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Laryngopharyngeal motor dysfunction and obstructive sleep apnea in Parkinson’s disease

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

LMD should be considered a factor that is involved in the obstructive phenomenon of UA in patients with OSA and PD.

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Correspondence to Christianne Martins Corrêa Silva Bahia.

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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

Informed consent was obtained from all individual participants included in the study.

Ethical approval

The study was approved by the institutional research ethics committee under number 500184.

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Cite this article

Bahia, C.M.C.S., Pereira, J.S. & Lopes, A.J. Laryngopharyngeal motor dysfunction and obstructive sleep apnea in Parkinson’s disease. Sleep Breath 23, 543–550 (2019). https://doi.org/10.1007/s11325-018-1729-0

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  • DOI: https://doi.org/10.1007/s11325-018-1729-0

Keywords

  • Parkinson’s disease
  • Laryngopharyngeal motor dysfunction
  • Upper airway
  • Obstructive sleep apnea
  • Spirometry
  • Mallampati score