Myofunctional assessment for obstructive sleep apnea and the association with patterns of upper airway collapse: a preliminary study.

Objectives: To organize an assessment instrument with questionnaires and myofunctional orofacial/oropharyngeal assessment for OSA patients and correlate it with the upper airway obstructive site detected during drug-induced sleep endoscopy (DISE). Material and Methods: 29 OSA patients aged 22-65 years with an indication to undergo DISE to evaluate an alternative treatment to PAP and signed the consent form. Patients over 65 years old with maxillofacial deficiency and BMI>30 were excluded. The subjects answered the Pittsburgh, Berlin (snore), and Epworth questionnaires. The myofunctional orofacial/oropharyngeal assessment comprised soft palate, palatine pillars, and uvula (structure and mobility), tonsils (size), mandible (bony bases), hard palate (depth and width), tongue (posture, volume, width, and height), floor of mouth (mylohyoid), tongue suction and sustaining (mobility), "lowering of the back of the tongue" (stimulus), which were scored by three speech-language pathologists with expertise. DISE was scored according to VOTE classification. The statistical analysis (t-test) compared groups without and with obstruction in VOTE with questionnaires and myofunctional orofacial/oropharyngeal assessment. Results: The following were significantly different: snoring frequency (p=0.03) with VOTE/velopharynx; intensity (p=0.02) and frequency of snoring (p=0.03) with VOTE/lateral wall of oropharynx; suction the tongue and sustain (p=0.02) with VOTE/velopharynx; hard palate depth (p=0.02) and width (p=0.05) with obstruction VOTE/epiglottis; tonsils volume (p=0.05) with VOTE/epiglottis; tongue posture (p=0.00) with obstruction VOTE/epiglottis; floor of the mouth (p=0.02) with VOTE/epiglottis. Conclusion: Higher snoring frequency and intensity was observed in patients with obstruction at the velopharynx and oropharyngeal lateral wall. Obstruction at the velopharynx was associated with poor tongue ability to suck the tongue against the hard palate. Obstruction at the epiglottis had structural and functional associations, including the oropharyngeal lateral wall, affected by the palatine tonsils size, depth and width of the hard palate, tongue position, and flaccidity of the floor of mouth. Considering that this is a preliminary study, the data should be carefully verified and not generalized.

Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse. / Apneia Obstrutiva do Sono: caracterização do sítio obstrutivo e tipo de colapso.

Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.

A Apneia Obstrutiva do Sono caracteriza-se por episódios recorrentes de colapso parcial ou completo da faringe, seguidos de diminuição da saturação de oxihemoglobina e despertares frequentes. É considerada problema de saúde pública com importantes sintomas noturnos e diurnos, impactando qualidade de vida. Seus efeitos associam-se as áreas de competência da Fonoaudiologia. Para estabelecer diagnóstico e métodos de tratamento eficientes, profissionais devem conhecer a patogênese da obstrução da via aérea superior durante o sono. Visando contribuir para a compreensão da fisiopatologia da apneia obstrutiva do sono, elegibilidade de procedimentos terapêuticos individualizados e direcionamento para terapêutica miofuncional orofacial, o presente estudo tem como objetivo descrever e ilustrar os locais e tipos de colapso da via aérea superior durante o sono. Após processos éticos, foram analisados registros originais das sonoendoscopias de uma série de casos com diagnóstico polissonográfico de apneia obstrutiva do sono. As imagens das gravações dos exames foram analisadas por cinco profissionais com expertise na área do sono. Os locais obstrutivos e tipos de colapso foram apresentados conforme classificação vigente. Os vídeos foram divididos em capturas de tela, originando figuras de cada sítio anatômico: sem colapso e com colapso. Os resultados foram apresentados por imagens dos casos, que ilustram cada colapso, predominando colapso velofaríngeo: anteroposterior, lateral ou concêntrico; seguido por colapso orofaríngeo lateral; colapso anteroposterior na hipofaringe e colapso anteroposterior da epiglote. O entendimento dos locais de obstrução e tipos de colapso ilustrados nesse estudo pode ser um preditor de respostas terapêuticas, auxiliando a compreensão das limitações ou direcionando propostas para cada paciente.

