An Investigation of Pulse Oximetry Levels During Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease

Salim S. Alani; Julie A.G. Stierwalt; Leonard L. LaPointe; Richard J. Morris; Allan C. Jeong; Jennifer Filson Moses; Thomas D. Upton

doi:10.1055/s-0042-1743486

Seminars in Speech and Language, Table of Contents

Semin Speech Lang 2022; 43(05): 361-377
DOI: 10.1055/s-0042-1743486

Data-Based Articles

An Investigation of Pulse Oximetry Levels During Swallowing in Healthy Adults and in Individuals with Severe and Very Severe Chronic Obstructive Pulmonary Disease

Salim S. Alani

¹Department of Speech-Language Pathology, College of Health and Human Services, California State University, Long Beach, Long Beach, California

,

Julie A.G. Stierwalt

²Division of Speech Pathology, Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota

,

Leonard L. LaPointe

³School of Communication Science and Disorders, Program in Neuroscience, Florida State University, Tallahassee, Florida

,

Richard J. Morris

⁴School of Communication Science and Disorders, Florida State University, Tallahassee, Florida

,

Allan C. Jeong

⁵Department of Educational Psychology and Learning Systems, Instructional Systems and Learning Technologies Program, Florida State University, Tallahassee, Florida

,

Jennifer Filson Moses

⁶Department of Psychology and Statistics, Los Angeles Pierce College, Woodland Hills, California

,

Thomas D. Upton

⁷Rehabilitation Education Training Program, School of Health Sciences, Applied Sciences and Arts, Southern Illinois University, Carbondale, Illinois

› Author Affiliations

Abstract

To compare pulse oximetry (PO) levels during swallowing in healthy adults and adults with severe chronic obstructive pulmonary disease (COPD). Participants included two groups of 60 healthy adults, balanced for gender. The young group ranged from 18 to 38 years, and the older group from 60 to 87 years. In addition, there were 11 participants with COPD aged 43 to 82 years. PO levels were collected as each participant swallowed 10 mL of water, 10 mL of applesauce, and a piece of diced pear (three trials each). Analyses for the healthy groups revealed neither statistically significant main effects for bolus type nor interactions between gender and age. For between-subject effects, there was no main effect for gender, but there was a large main effect for age, and a gender and age interaction. In the group with COPD, there were no significant differences across bolus types; however, PO measures were consistently lower than the healthy groups for all bolus types. Healthy adults exhibited stable PO levels across bolus types. Adults with COPD, although exhibiting significantly lower PO levels, also remained stable. For clinicians who monitor PO measures, these results offer a more comprehensive understanding of the nature of these measures during swallowing in these groups.

