| 제목 |
Cut-off Value of Voluntary Peak Cough Flow in Parkinson’s Disease Patients with Severe Dysphagia. |
| 소속 |
Dong-A University College of Medicine, Department of Physical Medicine and Rehabilitation1 |
| 저자 |
Seong Woo Kim1*, Sang Beom Kim1, Jong Hwa Lee1, Min-Gu Kang1, Kyeong Woo Lee1† |
| 사사 |
|
Background : Dysphagia is one of the most common symptom of Parkinson’s disease (PD) and related to considerable morbidity and mortality. As disease progresses, cough function decreases due to weakness and rigidity of respiratory muscle, which is highly important for removal of material from airway and prevent aspiration. Peak cough flow (PCF) is known as effective parameter of cough function and past studies revealed the association between cough and aspiration risk in PD using pneumotachograph and peak flow meter. Previous studies suggested voluntary PCF as an effective, non-invasive predictor of aspiration risk in PD. One study suggested that PCF could be used with existing clinical assessment for predicting aspiration in PD. However, cut-off value of voluntary PCF remain uncertain. Purpose of this study is to validate the cut-off value of voluntary PCF for aspiration in PD patients.
Method : We retrospectively collected the data of PD patients who underwent videofluoroscopic swallowing study (VFSS) from December 2017 to December 2020. PCF was measured before VFSS, and average value was obtained after total three trials. Patients were divided into 2 groups according to penetration-aspiration scale (PAS). Patients with PAS score of 6 or higher were classified as an aspiration group, and less than 6 were classified as a non-aspiration group.
Results : 219 patients were enrolled in this study. In the VFSS, aspiration was observed in 125 patients. Significantly lower PCF values were observed in the aspiration group compared to the non-aspiration group (132.63±83.62 vs 181.38±103.92 L/min, p<0.001). The receiver operating characteristic curve analysis showed that PCF cut-off value of 153 L/min (area under the receiver operating characteristic curve [AUC] 0.648; sensitivity 73.06%; specificity 51.06%) was associated with aspiration in PD. Univariate analysis showed the male gender, lower BMI, higher Hoehn and Yahr scale, PCF values of ≤153 increased risk of aspiration. Multivariable analysis showed that PCF value of ≤153 showed increased risk of aspiration by 3.648 (1.797-7.407).
Conclusion : In this study, low PCF value was associated with aspiration in PD. PCF value ≤153 is a risk factor of aspiration in PD.
|
|
Table 1. Baseline characteristics of study participants. Values are presented as numbers(%) or mean±standard deviation. *p<0.05
Table 2. Cut-off value determined by ROC curve analysis, with youden index. Result presented as values with 95% confidence intervals. PCF, Peak cough flow; PPV, positive predictive value; NPV, negative predictive value
Table 3. Logistic regression of the Aspiration in Parkinson’s disease (n = 125). OR - odds ratio, CI - confidence interval, BMI – body mass index, PCF – peak cough flow *p < 0.05
|
