Profile of scientific production of obstructive sleep apnea in interface of speech and language pathology

ABSTRACT

The purpose of this study was to investigate the scientific production of Speech-Language Pathology and Audiology at the interface with Obstructive Sleep Apnea, considering impact factor, level of evidence and corresponding area of the Speech-Language Pathology and Audiology. A literature search was performed in databases Lilacs, PubMed and Scopus, through the intersection of keywords and specific free terms of Speech-Language Pathology and Audiology and "Sleep Apnea, Obstructive". For the article would be included in this study, needed to approach as the main axis the Speech-Language Pathologist acting in patients with Obstructive Sleep Apnea. Were held a consultation on the WebQualis CAPES, investigating specific journals of Speech-Language Pathology and Audiology of Area 21 and their respective Qualis. Selected articles were analyzed for impact factor, level of evidence and area of the corresponding Speech-Language Pathology and Audiology. Were located 983 articles, being selected 39, originated mainly from Scopus. The prevalent was the Qualis B1, with an average impact factor of 3,49; higher number of publications of 2006, level of evidence 5 and the Speech-Language Pathology and Audiology prevalent area was the Orofacial Myology. The analysis of the scientific production of Speech-Language Pathology and Audiology was performed at the interface with Obstructive Sleep Apnea, verifying that the Orofacial Myology and the evidence level 5 predominated in this context.

Keywords:
Speech, Language and Hearing Sciences; Sleep Apnea, Obstructive; Impact Factor; Interdisciplinary Research; Evidence-Based Practice

RESUMO

Este estudo teve por objetivo averiguar a produção científica da Fonoaudiologia na interface com Apneia Obstrutiva do Sono, considerando fator de impacto, nível de evidência e área da Fonoaudiologia correspondente. Foi realizada uma busca na literatura nas bases de dados Lilacs, PubMed e Scopus, por meio do cruzamento das palavras-chave e termos livres específicos da Fonoaudiologia com "Apneia do Sono Tipo Obstrutiva". Para que o artigo fosse incluído no presente estudo, necessitava abordar como eixo principal da atuação fonoaudiológica nos pacientes com a Apneia Obstrutiva do Sono. Realizou-se uma consulta ao WebQualis da CAPES, investigando periódicos específicos da Fonoaudiologia da área 21 e seu respectivo Qualis. Os artigos selecionados foram analisados quanto ao fator de impacto, nível de evidência e área da Fonoaudiologia correspondente. Foram localizados 983 artigos, sendo selecionados 39, originados principalmente da base Scopus. O Qualis prevalente foi o B1, fator de impacto com média de 3.49, maior volume de publicações a partir do ano de 2006, nível de evidência 5 e área de atuação fonoaudiológica na maioria foi a Motricidade Orofacial. Foi realizada a análise da produção científica da Fonoaudiologia na interface com Apneia Obstrutiva do Sono, verificando-se que a Motricidade Orofacial e o nível de evidência 5 predominaram neste âmbito.

Descritores:
Fonoaudiologia; Apneia do Sono Tipo Obstrutiva; Fator de Impacto; Pesquisa Interdisciplinar; Prática Clínica Baseada em Evidências

Introduction

The consequences of obstructive sleep apnea (OSA) influence the general health of the individual, e.g. in cardiovascular disorders^1,2 and cerebrovascular accident³, besides the direct implications on communication processes and disorders, especially in the fields of work of Speech-Language Pathology.

For example, it may be associated with hearing aspects, such as reduced amplitude of P300⁴, sensorineural hearing loss⁵ and auditory processing disorders in children⁶ (AUDIOLOGY); signs of swallowing disorder^7,8 (DYSPHAGIA); association with work accidents⁹ (OCCUPATIONAL SPEECH-LANGUAGE PATHOLOGY) and learning and memory alterations¹⁰ (EDUCATIONAL SPEECH-LANGUAGE PATHOLOGY). Individuals with OSA present higher risk of cerebrovascular accident³ (NEUROFUNCTIONAL SPEECH-LANGUAGE PATHOLOGY), and OSA is more frequent with aging¹¹ (GERONTOLOGY). It is also associated with changes in performance in language levels^12,13 (LANGUAGE), alterations in oropharyngeal muscle tone^14,15 (OROFACIAL MYOLOGY), neurocognitive disorders in children (NEUROPSYCHOLOGY)¹⁶ and differences in acoustic voice parameters^17,18 (VOICE). Considering all these aspects, Speech-Language Pathology should also be involved in training programs for behavioral changes, favoring a better quality of sleep¹⁹ (COMMUNITY HEALTH).