Apneia Obstrutiva do Sono: caracterização do sítio obstrutivo e tipo de colapso / Obstructive Sleep Apnea: characterization of the obstructive site and type of collapse

RESUMO A Apneia Obstrutiva do Sono caracteriza-se por episódios recorrentes de colapso parcial ou completo da faringe, seguidos de diminuição da saturação de oxihemoglobina e despertares frequentes. É considerada problema de saúde pública com importantes sintomas noturnos e diurnos, impactando qualidade de vida. Seus efeitos associam-se as áreas de competência da Fonoaudiologia. Para estabelecer diagnóstico e métodos de tratamento eficientes, profissionais devem conhecer a patogênese da obstrução da via aérea superior durante o sono. Visando contribuir para a compreensão da fisiopatologia da apneia obstrutiva do sono, elegibilidade de procedimentos terapêuticos individualizados e direcionamento para terapêutica miofuncional orofacial, o presente estudo tem como objetivo descrever e ilustrar os locais e tipos de colapso da via aérea superior durante o sono. Após processos éticos, foram analisados registros originais das sonoendoscopias de uma série de casos com diagnóstico polissonográfico de apneia obstrutiva do sono. As imagens das gravações dos exames foram analisadas por cinco profissionais com expertise na área do sono. Os locais obstrutivos e tipos de colapso foram apresentados conforme classificação vigente. Os vídeos foram divididos em capturas de tela, originando figuras de cada sítio anatômico: sem colapso e com colapso. Os resultados foram apresentados por imagens dos casos, que ilustram cada colapso, predominando colapso velofaríngeo: anteroposterior, lateral ou concêntrico; seguido por colapso orofaríngeo lateral; colapso anteroposterior na hipofaringe e colapso anteroposterior da epiglote. O entendimento dos locais de obstrução e tipos de colapso ilustrados nesse estudo pode ser um preditor de respostas terapêuticas, auxiliando a compreensão das limitações ou direcionando propostas para cada paciente.

ABSTRACT Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech and Language Pathologists. To establish efficient diagnosis and treatment methods, professionals must know the pathogenesis of upper airway obstruction during sleep. This study seeks to enlarge the understanding of obstructive sleep apnea pathophysiology, eligibility of individualized therapeutic procedures and guidance for orofacial myofunctional therapy by describing and illustrating the locations and types of upper airway collapse during sleep. We analyzed original records of Drug Induced Sleep Endoscopy exams of a series of cases with polysomnographic diagnosis of obstructive sleep apnea following the proper ethical processes. The images of the exam recordings were analyzed by five professionals with expertise in the sleep area. Obstructive sites and types of collapse were presented according to the current classification. The videos were divided into screenshots, originating figures from each anatomical site: without collapse and collapsed. The results are visualized in the images of the cases showing a predominance of velopharyngeal collapse: anteroposterior, lateral, or concentric; oropharyngeal lateral collapse; tongue anteroposterior collapse and anteroposterior collapse of the epiglottis. Understanding the obstruction sites and types of collapse illustrated in this study may help to predict therapeutic responses and learn the limitations or direct individual proposals patient.

Scientific production of Brazilian speech language pathologists in sleep medicine.

