Yutma ve Solunum İlişkisi: Genel Bilgiler

Year 2018, Volume: 1 Issue: 2, 127 - 141, 01.08.2018

Cemil Yılmaz

Abstract

Yutma ve solunum arasında yakın bir ilişki vardır. Yutma ve solunumun birbirine yakın bölgede bulunan oromotor Central Pattern Generators (CPGs) tarafından düzenlenmeleri, benzer nöral yolları ve benzer oral-farengeal yapıları kullanmaları gibi nedenler, aralarında son derece gelişmiş bir koordinasyon olmasını zorunlu hale getirir. Yeni doğanlarda emmeyle birlikte yutma-solunum koordinasyonu da gelişmeye başlar. Bir yaştan itibaren de ağırlıklı olarak kullanılan yutma-solunum biçimi; nefes verme-yutma-nefes verme ve nefes alma-yutma-nefes vermedir. Yetişkinlerde ise baskın yutma-solunum biçimi nefes verme-yutma-nefes verme biçiminde olarak yerini alır. Bu yutma-solunum biçiminin, yutma sırasında görülebilecek olan aspirasyon-penetrasyon gibi sağlık risklerini en aza indirdiği düşünülmektedir. Solunumun bozulmasıyla da yutma-solunum koordinasyonunun bozulabileceği ve sonuçta da yutmanın etkilenebileceği göz ardı edilmemelidir. Yutma bozukluklarında kullanılan supraglottik ve süper-supraglottik yutma manevraları, doğrudan yutma ve solunum arasındaki ilişkiye dayanır ve yutma sonrasında mutlaka nefes vermenin yer almasını sağlar. Bu genel bilgilerden yola çıkılarak derleme 3 bölüme ayrılmıştır. İlk bölümde yutma ve solunum ilişkisini düzenleyen nöral mekanizmalardan olan CPGs üzerinde durulmaktadır. Sonraki bölümde ise yutma ve solunum mekanizmasının gelişimi açıklandığından dolayı ilk 1 yaştaki yutma ve solunum mekanizması üzerinde durulmaktadır. Son bölümde ise yetişkinlerdeki yutma ve solunum ilişkisi açıklanmaya çalışılmaktadır.

Keywords

yutma, solunum, CPGs, yutma-solunum biçimi, yutma apnesi

Swallowing and Breathing Relationship: General Knowledge

Abstract

There is a close association between swallowing and breathing. Both swallowing and breathing are regulated by the similar oromotor CPGs that are in the close proximity in the same brain region. They also use similar neural pathways and similar oral-pharyngeal structures. These features generate an obligatory coordination between swallowing and breathing. Swallowing and breathing coordination begin to build up with sucking in newborns. Uzm. Dkt., Eskişehir Bir İnci Özel Eğitim ve Rehabilitasyon Merkezi, [e-mail] derleme, sayın Hocam Doç. Dr. Müzeyyen Çiğiltepe’nin dersinde asistanlık yapabilme şansından doğduğu için kendisine ve CPGs konusundaki geri dönütü için Sema Karabulut’a teşekkürü bir borç bilirim. Generally used swallowing-breathing pattern after 1 year of age develops into breath out-swallow-breath out or breath in-swallow-breath out patterns. The dominant swallowing pattern established in adults is breath outswallow-breath out pattern which is seen close to 100%. This swallowing-breathing pattern is considered to have certain advantageous over other patterns such as decreasing the aspiration-penetration risk to a minimum during swallowing. Relying on the close relation between swallowing and breathing, it’s assumed that a breathing disorder can interrupt swallowing-breathing coordination and consequently swallowing could be disturbed. Supraglottic and super-supraglottic swallowing maneuvers used in deglutition disorders are exclusively depending on the swallowing-breathing relation and requiring a breathing out after the swallow. This review is consisted of 3 sections. CPGs are explained in the first section. CPGs are the neural mechanisms regulating swallowing-breathing relation and also other rhytmic events such as chewing, walking, running, swimming. Oromotor CPGs are a group of CPGs that regulate breathing, sucking, chewing, swallowing and coughing. Sucking is considered as an important biomarker for the development of other oromotor events. Oromotor CPGs are localized in the brain stem and receive feedback from the central and peripheral nervous systems. The second section is about the development of swallowing-breathing mechanism so that swallowing-breathing mechanism of newborns and infants are reviewed. Swallowing-breathing relation must be healthy for newborns and infants, otherwise serious health problems such as recurrent aspiration pneumonia could come out. There are various swallowing-breathing patterns seen in newborns and infants. Several of these swallowing-breathing patterns are assumed to be pathological. For example, if swallowing disturbs the breathing cycle or swallowing happens as breathing is ceased then these swallowing-breathing patterns are considered to be pathological. However, breath out-swallow-breath out and breath in-swallow-breath out patterns are considered as the ideal swallowingbreathing patterns. In newborns it was observed that the most frequent swallowing-breathing pattern is the breath in-swallow-breath out pattern. Sucking-swallowing coordination is also observed to be more rhytmic than swallowing-breathing coordination in the early stages of newborns. This state highlights the importance of sucking. Because swallowing and breathing coordination is also regulated by similar oromotor CPGs as in the case of sucking. As infants are observed through 1 year of age, two swallowing patterns of breath in-swallowbreath out and breath out-swallow-breath out were observed to be more frequent. Also the frequency of wake swallows were seen to decrease at the end of 1 year age. These are the markers for the development of swallowing-breathing relation in infants. Problems such as preterm births could distrupt the healthy swallowingbreathing development. The swallowing-breathing relation of the adults are explained in the last section. In adults there is a dominant swallowing-breathing pattern which is breath out-swallow-breath out. This dominant swallowing-breathing pattern is evaluated to posses several mechanical advantages over other patterns in relation to decrease aspiration and penetration possibility. Swallowing-breathing relation is evaluated through the length of swallowing apnea period. Swallowing apnea period is affected by type and volume of the bolus

Keywords

swallowing, breathing, CPGs - central pattern generators, swallowing-breathing pattern, swallowing apnea

References

• Arslan, S.S., Demir, N., Karaduman, A.A., (2016), Both Pharyngeal and Esophageal Phases of Swallowing are associated with recurrent pneumonia in pediatric patients, The Clinical Respiratory Journal, 12, 767– 771.
• Bamford, O., Taciak, V., Gewolb, I.H., (1992), The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates, Pediatric Research, 31(6), 619-624.
• Barlow, S.M., Lund, J.P., Estep, M., Kolta, A., (2010), Central pattern generators for orofacialmovements and speech, Brudzynski, S.M. (Ed.), Handbook of Mammalian Vocalization: An Integrative Neuroscience Approach, (pp. 351-369). United States of America: Elsevier.
• Barlow, S.M., (2009), Oral and respiratory control for preterm feeding, Current Opinion in Otolaryngology & Head and Neck Surgery, 17(3): 179–186.
• Costa, M.M.B., Lemme, E.M.O., (2010), Coordination of respiration and swallowing: functional pattern and relevance of vocal folds closure, Arquivos de Gastroenterologia, 47(1), 42-48.
• Fucile, S., McFarlan, D.H., Gisel, E.G., Lau, C., (2012), Oral and nonoral sensorimotor interventions facilitate suck–swallow–respirationfunctions and their coordination in preterm infants, Early Human Development, 88, 345–350.
• Kawasaki, M., Ogura, J.H., Takenouchi, S., (1964), Neurophysiologic observations of normal deglutation: I. Its relationship to the respiratory cycle, Laryngoscope, 74, 1747-65.
• Kelly, B.N., Huckabee, M.L., Jones, R.D., Frampton, C.M.A., (2007a), The early impact of feeding on infant breathing–swallowing coordination, Respiratory Physiology & Neurobiology, 156, 147–153.
• Kelly, B.N., Huckabee, M.L., Jones, R.D., Frampton, C.M.A., (2007b), Integrating swallowing and respiration: preliminary results of the effect of body position, Journal of Medical Speech-Language Pathology, 15(4), 347-355.
• Klahn, M.S., Perlman, A.L., (1999), Temporal and durational patterns associating respirationand swallowing, Dysphagia, 14, 131–138.
• Marder, E., Bucher, D., (2001), Central pattern generators and the control of rhythmicmovements, Current Biology, 11(23), 986–996.
• Martin-Harris, B., Brodsky, M.B., Price, C.C., Michel, Y., Walters, B., (2003), Temporal coordination of pharyngeal and laryngeal dynamicswith breathing during swallowing: single liquid swallows, Journal of Applied Physiology, 94, 1735–1743.
• Mizuno, K., Ueda, A., (2003), The maturation and coordination of sucking,swallowing, and respiration in preterm infants, The Journal of Pediatrics, January, 36-40.
• Nishino, T., Hiraga, K., (1991), Coordination of swallowing and respirationin unconscious subjects, American Physiological Society, 988-993.
• Nixon, G.M., Charbonneau, I., Kermack, A.S., Brouillette, R.T., McFarland, D.H., (2008), Respiratory- swallowing interactions during sleepin premature infants at term, Respiratory Physiology & Neurobiology, 160, 76–82.
• Park, G.W., Kim, S.K., Lee, C.H., Kim, C.R., Jeong, H.J., Kim, D.K., (2015), Effect of chronic obstructive pulmonary disease on swallowing function in stroke patients, Annals of Rehabilitation Medicine, 39(2), 218-225.
• Preiksaitis, H.G., Mills, C.A., (1996), Coordination of breathing and swallowing: effectsof bolus consistency and presentation in normal adults, American Physiological Society, R1707-R1714.
• Preiksaitis, H.G., Mayrand, S., Robins, K., Diamant, N.E., (1992), Coordination of respiration and swallowing:effect of bolus volume in normal adults, American Physiological Society, R624-R630.
• Shaker, R., Li, Q., Ren, J., Townsend, W.F., Dodds, W.J., Martin, B.J., Kern, M.K., Rynders, A., (1992), Coordination of deglutition and phases of respiration: Effect of aging, tachypnea, bolus volume, and chronicobstructive pulmonary disease, American Physiological Society, G750-G755.
• Shaw, S.M., Martino, R., (2013), The normal swallow, Otolaryngologic Clinics of North America, 46, 937–956.
• Troche, M.S., Huebner, I., Rosenbek, J.C., Okun, M.S., Sapienza, M., (2011), Respiratory-swallowing coordination and swallowing safetyin patients with Parkinson’s disease, Dysphagia, 26, 218–224.