Keywords

pulse oximetry - dysphagia - swallowing - swallowing disorders - COPD

Full Text

References

References
1 Sellars SC, Dunnet C, Carter R. A preliminary comparison of videofluoroscopy of swallow and pulse oximetry in the identification of aspiration in dysphagic patients. Int J Lang Commun Disord 1995; 30 (1 S): 420-420
2 Chan ED, Chan MM, Chan MM. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med 2013; 107 (06) 789-799
3 Verhovsek M, Henderson MPA, Cox G, Luo HY, Steinberg MH, Chui DH. Unexpectedly low pulse oximetry measurements associated with variant hemoglobins: a systematic review. Am J Hematol 2010; 85 (11) 882-885
4 Schutz SL. Oxygen saturation monitoring by pulse oximetry. In: Lynn-McHale DJ, Carlson KK. eds AACN Procedure Manual for Critical Care. 4th ed.. Maryland Heights, MO: Elsevier Saunders; 2001: 77-82
5 Buchholz DW, Robbins AJ. Neurological disease affect oropharyngeal swallowing. In: Perlman AL, Delrieu K. eds. Deglutition and Its Disorders. San Diego: Singular Publishing Group; 1997: 319-342
6 Jaradeh S. Neurophysiology of swallowing in the aged. Dysphagia 1994; 9 (04) 218-220
7 Donnerberg RL, Dixon GF. Pulmonary disease. In: Calkins E, Davis PJ, Ford AB. eds. The Practice of Geriatrics. Philadelphia: WB Sanders; 1986: 327-338
8 Zaidi NH, Smith HA, King SC, Park C, O'Neill PA, Connolly MJ. Oxygen desaturation on swallowing as a potential marker of aspiration in acute stroke. Age Ageing 1995; 24 (04) 267-270
9 Ricart A, Pages T, Viscor G, Leal C, Ventura JL. Sex-linked differences in pulse oxymetry. Br J Sports Med 2008; 42 (07) 620-621
10 Levental S, Picard E, Mimouni F. et al. Sex-linked difference in blood oxygen saturation. Clin Respir J 2018; 12 (05) 1900-1904
11 Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesth Analg 2007; 105 (6, Suppl): S18-S23
12 Severinghaus JW, Koh SO. Effect of anemia on pulse oximeter accuracy at low saturation. J Clin Monit 1990; 6 (02) 85-88
13 Rogers B, Msall M, Shucard D. Hypoxemia during oral feedings in adults with dysphagia and severe neurological disabilities. Dysphagia 1993; 8 (01) 43-48
14 Rogers BT, Arvedson J, Msall M, Demerath RR. Hypoxemia during oral feeding of children with severe cerebral palsy. Dev Med Child Neurol 1993; 35 (01) 3-10
15 Chan SYP, Lo RSK. Changes in arterial oxygen saturation (SaO(2)) before, during, and after meals in stroke patients in a rehabilitation setting. Dysphagia 2009; 24 (01) 77-82
16 Collins MJ, Bakheit AMO. Does pulse oximetry reliably detect aspiration in dysphagic stroke patients?. Stroke 1997; 28 (09) 1773-1775
17 Colodny N. Comparison of dysphagics and nondysphagics on pulse oximetry during oral feeding. Dysphagia 2000; 15 (02) 68-73
18 Colodny N. Effects of age, gender, disease, and multisystem involvement on oxygen saturation levels in dysphagic persons. Dysphagia 2001; 16 (01) 48-57
19 Lim SHB, Lieu PK, Phua SY. et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 2001; 16 (01) 1-6
20 Ramsey DJC, Smithard DG, Kalra L. Can pulse oximetry or a bedside swallowing assessment be used to detect aspiration after stroke?. Stroke 2006; 37 (12) 2984-2988
21 Rowat AM, Wardlaw JM, Dennis MS, Warlow CP. Does feeding alter arterial oxygen saturation in patients with acute stroke?. Stroke 2000; 31 (09) 2134-2140
22 Smith HA, Lee SH, O'Neill PA, Connolly MJ. The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. Age Ageing 2000; 29 (06) 495-499
23 Sulter G, Elting JW, Stewart R, den Arend A, De Keyser J. Continuous pulse oximetry in acute hemiparetic stroke. J Neurol Sci 2000; 179 (Suppl 1-2): 65-69
24 Wang TG, Chang YC, Chen SY, Hsiao TY. Pulse oximetry does not reliably detect aspiration on videofluoroscopic swallowing study. Arch Phys Med Rehabil 2005; 86 (04) 730-734
25 Umay EK, Unlu E, Saylam GK, Cakci A, Korkmaz H. Evaluation of dysphagia in early stroke patients by bedside, endoscopic, and electrophysiological methods. Dysphagia 2013; 28 (03) 395-403
26 Sherman B, Nisenboum JM, Jesberger BL, Morrow CA, Jesberger JA. Assessment of dysphagia with the use of pulse oximetry. Dysphagia 1999; 14 (03) 152-156
27 Higo R, Tayama N, Watanabe T, Nito T. Pulse oximetry monitoring for the evaluation of swallowing function. Eur Arch Otorhinolaryngol 2003; 260 (03) 124-127
28 Leder SB. Use of arterial oxygen saturation, heart rate, and blood pressure as indirect objective physiologic markers to predict aspiration. Dysphagia 2000; 15 (04) 201-205