INTRODUCTION: Previous diagnosis and intervention in patients with sleep-disordered breathing involves several health professionals. Speech-Language and Hearing Sciences (SLHS) performance has been solidified through scientific production. OBJECTIVE: To describe the inclusion of Brazilian Speech-Language Pathologists (SLP) in the field of sleep disorders, through the description of studies, scientific publications and participation in scientific events. DATA SYNTHESIS: A search and an analysis of the Brazilian SLP publications in the field of sleep disorders were carried out, including articles, monographs, dissertations, thesis and abstracts published in annals of events. The databases Lilacs, SciELO, Pubmed, Google Scholar tool and Lattes platform were accessed, with final search in January 2018. The analysis consisted of a description of the year of publication, type of publication, area of the SLHS, place of publication and/or event. 40 articles were found in national and international journals, from 1999 to 2017. In relation to publications in books, one book about the subject was published in 2009 and eight chapters of books were published. In the monograph format, 21 studies were carried out, there are 13 dissertations and eight thesis. A total of 151 abstracts were published in annals of scientific events, from 2001 to 2017 and 63 lectures were conducted by SLP. CONCLUSION: The inclusion of Brazilian SLP in the area of sleep disorders has been supported by scientific publications in the format of articles in national and international journals, monographs, thesis, dissertations, books and publications in event annals.

Effects of orofacial myofunctional therapy on the symptoms and physiological parameters of sleep breathing disorders in adults: a systematic review / Efeitos da terapia miofuncional orofacial em adultos quanto aos sintomas e parâmetros fisiológicos dos distúrbios respiratórios do sono: revisão sistemática

ABSTRACT Recently, the orofacial myofunctional therapy (OMT) has appeared as a possible alternative treatment for obstructive sleep apnea (OSA). Systematic reviews are required to achieve scientific evidence, seeking to direct the decision on therapeutic issues. The aim of this study was to systematically review the literature about the OMT proposals in adults with OSA related to symptoms and physiological parameters. Data sources were Lilacs, MEDLINE, Pubmed, Cochrane and Scielo using the descriptors: obstructive sleep apnea; myofunctional therapy; oropharyngeal exercises; breathing exercises; upper airway exercises; speech therapy. Studies published from 2000 to 2017 that evaluated the treatment with isolated OMT in subjects with OSA were included, obligatorily with polysomnographic data, pre and post therapy. Eight studies, out of 124 articles, were eligible according to the criteria adopted. Two systematic reviews, one clinical trial, three randomized clinical trials, and two case reports were included. Six studies showed a decrease in the Apnea and Hypopnea Index (AHI), five studies showed improvement in the minimum SpO2, decrease in the Epworth Sleepiness Scale (ESS) and in snoring. OMT proposals refer to a three-month program changing the parameters related to partial reduction of AHI, ESS index, snoring, and partial increase of SpO2. There are few randomized studies.

RESUMO Recentemente a terapia miofuncional orofacial (TMO) aparece como tratamento alternativo para a apneia obstrutiva do sono (AOS). Revisões sistemáticas são necessárias para apontar evidência científica buscando direcionar sua indicação. O objetivo foi analisar sistematicamente a literatura científica quanto às propostas de TMO em adultos com AOS e sintomas e parâmetros fisiológicos. As buscas ocorreram: Lilacs, MEDLINE, Pubmed, Cochrane e Scielo usando-se os descritores: apneia obstrutiva do sono; terapia miofuncional; exercícios orofaríngeos; exercícios respiratórios; exercícios da via aérea; Fonoaudiologia. Estudos publicados de 2000 a 2017 que avaliaram TMO isolada em sujeitos com AOS foram selecionados. Obrigatoriamente com dados de polissonografia pré e pós terapia. A partir de 124 artigos, oito estudos foram elegíveis de acordo com os critérios adotados. Duas revisões sistemáticas, um ensaio clínico, três ensaios clínicos randomizados e dois estudos de casos foram incluídos. Seis estudos mostraram diminuição do índice de apneia e hipopneia (IAH), cinco estudos mostraram melhora da saturação mínima SpO2, pontuação da escala de sonolência e do ronco. A TMO refere-se à programas de três meses com modificação dos parâmetros referentes à redução parcial do IAH, aumento parcial da saturação mínima SpO2, redução da sonolência diurna e do ronco. Ainda há poucos estudos randomizados.

