Date of Award


Document Type


Degree Name



Communication Sciences and Disorders

Committee Chair

Kendrea L. Garand, PhD.


Obstructive sleep apnea (OSA) is characterized by frequent narrowing of the upper airway during sleep. The estimated prevalence of swallowing impairments (dysphagia) in OSA patients ranges up to 80% and comprises approximately 50% of the caseload of practicing speech-language pathologists in the United States. Despite the high prevalence of dysphagia, there is a paucity of evidence supporting behavioral intervention(s) for ameliorating swallowing impairments in OSA. This pilot study assessed oropharyngeal swallowing physiology in persons with OSA and the feasibility and acceptability of a behavioral dysphagia intervention that specifically targets upper airway musculature – Expiratory Muscle Strength Training (EMST). A total of nine participants completed four weeks of intervention applying EMST. Outcome measures collected during three time points (double baseline and post-intervention), included: patient-reported swallowing and reflux measures; maximum expiratory pressure (MEP); voluntary cough strength; Modified Barium Swallow Impairment Profile (MBSImP) Composite (Oral Total and Pharyngeal Total) and 17 Component metrics; and biomechanical metrics of the pharyngeal swallow. At baseline, there were no significant differences in the MBSImP Composite scores for compared to an age-equivalent group (p > .05); however, higher xix atypical biomechanical measures were observed in the OSA cohort. Compared to baseline performance, post- EMST intervention assessment revealed no significant differences in MBSImP Composite scores or biomechanical measures (all p values > .05). However, significantly large gains were noted in MEPs (p < .001, d = 2.9), with moderate gains in cough strength, although this was not significant (p = .19). No adverse effects were reported by participants. This study contributes by enhancing our understanding of oropharyngeal swallowing impairments in OSA and guides clinical practices in to ameliorate such impairments.

Available for download on Friday, December 15, 2023