Abstract Introduction Obstructive sleep apnea (OSA) and sleep disruption by deglutition disorders frequently co-occur, making diagnosis and treatment challenging. Although the prevalence of dysphagia in individuals with OSA and the potential benefits of continuous positive airway pressure (CPAP) therapy on deglutition disorders have been described, the developmental trajectory of dysphagia symptoms across the lifespan remains unclear. COMISA exerts lifelong impacts, amplifying sleep fragmentation, cognitive and emotional burden, cardiometabolic risk, and functional impairment. Its interaction with developmental, aging, and neurobiological processes worsens vulnerability and complicates treatment across the lifespan. This review aimed to estimate the prevalence of dysphagia in individuals with OSA and to assess whether continuous positive airway pressure (CPAP) therapy improves deglutition disorders (gastroesophageal/laryngopharyngeal reflux and dysphagia) across aging processes. Methods A systematic review was performed following PRISMA guidelines. Original observational studies evaluating patients with OSA, deglutition disorders, and CPAP therapy were included. There were no age restrictions. Studies involving uncontrolled neurological diseases were excluded. This systematic review is registered at PROSPERO (CRD 42022370632). Results Among 120 screened papers, 13 met inclusion criteria, totaling 780 adults and 220 children. Pediatric studies were from the United States of America (USA) whereas the adult participants were mainly from the USA or Australia. Dysphagia prevalence in individuals with OSA ranged from 25% to 27.3%. Most studies focused on moderate to severe OSA. CPAP therapy consistently improved dysphagia symptoms and reduced gastroesophageal reflux manifestations. In pediatric samples, one study reported dysphagia in 28% of infants under two years old referred for tonsillectomy, with OSA being a frequent indication. Most showed symptom improvement after tonsillectomy. Another study involving 126 neonates and infants with OSA noted that the most common intervention was gastroesophageal reflux management (69.8%), and only a minority required positive airway pressure therapy. Conclusion CPAP improves deglutition disorders in OSA, whose association with dysphagia is highly complex and extends to COMISA phenotypes. Multimodal management should address respiratory and swallowing endophenotypes, with COMISA patients benefiting from adjunctive muscle therapies. Lifespan neuromuscular decline and neurodegenerative vulnerability may worsen with chronic sleep disruption. Routine dysphagia screening should be incorporated to optimize outcomes and overall quality of life. Support (if any)
Ottoline et al. (Fri,) studied this question.