Influence of interface and position on upper airway collapsibility assessed by negative expiratory pressure.

PURPOSE: Negative expiratory pressure (NEP) is a simple technique for the evaluation of upper airway collapsibility in patients with obstructive sleep apnea (OSA). Most studies evaluated NEP using a mouthpiece that may exclude the cephalic portion of the upper airway. We hypothesize that NEP determination is influenced by interface and position. METHODS: We evaluated patients with suspected OSA using polysomnography, NEP (-5 cmH2O in sitting and supine position with mouthpiece and nasal mask). A subgroup also underwent computed tomography (CT) of the upper airway. RESULTS: We studied a total of 86 subjects (72 male, age 46 ± 12 yrs, body mass index 30.0 ± 4.4 kg/m2, neck circumference 40.0 ± 3.5 cm, AHI 32.9 ± 26.4, range 0.5 to 122.5 events/hour). NEP was influenced by interface and position (p = 0.007), and upper airway was more collapsible with mouthpiece than with nasal mask in sitting position (p = 0.001). Position influenced NEP and was worse in supine only when evaluated by nasal mask. Expiratory resistance (R 0.2) at 0.2 s during NEP was significantly higher and independent of position with mouthpiece than with nasal mask (20.7 versus 8.6 cmH2O/L s-1, respectively, p = 0.018). NEP evaluated with nasal mask in supine position and with mouthpiece in sitting position, but not when evaluated with mouthpiece in supine position, were correlated with upper airway anatomical measurements including tongue dimensions and pharyngeal length. CONCLUSIONS: Interface and position influence NEP. NEP evaluated with nasal mask in supine position may convey more relevant information for patients under investigation for OSA than when evaluated with mouthpiece.

Upper Airway Collapsibility Assessed by Negative Expiratory Pressure while Awake is Associated with Upper Airway Anatomy.

STUDY OBJECTIVES: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness. We hypothesized that NEP will be, similarly to Pcrit, associated with upper airway anatomy assessed by computed tomography (CT) scan. METHODS: Patients under investigation for OSA underwent polysomnography, CT of the upper airway, NEP while awake, and Pcrit during sleep. NEP was performed with -5 cm H2O in supine position using a nasal mask. Pcrit was measured during sleep induced by low doses of midazolam. RESULTS: Twenty-eight male subjects were studied (age 45 ± 13 y, body mass index 29.4 ± 4.9 kg/m2, apnea-hypopnea index (AHI) 30 ± 26, range 2 to 86 events/h). NEP and Pcrit were similarly associated with tongue area (r = 0.646 and r = 0.585), tongue volume (r = 0.565 and r = 0.613) and pharyngeal length (r = 0.580 and r = 0.611), respectively (p < 0.05 for all comparisons). NEP and Pcrit were also significantly correlated with AHI (r = 0.490 and r = 0.531). NEP and Pcrit were significantly higher in patients with severe OSA than the remaining population. CONCLUSIONS: NEP is a simple and promising method that is associated with the anatomical component of upper airway collapsibility. NEP may be valuable to select patients for noncontinuous positive airway pressure alternative therapies for OSA.

Different Craniofacial Characteristics Predict Upper Airway Collapsibility in Japanese-Brazilian and White Men.

BACKGROUND: OSA pathogenesis is complex and may vary according to ethnicity. The anatomic component predisposing to OSA is the result of the interaction between bony structure and upper airway soft tissues and can be assessed using passive critical closing pressure (Pcrit). We hypothesized that Japanese-Brazilians and whites present different predictors of upper airway collapsibility, suggesting different causal pathways to developing OSA in these two groups. METHODS: Male Japanese-Brazilians (n = 39) and whites (n = 39) matched for age and OSA severity were evaluated by full polysomnography, Pcrit, and upper airway and abdomen CT scans for determination of upper airway anatomy and abdominal fat, respectively. RESULTS: Pcrit was similar between the Japanese-Brazilians and the whites (-1.0 ± 3.3 cm H2O vs -0.4 ± 3.1 cm H2O, P = .325). The Japanese-Brazilians presented smaller upper airway bony dimensions (cranial base, maxillary, and mandibular lengths), whereas the whites presented larger upper airway soft tissue (tongue length and volume) and a greater imbalance between tongue and mandible (tongue/mandibular volume ratio). The cranial base angle was associated with Pcrit only among the Japanese-Brazilians (r = -0.535, P < .01). The tongue/mandibular volume ratio was associated with Pcrit only among the whites (r = 0.460, P < .01). Obesity-related variables (visceral fat, BMI, and neck and waist circumferences) showed a similar correlation with Pcrit in the Japanese-Brazilians and the whites. CONCLUSIONS: Japanese-Brazilians and whites present different predictors of upper airway collapsibility. Although craniofacial bony restriction influenced Pcrit only in the Japanese-Brazilians, an anatomic imbalance between tongue and mandible volume influenced Pcrit among the whites. These findings may have therapeutic implications regarding how to improve the anatomic predisposition to OSA across ethnicities.

Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial.

BACKGROUND: Snoring is extremely common in the general population and may indicate OSA. However, snoring is not objectively measured during polysomnography, and no standard treatment is available for primary snoring or when snoring is associated with mild forms of OSA. This study determined the effects of oropharyngeal exercises on snoring in minimally symptomatic patients with a primary complaint of snoring and diagnosis of primary snoring or mild to moderate OSA. METHODS: Patients were randomized for 3 months of treatment with nasal dilator strips plus respiratory exercises (control) or daily oropharyngeal exercises (therapy). Patients were evaluated at study entry and end by sleep questionnaires (Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and full polysomnography with objective measurements of snoring. RESULTS: We studied 39 patients (age, 46 ± 13 years; BMI, 28.2 ± 3.1 kg/m2; apnea-hypopnea index (AHI), 15.3 ± 9.3 events/h; Epworth Sleepiness Scale, 9.2 ± 4.9; Pittsburgh Sleep Quality Index, 6.4 ± 3.3). Control (n = 20) and therapy (n = 19) groups were similar at study entry. One patient from each group dropped out. Intention-to-treat analysis was used. No significant changes occurred in the control group. In contrast, patients randomized to therapy experienced a significant decrease in the snore index (snores > 36 dB/h), 99.5 (49.6-221.3) vs 48.2 (25.5-219.2); P = .017 and total snore index (total power of snore/h), 60.4 (21.8-220.6) vs 31.0 (10.1-146.5); P = .033. CONCLUSIONS: Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01636856; URL: www.clinicaltrials.gov.

Upper airway collapsibility is associated with obesity and hyoid position.

STUDY OBJECTIVES: Upper airway anatomy plays a major role in obstructive sleep apnea (OSA) pathogenesis. An inferiorly displaced hyoid as measured by the mandibular plane to hyoid distance (MPH) has been consistently associated with OSA. The hyoid is also a common landmark for pharyngeal length, upper airway volume, and tongue base. Tongue dimensions, pharyngeal length, and obesity are associated with OSA severity, although the link between these anatomical variables and pharyngeal collapsibility is less well known. We hypothesized that obesity as measured by body mass index (BMI), neck and waist circumferences, and variables associated with hyoid position (pharyngeal length, upper airway volume, and tongue dimensions) would be associated with passive pharyngeal critical closing pressure (Pcrit). DESIGN: Cross-sectional. SETTING: Academic hospital. PATIENTS: 34 Japanese-Brazilian males age 21 to 70 y. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: We performed computed tomography scans of the upper airway, overnight polysomnography, and Pcrit measurements in all subjects. On average, subjects were overweight (BMI = 28 ± 4 kg/m(2)) and OSA was moderately severe (apnea-hypopnea index = 29 [13-51], range 1-90 events/h). Factor analysis identified two factors among the studied variables: obesity (extracted from BMI, neck and waist circumferences) and hyoid position (MPH, pharyngeal length, tongue length, tongue volume, and upper airway volume). Both obesity and hyoid position correlated with Pcrit (r = 0.470 and 0.630, respectively) (P < 0.01). In addition, tongue volume, tongue length, pharyngeal length, and MPH correlated with waist and neck circumferences (P < 0.05). CONCLUSIONS: Pharyngeal critical closing pressure is associated with obesity and hyoid position. Tongue dimensions, pharyngeal length, and the mandibular plane to hyoid distance are associated with obesity variables. These findings provide novel insight into the potential factors mediating upper airway collapse in obstructive sleep apnea.

Caracterização eletromiográfica da deglutição em indivíduos com e sem alterações clínicas / Surface electromyographic characterization of swallowing in subjects with and without swallowing disorders

OBJETIVO: verificar a possibilidade de avaliação da deglutição por análise dos traçados eletromiográficos (EMG), em sujeitos com e sem alterações clínicas da deglutição; buscando características específicas voltadas para associação do exame clínico com a eletromiografia. MÉTODO: 39 sujeitos foram divididos em dois grupos: Grupo pesquisa (GP): 25 com alteração de deglutição; controle (GC): 14 sem alteração da deglutição. Equipamento Miotool 200/400 USB, quatro canais, eletrodos na região submental bilateralmente (supra-hióideos). Avaliado deglutição de saliva e cinco mililitros de água. Os registros EMG foram analisados por três juízes, após fornecidos os traçado EMG. Classificaram-se os registros em: normal (pico único) e alterados (mais de um pico, pico não definido, modificações no onset/offset). Utilizou-se o Teste de igualdade de duas proporções. RESULTADOS: obteve-se grande número de registros com deglutições não esperados em ambos os grupos e para os dois tipos de deglutição. Deglutição de saliva, com maior porcentagem em GP de registros com deglutição alterada, não houve diferença entre os grupos. Deglutição de saliva: GC apresentou registros variados, sem predomínio significativo; GP observou-se predomínio de mais de um pico e menor ocorrência de modificações no onset/offset. Deglutição de água: GC predomínio de pico único e menor ocorrência de mais de um pico; GP predomínio de pico único e menor ocorrência de pico não definido. CONCLUSÃO: análise dos traçados EMG não mostrou características específicas e diferenciadas para os grupos; não refletindo padrões que pudessem caracterizar os registros em sujeitos com e sem alterações clínicas da deglutição. Não foi possível definir correlação entre avaliação clínica e EMG da deglutição.

PURPOSE: to verify the possibility of swallowing evaluation in subjects with and without swallowing disorders by the analysis of electromyographic (EMG) traces, search for specific characteristics and association with clinical examination and electromyography. METHOD: 39 subjects were divided into two groups: research (GP) 25 subjects with swallowing disorders and (CG) 14 without these disorders. Equipment Miotool 200/400 USB, 4 channels, with electrodes bilaterally on the submental region. Swallowing of saliva and of 5ml of water was registered. The EMG records were reviewed by three judges, after provided the EMG traces. The records were classified into normal and abnormal (single peak, more than one peak, not defined peak, changes in the onset/offset). Test of equality of two proportions was used. RESULTS: for both groups it was obtained a large number of records with unexpected swallows. The results for GP showed the highest percentage of altered swallowing of saliva records, but no statistical differences between groups was found. GC presented various types of swallowing records of saliva without significant prevalence; GP presented predominance of "more than one peak". In swallowing of water, GC showed predominance of "single peak" and a lower incidence of "more than one peak" and GP showed predominance of "single peak" and lower incidence of "not defined peak". CONCLUSION: analysis of EMG traces didn´t show specific characteristics and differences for groups, not reflecting patterns that could characterize the records in subjects with and without clinical swallowing. No correlation between clinical and EMG of swallowing was possible.