群（ASUBMG）の振幅が増加した．さらに、口蓋後方距離（PPD）、舌後方距離（PLD）、最小断面積（MCSA）は、治療群で明らかに上昇した。さらに，Gugging swallowing screen（GUSS）およびVFSSのスコアは，対照群に比べ，治療群で有意に上昇した．

RESULTS: Sixty patients with stroke (30 treatment and 30 control) were eligible to participate in this study. There were no significant differences in any assessment between two groups at baseline. After a 4-week intervention, compared with to control group, there was a significant decrease in the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), and increased mean and minimal oxygen saturation (SaO), amplitudes of suprahyoid muscle group (ASUPMG) and subhyoid muscle group (ASUBMG). Moreover, the posterior palatal distance (PPD), posterior lingual distance (PLD) and minimal cross-sectional area (MCSA) were obviously elevated in the treatment group. Additionally, the scores of Gugging swallowing screen (GUSS) and VFSS were significantly increased in the treatment group, compared to control group.

結論:

包括的嚥下介入は脳卒中後のOSAおよび嚥下障害に対して治療効果を示し，その機序は中咽頭筋力の増強と上気道構造の変化に関連することが明らかとなった．

CONCLUSIONS: The comprehensive swallowing intervention had therapeutic effects on OSA and dysphagia after stroke, and the mechanism was related to enhancing oropharyngeal muscle strength and changing upper airway structure.