Association between respiratory events and nocturnal gastroesophageal reflux events in patients with coexisting obstructive sleep apnea and gastroesophageal reflux disease

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• 作者：Nattapong Jaimchariyatam^a ; ^b ; ^{drboy48@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Warangkana Tantipornsinchai^a ; Tayard Desudchit^b ; ^c ; Sutep Gonlachanvit^d
• 关键词：Obstructive sleep apnea ; Gastroesophageal reflux disease ; Arousal ; Esophageal pH monitoring ; Esophageal impedance monitoring
• 刊名：Sleep Medicine
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：22
• 期：Complete
• 页码：33-38
• 全文大小：448 K

文摘

Literature has addressed the increased prevalence of gastroesophageal reflux disease (GERD) in obstructive sleep apnea (OSA). Significant improvement of GERD has been found after OSA treatment. However, precise mechanisms underlying this correlation remain unclear. We examined the association between nocturnal gastroesophageal reflux (GER) and sleep events in patients with coexisting OSA and GERD.

Methods

A case-crossover study among 12 patients with coexisting moderate–severe OSA and GERD was conducted. Participants underwent simultaneous polysomnography and esophageal impedance and pH monitoring. GER subtypes (ie, acid reflux, non-acid reflux) were defined as outcomes. Respective control time points were selected in all eligible control periods. Each sleep event was assessed individually. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed. A p-value of < 0.05 was considered significant.

Results

Patients were determined as moderate to severe OSA (respiratory disturbance index of 42.66 [±22.09]). There were a total of 50 GER episodes, 22 acid reflux and 28 non-acid reflux. Arousals and awakenings were significantly associated with subsequent GER events. The OR for GER following an arousal was 2.31 (95% CI 1.39–3.68; p < 0.001) and following an awakening was 3.71 (95% CI 1.81–7.63; p < 0.001). GER events were significantly less likely to occur after other respiratory events (OR 0.38 [95% CI 0.18–0.82]; p = 0.01). No sleep events followed GER events (p > 0.05).

Conclusions

Both awakening and arousal appear to precipitate any subtype of GER events in patients with coexisting GERD and moderate to severe OSA. However, GER events were significantly less likely to occur after other respiratory events and did not appear to cause sleep-related events.