These findings of scientific publications justify the action of Speech-Language Pathology in OSA, as well as the need of further investigations to elucidate the scope of such publications in scientific journals.

This production of knowledge is fundamental for the advancement of science and an important opportunity to diffuse and enhance the scientific findings²⁰.

This, this study analyzed the scientific production of Speech-Language Pathology in its interface with obstructive sleep apnea, considering the impact factor, level of evidence and corresponding specialty within Speech-Language Pathology.

Methods

A literature search was performed on the databases Lilacs, PubMed and Scopus, crossing the DeCS/MeSH keywords: "Sleep Apnea, Obstructive" (1), "Speech, Language and Hearing Sciences" (2), "Audiology" (3), "Language" (4), "Voice" (5), "Speech Therapy" (6), "Geriatrics" (7), "Public Health" (8) and "Deglutition Disorders" (9). Aiming at the comprehensive action of Speech-Language Pathology, the following free terms were also employed: Oropharyngeal exercises (10), Occupational Speech-Language Pathology (11), Educational Speech-Language Pathology (12), Neurofunctional Speech-Language Pathology (13). All keywords and free terms were used both in Portuguese and English. This generated 12 search strategies, as described in Figure 1.

Figure 1:
Search strategies employed by crossing DeCS/MeSH keywords and free terms, specific of the field under study

Further three searches were performed using the keywords (1) AND mastication, AND speech and AND swallowing, yet no further papers related to the issue were found, thus these were not considered.

Papers were included in the study if their main focus was the role of Speech-Language Pathology on the clinical presentation of OSA.

The following exclusion criteria were considered: studies specific of other procedures (surgery, dental treatment, drug therapy, CPAP); studies whose main focus was the development/evaluation of questionnaires on quality of life; investigations addressing other genetic syndromes (Down, craniosynostosis and velocardiofacial syndromes); editorials and letter to the editor. The search was conducted using the VPN system (Virtual Private Network), and papers whose full texts were not available were also excluded.

The references of included papers were also analyzed, so that any study not identified on the databases could also be analyzed and added in the study, in case it met the inclusion criteria.

The Qualis classification of journals was checked by assessing the full list of journals on the website WebQualis of the Coordination for the Improvement of Higher Education Personnel (CAPES), which consisted of 4,524 pages²¹. Searching only for journals of the "PHYSICAL EDUCATION" area and considering specific journals of Speech-Language Pathology, the journals were considered if their title included one of the following words, either in Portuguese, English or Spanish:

• Speech-Language Pathology

• Communication/Communicate/Communications

• Language

• Disfluency

• Speech

• Aphasia

• Orofacial Myology

• Dysphagia

• Audiology

• Hearing

• Deafness

• Noise

• Tinnitus

• Voice

In case the journal titles were acronyms, their websites were searched to investigate if the publications actually focused on Speech-Language Pathology. Thus, Figure 2 presents the list with ISSN, journal name and Qualis CAPES, of journals considered specific of Speech-Language Pathology (the list was accessed on July 2015).

Figure 2:
Scientific journals with respective ISSN, title and Qualis CAPES, considered specific of Speech-Language Pathology

The impact factor was also analyzed, which is considered an instrument to evaluate the quality of journals²². The impact factor was searched on September 2015 on the website http://www.citefactor.org/, searching all journals of included references.

The papers were initially selected by reading the titles and abstracts. Following, the selected papers were analyzed as to the journal, year of publication, title, specialty within Speech-Language Pathology, type of study, and level of evidence, in which the lowest was scored as 1 and the highest as 10, according to the study design²³.

Each paper was also classified in one or more specialties of Speech-Language Pathology addressed, among the 11 specialties, as described in Figure 3 ²⁴.

