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UBC Theses and Dissertations

Determining the feasibility of assessing salivary biomarkers and swallowing perception in those with Sjogren's syndrome and healthy controls Letawsky, Veronica Helen


Sjogren’s syndrome (SS) is an autoimmune disease characterized by altered saliva quantity and composition. Saliva is integral to swallowing, contributing to bolus formation, lubrication, and digestion. Salivary changes in SS can affect the perceptions and execution of deglutition resulting in increased residue and impaired bolus transport and formation. To date, no study has investigated the link between salivary biomarkers and swallowing perceptions. Our objectives were: 1) to explore the operational feasibility of investigating saliva quantity (volume) and quality (proteins/hormones) in those with and without SS, and 2) to explore the relation between saliva and swallowing perceptions across participants. We conducted a matched case-control, mixed methods study, collecting feasibility data and conducting quantitative and qualitative measures. We collected unstimulated and stimulated whole saliva conducting sialometric (flow rate) and sialochemical analyses including α-amylase, cortisol, mucins (MUC5B, MUC7), C-reactive protein (CRP), and total protein. We measured oral dryness (Clinical Oral Dryness Score [CODS]) and swallowing perception (SWAL-QOL Survey). We described the data using means (±SD) and medians (IQR), compared between groups using t-tests and Mann-Whitney U, as appropriate. We explored Pearson correlations comparing salivary data with oral dryness and swallowing perception. Over 13-weeks, we enrolled a convenience sample of 12 (N): cases (n1) = 6, controls (n₂) = 6 with five females, one male per group. Ages ranged from 31 to 68 years (n1, primary SS) and 31 to 64 years (n₂). All participants completed assessments and produced analyzable saliva. Those with SS presented with reduced flow rate (p = .003) and increased total protein, cortisol, and CRP (p < .01). Oral dryness correlated negatively with unstimulated flow rates (r = -.63, p = .03) and positively with total protein (r = .77, p = .003) and α-amylase (r = .83, p = .001) concentrations. Swallowing perception, specifically salivary lubricative properties, negatively correlated with total protein (r = -.81, p = .001) and α-amylase (r = -.83, p = .001) concentrations. The study design was feasible as proposed. We were the first to determine correlations between salivary properties and swallowing perceptions in those with and without SS. We propose suggestions for future investigations.

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