29 Teramoto S, Fukuchi Y, Ouchi Y. Oxygen desaturation on swallowing in patients with stroke: what it mean?. Age Ageing 1996; 25 (04) 333-334
30 Britton D, Roeske A, Ennis SK, Benditt JO, Quinn C, Graville D. Utility of pulse oximetry to detect aspiration: an evidence-based systematic review. Dysphagia 2018; 33 (03) 282-292
31 Coelho CA. Preliminary findings on the nature of dysphagia in patients with chronic obstructive pulmonary disease. Dysphagia 1987; 2 (01) 28-31
32 Good-Fratturelli MD, Curlee RF, Holle JL. Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. J Commun Disord 2000; 33 (02) 93-110
33 Gross RD, Atwood Jr CW, Ross SB, Olszewski JW, Eichhorn KA. The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 179 (07) 559-565
34 Shaker R, Li Q, Ren J. et al. Coordination of deglutition and phases of respiration: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. Am J Physiol 1992; 263 (5, Pt 1): G750-G755
35 Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest 1990; 97 (02) 347-352
36 Kobayashi S, Kubo H, Yanai M. Impairment of the swallowing reflex in exacerbations of COPD. Thorax 2007; 62 (11) 1017
37 Teramoto S, Kume H, Ouchi Y, Mokhlesi B. Altered swallowing physiology and aspiration in COPD [5] (multiple letters). Chest 2002; 122 (03) 1104-1105 , author reply 1105
38 Brown SE, Casciari RJ, Light RW. Arterial oxygen saturation during meals in patients with severe chronic obstructive pulmonary disease. South Med J 1983; 76 (02) 194-198
39 Schols A, Mostert R, Cobben N, Soeters P, Wouters E. Transcutaneous oxygen saturation and carbon dioxide tension during meals in patients with chronic obstructive pulmonary disease. Chest 1991; 100 (05) 1287-1292
40 Wolkove N, Fu LY, Purohit A, Colacone A, Kreisman H. Meal-induced oxygen desaturation and dyspnea in chronic obstructive pulmonary disease. Can Respir J 1998; 5 (05) 361-365
41 López-Campos JL, Soler-Cataluña JJ, Miravitlles M. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2019 report: future challenges. Arch Bronconeumol (Engl Ed) 2020; 56 (02) 65-67
42 ‘Electric shocks were used as unconditioned stimuli (US) and delivered to the subjects’ dorsal right lower arm via disposable radiotransluscent electrodes (EL509, BIOPAC Systems, Goleta, CA, USA) by the STM100C module connected to the STM200 constant voltage stimulator and controlled by the BIOPAC MP150 (BIOPAC Systems, Goleta, CA, USA)
43 Ouahchi Y, Ben Salah N, Mjid M. et al. Breathing pattern during sequential swallowing in healthy adult humans. J Appl Physiol (1985) 2019; 126 (02) 487-493
44 Troche MS, Huebner I, Rosenbek JC, Okun MS, Sapienza CM. Respiratory-swallowing coordination and swallowing safety in patients with Parkinson's disease. Dysphagia 2011; 26 (03) 218-224
45 Hirst LJ, Ford GA, Gibson GJ, Wilson JA. Swallow-induced alterations in breathing in normal older people. Dysphagia 2002; 17 (02) 152-161
46 Youmans SR, Stierwalt JAG. An acoustic profile of normal swallowing. Dysphagia 2005; 20 (03) 195-209
47 IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.
48 George D, Mallery P. SPSS for Windows Step by Step: A Simple Guide and Reference. 11.0 update. 4th ed.. Boston, MA: Allyn & Bacon; 2003
49 Stevens J. Applied Multivariate Statistics for the Social Sciences. 4th ed.. Mahwah: Lawrence Erlbaum; 1996
50 Hayes AF, Cai L. Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation. Behav Res Methods 2007; 39 (04) 709-722
51 Girden ER. ANOVA: Repeated Measures. Newbury Park: Sage; 1992. . doi: https://doi.org/10.4135/9781412983419
52 Morgan AT, Omahoney R, Francis H. The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia. Dev Neurorehabil 2008; 11 (01) 25-38
53 Smith J, Wolkove N, Colacone A, Kreisman H. Coordination of eating, drinking and breathing in adults. Chest 1989; 96 (03) 578-582
54 Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA, Corbridge TC. Oropharyngeal deglutition in stable COPD. Chest 2002; 121 (02) 361-369
55 Cvejic L, Harding R, Churchward T. et al. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 2011; 16 (02) 269-275
56 Cassiani RDA, Manfredi C, Antonio J, Martinez B, Dantas RO. Arterial oxygen saturation and heart rate during a meal in chronic obstructive pulmonary disease. J Pharm Pharmacol 2011; 1 (September): 119-125
57 Schermer T, Leenders J, in 't Veen H. et al. Pulse oximetry in family practice: indications and clinical observations in patients with COPD. Fam Pract 2009; 26 (06) 524-531