Figure 3:
Fields of Speech-Language Pathology assigned for selected papers

Data were analyzed in characterizer mode, using descriptive and inductive statistics and Spearman correlation (p<0.05), analyzing the relationship between:

• Qualis and year of publication

• Qualis and level of evidence

• Year and level of evidence

Literature Review

By the strategies adopted to search the databases, 10 papers were found in Lilacs, 598 in PubMed and 375 in Scopus. Table 1 describes this result, highlighting that repeated papers found in different databases are included, as well as repetition of strategies in different searches.

Table 1:
Number of papers found and selected in databases Lilacs, PubMed and Scopus, for each search strategy

Figure 4 presents the specific relationship of main focus of studies that were excluded, according to the exclusion criteria.

Figure 4:
Focus of excluded studies, according to the exclusion criteria, for each search strategy

Table 2 displays the analysis of papers selected for the study. It also presents the scoring of the level of evidence, in which the lowest was scored as 1 and the highest as 10, according to the study design²³.

Table 2:
Information on the journal, author, title year, type of study, level of evidence and specialty of Speech-Language Pathology of papers considered in the present study

• Legend: ^(NQ) Not included in Qualis CAPES scoring; (*) Not scored in the Physical Education area; IF: Impact factor

The descrip5ive statistical analysis revealed that the Qualis of publications was A1 in 7 papers (17.9%), A2 in 4 (10.3%), B1 in 14 papers (35.9%), 1 paper B2, 1 B3, 1 B4 (2.6%). The remaining 11 papers (28.1%) were published in journals not scored in the Qualis for area 21 of CAPES.

Considering the 30 journals with publications included in this study, 9 did not have impact factor, and the other 21 journals had impact factor with mean 3.49, median 2.42, standard deviation 2.82, maximum 11.99 and minimum 0.78.

Concerning the indexing of papers, 7 were found both on PubMed and Scopus (17.9%), 9 in Scopus (23.1%), 8 only in PubMed (20.5%), 6 in Lilacs (15.4%) e 1 was found both in Lilacs and Scopus (2.6%); further 8 (20.5%) were found by consulting the references of included papers.

The distribution of publication years was diffuse, with 1 paper published in years 1987, 1993, 2002 and 2004; 3 publications in 2006 and 2007; 2 in 2008; 4 in 2009; 5 in 2010;1 in 2011; 3 in 2012 and 2013; 4 in 2014 and 7 in 2015. Analysis in 5-year periods revealed the distribution presented in Figure 5.

Figure 5:
Analysis of number of papers according to year of publication, in 5-year periods

The levels of evidence 10, 9, 8 and 6 presented 2 papers each (5.2%); level 5 was assigned to 17 papers (43.6%), 4 for 7 papers (17.8%), and level 1 for 7 papers (17.8%), as described in Figure 6.

Figure 6:
Number of papers according to level of evidence

Among the 11 specialties of Speech-Language Pathology, 20 papers were specific of Orofacial Myology, 7 of Voice, 3 Language, and the fields of Audiology, Neuropsychology and Neurofunctional Speech-Language Pathology presented 2 publications, while Community Health, Gerontology/Neurofunctional Speech-Language Pathology and Language/Orofacial Myology had 1 publication each (Figure 7).

Figure 7:
Number of papers according to specialty of Speech-Language Pathology

The Spearman correlation did not reveal significant difference, as presented in Table 3.

Table 3:
Spearman correlation of the variables Qualis, year of publication and level of evidence

• Legend: p<0.05 - statistically significant value

Characterization of publications of a certain field widens the knowledge on the advancement of science, allowing more effective establishment of new pathways for scientists. Especially for OSA and its interface with Speech-Language Pathology, this process is justified to strengthen the advanced action of this area in the evaluation, treatment, prevention and health promotion in clinical situations with OSA.

During the search, more papers were found in PubMed and Scopus. Analyzing only the included papers, the Scopus database promoted the greatest refinement of the search, followed by papers located in PubMed and Scopus, and then papers located among the references of included papers. Concerning the PubMed and Scopus, it should be highlighted that the former presents 25 millions of biomedical citations on the Medline, online journals and books²⁵ while the second is considered the largest database of abstracts and literature citations, besides including conference proceedings²⁶.

Despite the high number of papers found (983), the percentage of exclusion was also high (96.03%) and may be explained by the diverse descriptors and free terms used in an attempt to address all fields of Speech-Language Pathology.

