Severity Of Sleep-Related Breathing Disorders
Correlates With Severity Of Gastroesophageal Reflux Disease In
Patients With Heartburn And Sleep Abnormalities
August 11, 2004
Palombini LO, Robinson A, Black J, Triadafilopoulos G
Sleep Disorders Clinic, Stanford University, Stanford, CA, USA
Introduction
Background and Aims: The association of sleep-related breathing
disorders (SRBD) and gastroesophageal reflux disease (GERD) has
been suggested in several studies. Although the prevalence of
GERD in SRBD ranges from 53 to 76%, the nature and mechanism(s)
of their relationship are still unknown. The purpose of this study
was to evaluate if the severity of the sleep related breathing
disorder correlates with the severity of the gastroesophageal
reflux in patients with clinical symptoms of both conditions.
Methods
Patients with GERD and SRBD symptoms, such as heartburn, regurgitation,
snoring, witnessed apnea and excessive daytime sleepiness had
portable polysomnography and 24-h esophageal pH monitoring off
medications. Gastroesophageal Reflux severity was indicated by
DeMeester Criteria (J Clin Gastroenterol,1986). Sleep breathing
disorder severity was based on apnea/hypopnea Index. Correlation
was made using the Pearson Correlation Method.
Results
24 patients had pH and sleep study (mean age: 53.2(14) years;
mean BMI: 29.9 (14.2) kg/m2; mean RDI: 16.6 (20.2) events/h; mean
DeMeester Score : 40.1(32.5), mean % of time with pH <4: 8
(6.7) and mean lowest oxygen saturation: 84.2% (8.8). The correlation
between RDI and pH score was .5 (p < .05) and the correlation
between AHI and % of time pH was < 4 was .5 (p < .05). Analysis
of acid reflux and respiratory events (10 subjects): 347 reflux
events analyzed, 322 occurred during wakefulness and 25 occurred
during sleep. All sleep events were associated with arousals (7
were preceded and 4 were followed by arousals). There was no significant
association with time of reflux and respiratory events and only
2 nocturnal events occurred after a respiratory event (hypopnea).
Conclusion
In patients with sleep complaints related to obstructive sleep
apnea and gastroesophageal reflux, the severity of the sleep breathing
disorder is correlated with the GER severity. It has been suggested
that the increase in nocturnal clearance time could be a possible
explanation for the increase in acid exposure and consequently
increase in GER severity, but the almost absence of nocturnal
events in the subgroup of patients studied did not confirm this
hypothesis. Other possible mechanisms are the impact of increased
respiratory effort on LES function. More studies are necessary
to establish a causal relationship between the two entities, if
one exists, and elucidate the mechanism for the severity correlation
between both disorders.
