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. 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 out-swallow-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 swallowing-breathing 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-swallow-breath 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 swallowing-breathing
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
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