There was greater number of papers in score B1 of Qualis, followed by papers without Qualis score in the area 21 of CAPES. A previous study analyzing the level of publications of a post graduation program in Speech-Language Pathology revealed the same predominance of Qualis B1²⁷.

Among the journals included, 77% presented impact factor, different from a previous study in Speech-Language Pathology in which only 23% of journals had impact factor, besides presenting lower minimum and maximum values compared to the present study²⁷. The finding that only 5% of papers were specific of Speech-Language Pathology may explain the higher impact factor observed in studies of Speech-Language Pathology and OSA, since this factor is calculated according to the number of citations of papers published by a certain journal, evidencing low citation of papers published in national journals of Speech-Language Pathology²⁸.

There was greater volume of publications in Speech-Language Pathology about OSA after year 2006 and greater concentration of papers in level of evidence 5, corresponding to observational study design. No studies were found about this aspect, yet this data agrees with a previous study about the level of evidence of publications in Dentistry²⁹.

Finally, concerning the field of Speech-Language Pathology, there was predominance of Orofacial Myology, which differs from the results of publications of Speech-Language Pathology in general, which identified Language as the first area of publication, followed by Audiology³⁰.

The importance of this study is the characterization of the advancement of Speech-Language science within the scope of OSA, broadening this diffusion and guiding the onset of new investigations in this field.

Conclusion

The scientific production of Speech-Language Pathology was analyzed in its interface with obstructive sleep apnea, evidencing the predominance of Orofacial Myology as the specialty of publication, with higher frequency of level of evidence 5, corresponding to cross-sectional observational study.

Referências

• ¹
  Carpio C, Alvarez-Sala R, García-Río F. Epidemiological and pathogenic relationship between sleep apnea and ischemic heart disease. Pulm Med. Pulmonary Medicine vol. 2013, Article ID 405827, 8 pages, 2013. doi:10.1155/2013/405827
  » https://doi.org/10.1155/2013/405827
• ²
  Won CH, Chun HJ, Chandra SM, Sarinas PS, Chitkara RK, Heidenreich PA. Severe obstructive sleep apnea increases mortality in patients with ischemic heart disease and myocardial injury. Sleep Breath. 2013;17(1):85-91.
• ³
  Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;182(2):269-77.
• ⁴
  Martins CH, Castro Júnior Nd, Costa Filho OA, Souza Neto OM. Obstructive Sleep Apnea and P300 Evoked Auditory Potential. Braz J Otorhinolaryngol. 2011;77(6):700-5.
• ⁵
  Sheu JJ, Wu CS, Lin HC.Association between obstructive sleep apnea and sudden sensorineural hearing loss: a population-based case-control study. Arch Otolaryngol Head Neck Surg. 2012;138(1):55-9.
• ⁶
  Ziliotto KN, Santos MFC, Monteiro VG, Pradella-Hallinan M, Moreira GA, Pereira LD et al. Avaliação do processamento auditivo em crianças com síndrome da apnéia/hipopnéia obstrutiva do sono. Rev Bras Otorrinolaringol. 2006;72(3):321-7.
• ⁷
  Schindler A, Mozzanica F, Sonzini G, Plebani D, Urbani E, Pecis M, Montano N.Oropharyngeal Dysphagia in patients with obstructive sleep apnea syndrome. Dysphagia. 2014;29(1):44-51.
• ⁸
  Valbuza JS, Oliveira MM, Zancanella E, Conti CF, Prado LB, Carvalho LB et al. Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study. Sleep Breath. 2011;15(2):209-13.
• ⁹
  Santos Neto LC, Miranda GA, Cunha LLG, Canto BES, Strufaldi VP, Tetti MF et al. Consequências individuais e socioeconômicas da síndrome da apneia obstrutiva do sono. Arq Bras Ciênc Saúde. 2013;38(1):33-9.
• ¹⁰
  Uema SFH, Pignatari SSN, Fujita RR, Moreira GA, Pradella-Hallinan M, Weckx L et al. Avaliação da função cognitiva da aprendizagem em crianças com distúrbios obstrutivos do sono. Rev Bras Otorrinolaringol. 2007;73(3):315-20.
• ¹¹
  Ayalon L, Ancoli-Israel S, Drummond SPA. Obstructive Sleep Apnea and Age A Double Insult to Brain Function? Am J Respir Crit Care Med. 2010;182(3): 413-9.
• ¹²
  Kurnatowski P, Putynski L, Lapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2006;70(3):419-24.
• ¹³
  Andreou G, Agapitou P. Reduced language abilities in adolescents who snore. ArchClin Neuropsychol. 2007;22(2):225-9.
• ¹⁴
  Guimarães KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. Am J Respir Crit Care Med. 2009;179(10):962-6.
• ¹⁵
  Steele CM. On the plausibility of upper airway remodeling as an outcome of orofacial exercise.Am J Respir Crit Care Med. 2009;179(10):858-9.
• ¹⁶
  Hilario SM, Silva EVCM, Chiloff CLM, Bertoz APM, Micheletti KR, Cuoghi OA et al. Distúrbios neuropsicológicos e Síndrome da Apneia do Sono em crianças. Arch Health Invest. 2014;3(3):65-75.
• ¹⁷
  Benavidesa AM, Pozo RF, Toledano TD, Murillo JLB, Gonzalo EL, Gómez LH. Analysis of voice features related to obstructive sleep apnoea and their application in diagnosis support. Comput Speech Lang. 2014;28(2):434-52.
• ¹⁸
  Solé-Casals J, Munteanu C, Martín OC, Barbé F, Queipo C, Amilibia J et al. Detection of severe obstructive sleep apnea through voice analysis. Appl Soft Comput. 2014;23:346-54.
• ¹⁹
  Moseley L, Gradisar M. Evaluation of a school-based intervention for adolescent sleep problems. Sleep. 2009;32(3):334-41.
• ²⁰
  Oliveira Filho RSd, Hochman B, Nahas FX, Ferreira LM. Fomento à publicação científica e proteção do conhecimento científico. Acta Cir Bras. 2005;20(supl.2):35-9.
• ²¹
  Qualis CAPES. Disponível em: http://qualis.capes.gov.br/ Acesso em: 10 mai 2015
  » http://qualis.capes.gov.br/
• ²²
  Quindós G. Confundiendo al confuso: reflexiones sobre el factor de impacto, el índice H(irsch), el valor Q y otros cofactores que influyen en la felicidad del investigador. Rev Iberoam Micol. 2009;26(2):97-102.
• ²³
  Kyzas PA. Evidence-Based Oral and Maxillofacial Surgery. J Oral Maxillofac Surg. 2008;66(3):973-86.
• ²⁴
  Conselho Federal de Fonoaudiologia. Especialista por área. Disponível em: http://www.fonoaudiologia.org.br/cffa/ Acesso em: 23 set 2015
  » http://www.fonoaudiologia.org.br/cffa/
• ²⁵
  PubMed - US National Library of Medicine National Institutes of Health. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed Acesso em: 23 set 2015.
  » http://www.ncbi.nlm.nih.gov/pubmed
• ²⁶
  Elsevier. Scopus. Disponível em: http://www.elsevier.com/solutions/scopus . Acesso em: 23 set 2015
  » http://www.elsevier.com/solutions/scopus
• ²⁷
  Braga MER, Chiari BM, Goulart BNG. Produção bibliográfica em artigos, livros e capítulos de livros de um programa de pós-graduação em fonoaudiologia: análise de indicadores bibliométricos. Distúrb Comun. 2014;26(1):118-30.
• ²⁸
  Campanatti-Ostiz H, Andrade CRF. Periódicos nacionais em Fonoaudiologia: caracterização de indicador de impacto. Pró-Fono R. Atual. Cientif. 2006;18(1):99-110.
• ²⁹
  Cavalcanti YW, Freires IA, Carreiro Júnior E, Gonçalves DT, Morais FR, Lira Júnior R et al. Determinação do Nível de Evidência Científica de Artigos sobre Prótese Total Fixa Implanto-Suportada. Rev Bras Ciênc Saúde. 2011;14(4):45-50.
• ³⁰
  Hernández-Jaramillo J, Cruz-Velandia I, Torres-Narváez M. Investigación clínica en fonoaudiología: análisis de la literatura científica 2005-2009. Rev Fac Med. 2010;58(3):204-13.

Publication Dates

• Publication in this collection
  Sep-Oct 2016

History

• Received
  17 Dec 2015
• Accepted
  11 Aug 2016