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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 
1   Department of Speech-Language Pathology, College of Health and Human Services, California State University, Long Beach, Long Beach, California
,
Julie A.G. Stierwalt
2   Division of Speech Pathology, Department of Neurology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota
,
Leonard L. LaPointe
3   School of Communication Science and Disorders, Program in Neuroscience, Florida State University, Tallahassee, Florida
,
Richard J. Morris
4   School of Communication Science and Disorders, Florida State University, Tallahassee, Florida
,
Allan C. Jeong
5   Department of Educational Psychology and Learning Systems, Instructional Systems and Learning Technologies Program, Florida State University, Tallahassee, Florida
,
Jennifer Filson Moses
6   Department of Psychology and Statistics, Los Angeles Pierce College, Woodland Hills, California
,
Thomas D. Upton
7   Rehabilitation Education Training Program, School of Health Sciences, Applied Sciences and Arts, Southern Illinois University, Carbondale, Illinois
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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


Publication History

Article published online:
11 March 2022

© 2022. Thieme. All rights reserved.

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  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 6 Jaradeh S. Neurophysiology of swallowing in the aged. Dysphagia 1994; 9 (04) 218-220
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Levental S, Picard E, Mimouni F. et al. Sex-linked difference in blood oxygen saturation. Clin Respir J 2018; 12 (05) 1900-1904
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Severinghaus JW, Koh SO. Effect of anemia on pulse oximeter accuracy at low saturation. J Clin Monit 1990; 6 (02) 85-88
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Collins MJ, Bakheit AMO. Does pulse oximetry reliably detect aspiration in dysphagic stroke patients?. Stroke 1997; 28 (09) 1773-1775
    CrossrefPubMedGoogle Scholar
  • 17 Colodny N. Comparison of dysphagics and nondysphagics on pulse oximetry during oral feeding. Dysphagia 2000; 15 (02) 68-73
    CrossrefPubMedGoogle Scholar
  • 18 Colodny N. Effects of age, gender, disease, and multisystem involvement on oxygen saturation levels in dysphagic persons. Dysphagia 2001; 16 (01) 48-57
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 31 Coelho CA. Preliminary findings on the nature of dysphagia in patients with chronic obstructive pulmonary disease. Dysphagia 1987; 2 (01) 28-31
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 35 Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest 1990; 97 (02) 347-352
    CrossrefPubMedGoogle Scholar
  • 36 Kobayashi S, Kubo H, Yanai M. Impairment of the swallowing reflex in exacerbations of COPD. Thorax 2007; 62 (11) 1017
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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)
    PubMed
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 45 Hirst LJ, Ford GA, Gibson GJ, Wilson JA. Swallow-induced alterations in breathing in normal older people. Dysphagia 2002; 17 (02) 152-161
    CrossrefPubMedGoogle Scholar
  • 46 Youmans SR, Stierwalt JAG. An acoustic profile of normal swallowing. Dysphagia 2005; 20 (03) 195-209
    CrossrefPubMedGoogle Scholar
  • 47 IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 49 Stevens J. Applied Multivariate Statistics for the Social Sciences. 4th ed.. Mahwah: Lawrence Erlbaum; 1996
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 51 Girden ER. ANOVA: Repeated Measures. Newbury Park: Sage; 1992. . doi: https://doi.org/10.4135/9781412983419
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 53 Smith J, Wolkove N, Colacone A, Kreisman H. Coordination of eating, drinking and breathing in adults. Chest 1989; 96 (03) 578-582
    CrossrefPubMedGoogle Scholar
  • 54 Mokhlesi B, Logemann JA, Rademaker AW, Stangl CA, Corbridge TC. Oropharyngeal deglutition in stable COPD. Chest 2002; 121 (02) 361-369
    CrossrefPubMedGoogle Scholar
  • 55 Cvejic L, Harding R, Churchward T. et al. Laryngeal penetration and aspiration in individuals with stable COPD. Respirology 2011; 16 (02) 269-275
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar