Objective: To assess the feasibility of using 24-hours ambulatory impedance-pH monitoring (24-hAlpHM) to precisely measure saliva swallowing frequency (SSF) in patients with Parkinson’s disease (PD).

Background: The pathophysiology of drooling is multifactorial, including reduced swallowing capacity, open mouth due to hypomimia, and stooped posture. In addition, it is generally assumed that PD patients also have a reduced SSF prior to the loss of saliva, which generates accumulation of saliva. However, this has not yet been convincingly demonstrated and understood. The main reason for this is that measurement of SSF is only relevant when done during 24 hours in everyday life. Non-invasive SSF-measurements are either limited in time or location or they interfere with other upper airway sounds or body movements. 24-hAlpHM (used to analyze gastro-esophageal reflux) seems suitable for SSF-registration in PD patients.

Methods: Validity of 24-hAlpHM was assessed by one-hour comparison with simultaneous sEMG, acoustic measurement and video in a healthy volunteer. It was then used to measure SSF in five participants having PD and mild to severe drooling for 24 hours, while patients were at home in their daily routine. All saliva swallows were identified and counted. Participants’ opinion on feasibility and burden of the 24-hAlpHM was noted. Intra-rater and inter-rater agreement was assessed using one-hour clips.

Results: Saliva swallow registration with 24-hAlpHM was exactly synchronous with sEMG, acoustics and video. No adverse events were observed or reported and all patients indicated that the measurement was feasible with a reasonable burden. Intra-rater agreement was 91% and inter-rater agreement 86% rising to 93% after discussion. In addition, SSF showed a trend of being lower with increase of drooling: mild (1) = 57.8, moderate (3) = 32.3 and severe (1) = 14.7 swallows/hour (p = 0.11).

Conclusions: 24-hAlpHM is a new technique to safely measure SSF during 24-hours in PD, making it a promising tool to better understand the pathophysiology of drooling and to study possible treatment approaches. The inter-rater agreement can be further improved, but reliability is good when two examiners do the analysis.

This abstract has previously been presented on the 2016 Annual Meeting of the Dysphagia Research Society (February 25 – 27, 2016, Tuscon, Arizona).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/saliva-swallowing-frequency-measured-using-24-hours-ambulatory-impedance-ph-monitoring-in-patients-with-parkinsons-disease-and-drooling/